Pediatric Radiology and Imaging

Orthopedic imaging, including Magnetic Resonance (MRI), Computed Tomography (CT), Ultrasound, and interventional (musculoskeletal and spinal) procedures, in addition to conventional X-ray examinations (X-ray), can be very scary for children and possibly even more so for their parents. For the child, it is a fear of the unknown and potential for being inflicted with pain or that their pain will be made worse. For the parent, there is the fear of what their child will have to undergo, the potential danger of the examination, the possible results of the examination, and the overall lack of control of the situation.

Children are special patients and parents should seek an imaging provider who understands their special needs and concerns and can help ensure that the experience, from registration to discharge, is as easy, as comfortable, and as quick as possible.

The imaging department/center should be dedicated to the needs of the child and their parents. Ideally, there should be a "child friendly" ambiance and established pediatric protocols for image acquisition that address the special needs of the child. In addition, the team of radiologists and technologists should be familiar with the specific pediatric conditions and diagnoses that may be responsible for the child's complaints and symptoms.

The ideal pediatric imaging department/center is one dedicated to patients with similar conditions to that of child's complaint (e.g., orthopedics, oncology, gastrointestinal, etc.) so the requested examination is "routine" and performed often. At these dedicated centers, the personnel are experienced in positioning the child in pain or with decreased range of motion in order to acquire a diagnostic image, the first time.

It is recommended that parents consider the following with regard to imaging for their children's medical needs:

General concerns to investigate

• When scheduling an appointment ask if the imaging center has professional and technical expertise for a patient of your child's age.
• Verify that the department's Radiologists, the physicians supervising the image acquisition and interpreting the imaging examinations, have specific sub-specialized training in your child's suspected problem or condition.
• Ensure that the provider has patient liaisons that can help to facilitate the process, and provide knowledgeable answers to questions and concerns from the patient and the parent.
• Ask about the examination gowns for the child. Do they have child-sized gowns?
• Inquire about the environment and availability of items to divert the child's attention during the examination.
• Inquire if imaging is digitally acquired so the images can be instantly distributed to the referring physician via a PACS system and eliminate the need to hand carry X-rays to the doctor's office. If copies of digital images are required, can the images be burned onto a CD, which is much easier to transport than film.
• Diagnostic accuracy can be enhanced if the technologist obtains information as to recent history or falls, prior surgery or any internal fixation devices or congenital anomalies that may be present. This information may negate the need for repeat examination. If the technologist does not inquire, volunteer the information.
• Inquire about the image retake rate. A facility focused on specific conditions typically has fewer image retakes, which means less time in the radiology center and less exposure to ionizing radiation.

Specific concerns to investigate regarding Ionizing radiation

• Inquire about protocols for pediatric patients – do they limit the number of x-rays required for the series?
• Do they limit the area exposed to ionizing radiation with collimation (i.e. only the targeted area is exposed).
• Do they routinely take the opposite link for comparison? In most circumstances, examinations of the extremity are not needed and exposes the youngster unnecessarily.
• Inquire about shielding. Do they have child size safety shields? Do they use breast shields for scoliosis studies?
• Ask if there is an alternative to an examination that uses ionizing radiation (X-ray, CT) such as MRI or ultrasound that is applicable for your child's specific condition.
• Ask if the MRI or ultrasound departments are equipped for the pediatric patient.

Specific concerns to investigate regarding MRI examinations

• Inquire if the child may need to be sedated. Ask at what age sedation is required.
• Ask how long the examination will take.
• Ask if you, the parent, will be allowed to remain with your child during the examination.
• If you think it would help, ask if you and your child can see the examination room before the actual procedure.
• Ask if the child can bring a toy or music (iPod) with them for the examination.

The American College of Radiology (ACR) launched a campaign called "Image Gently" which attempts to raise awareness among patients and practitioners about ionizing radiation and the importance of using the lowest possible dose parameters when imaging a child. Using adult protocols for X-rays or CT scans on children introduces unnecessary exposure to radiation. Although a lower dose can result in inadequate penetration of the body part and a poor quality image, there are various means of reducing the dose while still preserving quality diagnostic imaging. By lowering the dose for conventional X-rays and CT examinations, the risk that a pediatric patient might develop cancer later in life from exposure to ionizing radiation is significantly reduced.

It is important to remember that imaging studies provide enormous information about medical diseases and conditions and these examinations should not be avoided because of the fear of radiation exposure. Unnecessary X-rays and CT scans are dangerous but the risk needs to be weighed against the benefit whenever an X-ray or CT scan is recommended. Alternative imaging techniques such as MRI or ultrasound should always be considered whenever possible to avoid unnecessary exposure to ionizing radiation. Paying attention to the above tips will help parents make a more educated choice as to where they should have their child's imaging performed.