Children are NOT small adults. They experience and express illness and injury very differently from adults. Which is why paediatric diagnostic imaging is a highly specialised field of medical imaging and is specifically designed for children, from birth to adolescence.
Dr Ebrahim Banderker, a paediatric radiologist at Red Cross War Memorial Children’s Hospital (RXCH), explains why children need a different approach to imaging and the role of radiology in children. He also talks about the success of a public-private initiative with SCP Radiology where he is a consulting radiologist.
Why is paediatric imaging so important?
Children are often unable to, or struggle to describe the nature of their discomfort, pain or symptoms clearly. Imaging helps doctors understand what is happening inside the body, when language and understanding are limited.
When we diagnose early, we are often preventing future pain, disability or developmental issues as well as reducing the anxiety of the family.
What should parents know or understand about paediatric radiology?
Paediatric imaging is designed with the needs, safety and the specific conditions of children in mind. It is a tool for clarity, reassurance and early care. Our goal is to care for the child in their imaging journey and provide their doctors and families with clear answers they can trust.
How is paediatric radiology different from adult radiology?
- The choice of the method of imaging is primarily based on how safe it is. The effects of radiation from X-rays and CT scans have a greater risk for a child than an adult – so ultrasound and MRI are preferred where possible.
- Children are often afraid, unsettled because of pain and anxiety and may require sedation or anaesthesia to make them comfortable during the imaging process.
- Paediatric imaging equipment, anaesthetic apparatus, monitoring and emergency equipment have to be adapted to children of different ages.
Do paediatric radiologist work directly with children and their parents?
Paediatric radiologists interact with the child and their caregivers far more often than adult radiologists interact with their patients. It is one of the most rewarding aspects of our work. Parents are generally more involved and can help the radiologist by confirming the history and symptoms. The radiologist in turn can reduce parent anxiety, explain the procedure and obtain consent where needed.
Please can you talk about radiation and safety in children – we know that one of the issues both parents and other adults have is safety and radiation?
Children have rapidly developing cells and tissues, often tightly packed together in small bodies and are considered to be 10-15 times more sensitive to radiation.
The guiding principle of all radiation safety is ‘ALARA,’ which stands for ‘As Low As Reasonably Achievable’ or as we say, ‘when benefit clearly outweighs the risk.’ Ultrasound and MRI do not use radiation and these should be used where possible.
What injuries are commonly seen in children that require imaging?
Common injuries include those from motor vehicle accidents and particularly pedestrian accidents, fractures from falls or playing sport and unfortunately, increasingly from child abuse which is sometimes first identified by the radiologist.
Children’s bones are different from adults and have areas where the bone is still growing. These are called growth plates. Injuries to the growth plates require special care because they can affect how a bone develops and this impacts the overall growth of the child.
Outside of injuries, paediatric imaging also looks at chest infections, abdominal pain, appendicitis, urinary tract problems and hip development in infants. Brain imaging may be used for seizures, headaches or developmental concerns. In essence, imaging can help us rule out serious causes quickly, which brings enormous reassurance to families.
Even for adults, radiology can be stressful and frightening – for children it must be worse. How are children supported during scans?
Radiographers and radiologists are trained to work gently and calmly with children and parents are encouraged to be involved and ask questions. For example, when a child needs to be sedated for an MRI, the parent will stay with them until they are asleep. When children feel safe, the scan is quicker, easier and more accurate. The team ensures the child is warm and comfortable and the environment is child friendly with toys and reading material to distract patients and to keep them happy and engaged.
What developments in paediatric radiology do you feel are the most important – especially over the 5 years?
- Digital radiography allows for digital manipulation of images improving image quality and accuracy. Retakes are reduced so there is less radiation involved
- Ultrasound machines have improved in-depth visualisation of body parts, disease processes and blood vessels
- CT scanners are faster and offer lower radiation dose options. There are scanners which can scan the entire body of a child in less than a second. There is not even time to wriggle…
- MRI imaging is developing at a galloping pace with faster scanning techniques and finer image detail
- Functional MRI and the ability to do tissue sampling in cancer imaging, is opening many exciting new avenues.
The scope of interventional radiology techniques (treating not just diagnosing) is expanding rapidly to make less invasive treatment possible, with less complications for patients and much shorter recovery times. Paediatric radiology increasingly includes minimally invasive procedures (image-guided drainages, biopsies, nephrostomies, angiography), which can shorten hospital stays and reduce surgical burden.
