some attempts of screening in children , but not directed toward tumors , had been made in the diagnosis of subclinical varicocele , brain lesions , or adrenal hemorrhage in newborn infants . there are no known attempts at performing screening imaging studies focused on neoplasms in wider pediatric population . in poland , the annual number of new cases of malignant tumors ranges from 102 to 118 per 1 million children and adolescents below the age of 18 . peak incidence during the earliest years of life features embryonic tumors like hepatoblastoma , nephroblastoma , or neuroblastoma . out of these tumors the highest incidence rate is 9.3 for neuroblastoma , slightly lower for nephroblastoma 7.4 and lowest for hepatoblastoma 1.3 . unfortunately in poland these tumors are usually detected as large masses in rather advanced stage ( iii or iv ) , so prevention and early detection of cancer at the developmental age should become a priority for national health policy . in case of pediatric population , noninvasiveness of the screening method was of great importance , therefore an attempt of ultrasound ( us ) screening test for the detection of neoplastic lesions in children in less advanced stages to improve prognosis and treatment of young patients was performed . within the  no to neoplasms in children  program , ronald mcdonald foundation since 2005 established national ultrasound screening program for children on board of the special medical mobile ambulance . an additional objective of the program was to detect other pathologies of the developmental age , such as congenital anomalies of the urinary tract , in the period before the onset of clinical symptoms . screening us scans , including cervical , abdominal , pelvical , and scrotal us , were performed in the population of asymptomatic children aged from 9 months to 6 years . the study protocol was proposed by a national consultant in the field of pediatric oncology in cooperation with pediatric radiologists . it was based on the incidence of childhood cancers in poland for particular age groups . parents of children at particular age were invited to participate in the study by press announcements . there was huge interest in the program ; however , only small part of the population could benefit from the studies . the children were scanned in mobile pediatric us unit , containing of 2 independent consulting rooms ( fig . two experienced pediatric radiologists performed examinations simultaneously , overall 12 pediatric radiologists took part in the project . all scans were performed according to standardized protocols . the ambulance ( upper image ) with pediatric ultrasound ( us ) unit ( bottom image ) . initially 2 sonoace pico us scanners with 2 probes : convex c 3 - 7 ed and linear l 59 ec , with power and color doppler applications were used ( samsung medison , seoul , south korea ) , recently replaced with similarly equipped esaote mylab scanners ( esaote , florence , italy ) . in case of detection of any abnormality the children were referred for further diagnosis or control studies to family doctors . in most cases , the researchers were informed about the results of follow - up , especially about proven malignancies . the scans of 14,324 children were analyzed in this study , 7247 boys and 7077 girls . totally 42,538 us examinations were performed , including 14,187 cervical scans , 14,259 abdominal scans , 6942 female pelvical scans , and 7150 scrotal scans . the results are divided into specific areas of interest , such as the neck , abdominal cavity , urinary tract , and the male and female reproductive system . totally , 5426 abnormalities were detected which represent 12.7% of all examinations and 30% of patients  some children had more than one abnormality . in most cases , a us was sufficient to establish the final diagnosis . in 1538 cases ( 3.6% ) there were suggested specialist consultations , and in 938 cases ( 2.2% ) further imaging studies were advised . the abnormalities of the neck . the abdominal abnormalities . the urinary tract abnormalities . the reproductive system abnormalities . they were found in 2575 children , which represent nearly 18% of all patients with examinations of the neck . abnormalities of the urinary tract were diagnosed in 554 children ( 3.9% ) , of the male reproductive system in 1461 boys ( 20.4% ) and female reproductive system in 55 girls ( 0.8% ) . until now , in 14,459 children , 3 malignant tumors were detected , which represent 0.02% of the examined population . these are renal malignant tumor diagnosed as wilms tumor , neurogenic tumor of the rib ( fig . the intention of screening program is to identify disease in a community as early as possible , thus enabling earlier intervention and management in the hope of reducing mortality and suffering from a disease . nowadays it is difficult to imagine modern diagnostics without us . due to its noninvasive nature , us examination is especially recommended for children , but until now it was not applied in extensive screening . the reason for this could be its low sensitivity and specificity , but in fact this has not been investigated . some attempts of us screening had been made in the diagnosis of urinary tract abnormalities , brain or adrenal hemorrhage in newborn infants and in patients with cancer predisposition , for example , in children with beckwith the pilot program of early detection of neoplasms , such as wilms tumor and neuroblastoma , was introduced . within it , screening us including cervical , abdominal , pelvical , and scrotal us were performed . since the peak incidence of these neoplasms occurs in early childhood , the population of children under 6 years of life were selected for exams . it is quite a difficult age group in clinical practice , because most of the patients can not precisely explain their complaints . research has been directed to children that had not previously undergone an us examination and children without clinical symptoms . overall 12 pediatric radiologists with at least 5 years experience in the field of pediatric us took part in the project . the scans of about 15,000 children were analyzed , in whom 3 tumors were found , such as wilms tumor , neurogenic tumor of the rib , and teratoma of the testis . many other lesions were referred for further diagnosis , like thyroid , liver , spleen , pancreas , kidneys , and testes lesions , which in further observation were proved to be benign or developmental variations . at this point these were mainly supported by the family doctors , but many of patients could also benefit from additional examinations in the pediatric hospitals which cooperated with the program . the number of detected neoplasms , which would confirm the validity of such screening , is controversial . such a state of things could be due to a random selection of partial populations from different regions , not covering the entire population of children in that age group in the areas covered by the survey . so , it was not fully reliable screening , that is why we should consider the possibility of introducing larger population of healthy children of a certain age for us . anyway 1 case of wilms tumor based on the number of examined patients gives incidence rate 7 , which corresponds to the incidence rate of wilms tumor of the whole population . the sensitivity of us differs depending on the tumor type . in the case of these screening , the main idea was to detect the tumor and then direct the patient for further diagnosis . moreover , during the study , a large number of other abnormalities were found , with various degree of clinical significance , which were observed in approximately 30% of patients . they provide valuable information about the frequency of certain diseases , that may be conditions predisposing to the occurrence of neoplasms in the pediatric population . starting from examinations of the neck , enlarged lymph nodes were found in 16% of children . cervical lymphadenopathy was defined when cervical lymph nodes had more than 1  cm in long axis or 0.5  cm in short axis diameter . these dimensions do not apply to the angular nodes that can reach a size of 2 to 3  cm in long axis and 1  cm in short axis . although enlarged cervical lymph nodes are common in children , during the 1st 6 years of life , neuroblastoma and lymphoma are the most common tumors associated with cervical lymphadenopathy . the role of us was to identify nodes suspected of malignancy , with the round shape and long axis to short axis ratio less than 2 . none of the enlarged lymph nodes in our study had such features and that is why all enlarged lymph nodes were diagnosed as benign lymphadenopathy . abnormalities in the thyroid gland , which required further evaluation , were found in 1.5% of children . incidental thyroid abnormalities detected in us examinations in children are commonly identified , but have not been well documented . follow - up studies and laboratory investigations can lead to increased anxiety of families and additional expenses for the health care system . our data show no development of thyroid dysfunction or malignancy in this group of patients . in abdominal us , an interesting observation related to the presence of additional spleen was noticed , which occurred in approximately 10% of children . approximately in 0.2% of the children agenesis of the one kidney was diagnosed and 0.1% of the children had a horseshoe kidney . the most common urinary tract pathology was related to dilation of collecting systems of the kidneys , reflecting changes in development and a potential risk for urinary tract infections or already present postinflammatory changes . renal congenital defect may give no symptoms for a long time , but potential complications can be very serious . the study concerning those observation was published in 2012 , in the early human development journal . many pathologies such as an undescended and migrating testis , microlithiasis are proven conditions predisposing to the occurrence of cancer , so treatment or follow - up of those is essentially the prevention of tumors . in case of the female reproductive system , no significant pathology in the course of research was found . simple ovarian cysts with a diameter up to 10  mm should be considered as normal findings which require no intervention . larger cysts should be monitored . in summary , if not for cancer screening , then for multidirectional screen tests of the abdomen and pelvis or scrotum such a scheme could be introduced . authors realize that there is a potential risk of this program which may lead to unnecessary and even risky procedures , but over many years of research some experience have been gained in capturing most dangerous pathologies . the program is reaching the smaller centers , with difficult access to specialists and us exams . what is more awareness of not only the parents whose children attended to exams , but also the entire communities is raised .
abstractthe aim of the ultrasound ( us ) screening program was to detect neoplastic lesions in children , together with other pathologies of the developmental age in the area of the neck , abdomen , female pelvis , and scrotum in boys.us screening scans , including cervical , abdominal , pelvical , and scrotal us , were performed in the population of asymptomatic children aged from 9 months to 6 years . 
 the children were scanned in mobile pediatric us unit , consisting of 2 independent consulting rooms.the scans of 14,324 children were analyzed , 7247 boys and 7077 girls . 
 totally 42,538 us examinations were performed , including 14,187 cervical scans , 14,259 abdominal scans , 6942 female pelvical scans , and 7150 scrotal scans . 
 totally 5426 abnormalities were detected , which represent 12.7% of all examinations and 30% of patients . 
 three tumors were recognized , which are renal malignant tumor diagnosed as wilms tumor , neurogenic tumor of the rib , and teratoma of the testis.us screening in pediatric population can be used to reveal lesions inaccessible to clinical examination , like tumors or other pathologies of developmental age before the onset of clinical symptoms . due to the large number of detected abnormalities 
 it should be recommended to the whole population of certain age .