Paediatric radiology

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Paediatric radiology (or pediatric radiology) is a subspecialty of radiology involving the imaging of fetuses, infants, children, adolescents and young adults. Many paediatric radiologists practice at children's hospitals.

Contents

Although some diseases seen in paediatrics are the same as that in adults, there are many conditions which are seen only in infants. The specialty has to take in account the dynamics of a growing body, from pre-term infants to large adolescents, where the organs follow growth patterns and phases. These require specialised imaging and treatment which is carried out in a Children's hospital, which has all the facilities necessary to treat children and their specific pathologies.

Environment

To successfully diagnose a paediatric condition, high-quality images are needed to give a diagnosis. To achieve this requires creating an environment where a child is comfortable. This is one of the most essential elements to paediatric radiology. For imaging departments which specialise in paediatric radiology, this is very easy as rooms can be tailored to suit a child's needs. For example, bright wall designs, visual stimulation and toys. These can be permanent fixtures as the department wouldn't need to cater to any other age range. For departments which only see children occasionally, creating a 'child friendly' environment is more difficult. It is usually achieved by creating one room a 'child friendly room' where murals / stencils can be painted on the wall. Modern children's hospitals are now designed with much glass to allow as much natural light in as possible, the Evelina Children's Hospital being one of these.

A child-friendly MRI scanner 1 MRI-Virtual-Window.jpg
A child-friendly MRI scanner

Challenges

Paediatric radiology comes with many challenges. Unlike adults, children cannot always understand / comprehend a change of environment. Therefore, staff are usually required to wear colourful uniforms, usually 'scrubs', as opposed to a normal hospital uniform. It is also important to recognise that when a child is unwell, they follow their instincts, which is usually to cry and stay close to their parents. This presents a huge challenge for the radiographer, who must try to gain the child's trust and gain their co-operation. Once co-operation has been achieved there is another big challenge of keeping the child still for their imaging test. This can be very difficult for children in a lot of pain. Coercion and support from parents is usually enough to achieve this, however, in some extreme cases (such as MRI and CT), it may be necessary to sedate the child.

Another challenge faced is the radiation difference between an adult and child.

Medical Use of Radiation: Medicine has used ionizing radiation for decades to help diagnose or treat children (and adults). There is no doubt that this imaging has saved lives. Medical imaging use has grown exponentially in the past few years, particularly the use of CAT Scans (also called CT scans). There are approximately 65 million CT scans done in the United States annually with an estimated 8 million in children. However, there is a much higher radiation dose from CT scans than from the traditional radiographs and fluoroscopy tests that radiologists perform and interpret. CT scans provide in general more information about the anatomy and diseases in the body but could be replaced for some orthopedic indications by other low-dose imaging modalities like EOS. [1] To do this, though, they may expose a person to 100 to 250 times the radiation dose compared to a chest x-ray. [2]

Radiation Safety Issues: There are risks from ionizing radiation that are comprehensively studied in the survivors of the atomic bomb in Hiroshima in 1945. Longitudinal studies led by the National Academy of Sciences in the United States have shown increased cancer rates in this population that are dose dependent. From these data, modelling research suggests that even at the lower doses used in medical imaging, there may be an added risk of cancer. [3] Last year, two medical physicists suggested that the increasing use of CAT Scans in the United States may increase cancer incidence in the future. [4]

Paediatric Radiation Protection Issues: Children are more radiosensitive than adults. They also have a longer life expectancy over which they may develop cancer from exposures to ionizing radiation. The paediatric radiology and medical community has long had an awareness of this issue and has developed radiation protection policies and practices that reflect this. With the increased use of imaging and in particular, CT scanning, there is increasing attention to this issue by the entire medical and radiology communities. An educational resource for health care providers as well as patients and parents is the Image Gently web site started in 2008. There is collaboration by several radiology, medical physics, paediatrics, and governmental organizations to increase awareness of radiation safety issues in children and to provide education to all stakeholders caring for children on ways to decrease the ionizing radiation exposure in children . For parents, basic information brochures that can be printed or downloaded that describe what an X ray is, what are its risks and benefits, and what can be done to decrease these risks . A call to action has been published advocating a reduction of ionizing radiation exposure to children by delivering the right imaging exam, the right way with the right dose. [5]

Equipment

Equipment adapted for use in paediatric radiology includes:

An example of positioning equipment for X ray scans on infants is the Pigg-O-Stat baby tube. [6]

Most equipment is the same used for adult imaging, but using lower dose and exposure setting adapted for children.

Paediatric radiology training

In many countries, paediatric radiology does not officially require a specific training. Where there is, paediatric radiologists have usually completed a diagnostic radiology residency, then complete one or two more years of subspecialty fellowship training before they are eligible to take the board examination for official subspecialty certification (e.g. Canada, UK, Switzerland). This then qualifies them in the specialised area of paediatric radiology.

Common paediatric pathologies requiring imaging

See also

Related Research Articles

<span class="mw-page-title-main">Pediatrics</span> Branch of medicine caring for children

Pediatrics is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until the age of 18. The American Academy of Pediatrics recommends people seek pediatric care through the age of 21, but some pediatric subspecialists continue to care for adults up to 25. Worldwide age limits of pediatrics have been trending upward year after year. A medical doctor who specializes in this area is known as a pediatrician, or paediatrician. The word pediatrics and its cognates mean "healer of children", derived from the two Greek words: παῖς and ἰατρός. Pediatricians work in clinics, research centers, universities, general hospitals and children's hospitals, including those who practice pediatric subspecialties.

<span class="mw-page-title-main">Radiation therapy</span> Therapy using ionizing radiation, usually to treat cancer

Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radiation therapy may be curative in a number of types of cancer if they are localized to one area of the body. It may also be used as part of adjuvant therapy, to prevent tumor recurrence after surgery to remove a primary malignant tumor. Radiation therapy is synergistic with chemotherapy, and has been used before, during, and after chemotherapy in susceptible cancers. The subspecialty of oncology concerned with radiotherapy is called radiation oncology. A physician who practices in this subspecialty is a radiation oncologist.

<span class="mw-page-title-main">X-ray</span> Form of short-wavelength electromagnetic radiation

X-ray radiation, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 nanometers to 10 picometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz (3×1016 Hz to 3×1019 Hz) and energies in the range 124 keV to 145 eV, respectively. X-ray wavelengths are shorter than those of UV rays and typically longer than those of gamma rays. In many languages, X-radiation is referred to as Röntgen radiation, after the German scientist Wilhelm Conrad Röntgen, who discovered it on November 8, 1895. He named it X-radiation to signify an unknown type of radiation. Spellings of X-ray(s) in English include the variants x-ray(s), xray(s), and X ray(s).

<span class="mw-page-title-main">CT scan</span> Medical imaging procedure using X-rays to produce cross-sectional images

A computed tomography scan is a medical imaging technique used to obtain detailed internal images of the body. The personnel that perform CT scans are called radiographers or radiology technologists.

<span class="mw-page-title-main">Radiography</span> Imaging technique using ionizing and non-ionizing radiation

Radiography is an imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical radiography and industrial radiography. Similar techniques are used in airport security. To create an image in conventional radiography, a beam of X-rays is produced by an X-ray generator and is projected toward the object. A certain amount of the X-rays or other radiation is absorbed by the object, dependent on the object's density and structural composition. The X-rays that pass through the object are captured behind the object by a detector. The generation of flat two dimensional images by this technique is called projectional radiography. In computed tomography an X-ray source and its associated detectors rotate around the subject which itself moves through the conical X-ray beam produced. Any given point within the subject is crossed from many directions by many different beams at different times. Information regarding attenuation of these beams is collated and subjected to computation to generate two dimensional images in three planes which can be further processed to produce a three dimensional image.

<span class="mw-page-title-main">Radiology</span> Branch of Medicine

Radiology is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography, but today it includes all imaging modalities, including those that use no electromagnetic radiation, as well as others that do, such as computed tomography (CT), fluoroscopy, and nuclear medicine including positron emission tomography (PET). Interventional radiology is the performance of usually minimally invasive medical procedures with the guidance of imaging technologies such as those mentioned above.

<span class="mw-page-title-main">Sievert</span> SI unit of equivalent dose of ionizing radiation

The sievert is a unit in the International System of Units (SI) intended to represent the stochastic health risk of ionizing radiation, which is defined as the probability of causing radiation-induced cancer and genetic damage. The sievert is important in dosimetry and radiation protection. It is named after Rolf Maximilian Sievert, a Swedish medical physicist renowned for work on radiation dose measurement and research into the biological effects of radiation.

Ionizing radiation, including nuclear radiation, consists of subatomic particles or electromagnetic waves that have sufficient energy to ionize atoms or molecules by detaching electrons from them. Some particles can travel up to 99% of the speed of light, and the electromagnetic waves are on the high-energy portion of the electromagnetic spectrum.

<span class="mw-page-title-main">Medical imaging</span> Technique and process of creating visual representations of the interior of a body

Medical imaging is the technique and process of imaging the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to reveal internal structures hidden by the skin and bones, as well as to diagnose and treat disease. Medical imaging also establishes a database of normal anatomy and physiology to make it possible to identify abnormalities. Although imaging of removed organs and tissues can be performed for medical reasons, such procedures are usually considered part of pathology instead of medical imaging.

Radiation dosimetry in the fields of health physics and radiation protection is the measurement, calculation and assessment of the ionizing radiation dose absorbed by an object, usually the human body. This applies both internally, due to ingested or inhaled radioactive substances, or externally due to irradiation by sources of radiation.

<span class="mw-page-title-main">Nuclear medicine</span> Medical specialty

Nuclear medicine or nucleology is a medical specialty involving the application of radioactive substances in the diagnosis and treatment of disease. Nuclear imaging, in a sense, is "radiology done inside out" because it records radiation emitting from within the body rather than radiation that is generated by external sources like X-rays. In addition, nuclear medicine scans differ from radiology, as the emphasis is not on imaging anatomy, but on the function. For such reason, it is called a physiological imaging modality. Single photon emission computed tomography (SPECT) and positron emission tomography (PET) scans are the two most common imaging modalities in nuclear medicine.

<span class="mw-page-title-main">Linear no-threshold model</span> Deprecated model predicting health effects of radiation

The linear no-threshold model (LNT) is a dose-response model used in radiation protection to estimate stochastic health effects such as radiation-induced cancer, genetic mutations and teratogenic effects on the human body due to exposure to ionizing radiation. The model statistically extrapolates effects of radiation from very high doses into very low doses, where no biological effects may be observed. The LNT model lies at a foundation of a postulate that all exposure to ionizing radiation is harmful, regardless of how low the dose is, and that the effect is cumulative over lifetime.

<span class="mw-page-title-main">Backscatter X-ray</span> Advanced X-ray imaging technology

Backscatter X-ray is an advanced X-ray imaging technology. Traditional X-ray machines detect hard and soft materials by the variation in x-ray intensity transmitted through the target. In contrast, backscatter X-ray detects the radiation that reflects from the target. It has potential applications where less-destructive examination is required, and can operate even if only one side of the target is available for examination.

<span class="mw-page-title-main">Virtual colonoscopy</span>

Virtual colonoscopy is the use of CT scanning or magnetic resonance imaging (MRI) to produce two- and three-dimensional images of the colon, from the lowest part, the rectum, to the lower end of the small intestine, and to display the images on an electronic display device. The procedure is used to screen for colon cancer and polyps, and may detect diverticulosis. A virtual colonoscopy can provide 3D reconstructed endoluminal views of the bowel. VC provides a secondary benefit of revealing diseases or abnormalities outside the colon.

Radiobiology is a field of clinical and basic medical sciences that involves the study of the action of ionizing radiation on living things, especially health effects of radiation. Ionizing radiation is generally harmful and potentially lethal to living things but can have health benefits in radiation therapy for the treatment of cancer and thyrotoxicosis. Its most common impact is the induction of cancer with a latent period of years or decades after exposure. High doses can cause visually dramatic radiation burns, and/or rapid fatality through acute radiation syndrome. Controlled doses are used for medical imaging and radiotherapy.

<span class="mw-page-title-main">Computed tomography of the head</span> Cross-sectional X-rays of the head

Computed tomography of the head uses a series of X-rays in a CT scan of the head taken from many different directions; the resulting data is transformed into a series of cross sections of the brain using a computer program. CT images of the head are used to investigate and diagnose brain injuries and other neurological conditions, as well as other conditions involving the skull or sinuses; it used to guide some brain surgery procedures as well. CT scans expose the person getting them to ionizing radiation which has a risk of eventually causing cancer; some people have allergic reactions to contrast agents that are used in some CT procedures.

Exposure to ionizing radiation is known to increase the future incidence of cancer, particularly leukemia. The mechanism by which this occurs is well understood, but quantitative models predicting the level of risk remain controversial. The most widely accepted model posits that the incidence of cancers due to ionizing radiation increases linearly with effective radiation dose at a rate of 5.5% per sievert; if correct, natural background radiation is the most hazardous source of radiation to general public health, followed by medical imaging as a close second. Additionally, the vast majority of non-invasive cancers are non-melanoma skin cancers caused by ultraviolet radiation. Non-ionizing radio frequency radiation from mobile phones, electric power transmission, and other similar sources have been investigated as a possible carcinogen by the WHO's International Agency for Research on Cancer, but to date, no evidence of this has been observed.

<span class="mw-page-title-main">EOS imaging</span>

EOS imaging is a medical device company based in Paris, France, that designs, develops, and markets EOSedge and the EOS system, innovative, orthopedic medical imaging systems, associated with several orthopedic solutions along the patient care pathway – from diagnosis to post-operative treatments. The EOS platform targets musculoskeletal disorders and orthopedic surgical care through 2D X-ray scans and 3D skeletal models from stereo-radiographic images of patients in a seated or standing position.

<span class="mw-page-title-main">Radiation exposure</span> Measure of ionization of air by ionizing radiation

Radiation exposure is a measure of the ionization of air due to ionizing radiation from photons. It is defined as the electric charge freed by such radiation in a specified volume of air divided by the mass of that air. As of 2007, "medical radiation exposure" was defined by the International Commission on Radiological Protection as exposure incurred by people as part of their own medical or dental diagnosis or treatment; by persons, other than those occupationally exposed, knowingly, while voluntarily helping in the support and comfort of patients; and by volunteers in a programme of biomedical research involving their exposure. Common medical tests and treatments involving radiation include X-rays, CT scans, mammography, lung ventilation and perfusion scans, bone scans, cardiac perfusion scan, angiography, radiation therapy, and more. Each type of test carries its own amount of radiation exposure. There are two general categories of adverse health effects caused by radiation exposure: deterministic effects and stochastic effects. Deterministic effects are due to the killing/malfunction of cells following high doses; and stochastic effects involve either cancer development in exposed individuals caused by mutation of somatic cells, or heritable disease in their offspring from mutation of reproductive (germ) cells.

<span class="mw-page-title-main">Medical imaging in pregnancy</span> Types of pregnancy imaging techniques

Medical imaging in pregnancy may be indicated because of pregnancy complications, intercurrent diseases or routine prenatal care.

References

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  3. Biological Effects of Ionizing Radiation (BEIR) VII
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