Pediatric Radiology is a subspecialty of radiology that deals with the imaging of infants, children, and adolescents. Children and young adults under 21 have different anatomy, disease processes, and emotional and physical needs when compared to adult patients. Understanding the various needs and differences between adult and pediatric patients is ESSENTIAL to proper diagnosis and care during the radiology experience itself; as is the Radiologist’s interpretation after the exam has been performed.

While the same imaging scanners are used for pediatric radiology, the protocols and interpretations are very different. Pediatric patient’s/children’s bodies are still developing; therefore, their anatomy looks different from adults. Unless the Radiologist understands pediatric anatomy, they won’t be able to provide an accurate interpretation of the exam. 

For example, all humans have an epiphysis and diaphysis of their long bones. The epiphysis is the end/encap of the bone, and the diaphysis is the long portion. In adults, these two parts of the bone look like one bone. The epiphysis and diaphysis don’t fully close/fuse until about the age of 21, so the X-Rays of pediatric patients look much different. Below, you will see an adult femur X-Ray, and to the right, a pediatric femur X-ray.

Notice in the pediatric femur X-Ray to the right, there are arrows pointing to, what appears to be, separate bone pieces on the tops and bottoms of the femur. These “pieces” are the two epiphyseal plates of the femur. These will fuse later in life and appear more like the adult femur image. If the interpreting Radiologist isn’t well-versed in pediatric anatomy, it would be easy to call these endplates a fracture.  This is just one variation between adult and pediatric anatomy, but there are hundreds more that can make a big difference in radiologic diagnoses. 

The other important factor to consider when interpreting/reading pediatric radiology cases are the pathologies (disease processes) that are prevalent in children. While adults and children may have similar pathology, some processes are more prevalent in pediatrics and must be considered when interpreting pediatric imaging.

 

For example, Wilms Tumor is a rare kidney tumor that is almost exclusive to children. Adults develop different kinds of kidney tumors that require different management. Proper diagnosis is essential to treatment. The image below shows a pediatric patient with a right-sided Wilms Tumor. The black arrow shows the tumor while the blue arrow is pointing to the kidney itself. If this was an adult patient, the diagnosis would likely be Renal Cell Carcinoma and NOT Wilms Tumor. 

One additional consideration when imaging pediatric patients is their exposure to ionizing radiation. While MRI and Ultrasound produce NO ionizing radiation, X-Ray, CT, PET, and Nuclear Medicine studies do and therefore must be scrutinized when recommending and/or performing radiologic examinations. 

Since children are more radiosensitive and prone to the negative repercussions of radiation than adults, technical factors should be modified to limit radiation to ONLY what’s necessary for diagnosis. In some instances, this means that the Radiologist will prescribe a modified technique on the scanners themselves.

 For example, in an X-ray examination, the kilovoltage can be increased by 15% and the milliamperage decreased by 50%. This will provide a diagnostic image with roughly half the radiation dose but with little degradation of the image quality. 

In some instances, the Radiologist will directly supervise the study and terminate the exam when the required information has been acquired, omitting unnecessary scans and limiting the patient’s dose. 

In the example below, you can see a region of higher density on the right side of this patient’s X-Ray (your left if you’re looking at it). This area is a right middle lobe pneumonia and is indicated by a black arrow. In this instance, the Radiologist terminated the exam after this single view. Additional views were not necessary for diagnosis and would only increase the radiation dose to the patient. 

Imaging pediatric patients can be a challenge if not well-versed in pediatric anatomy, pathology, and radiation reduction techniques. Experienced Radiologists are able to evaluate a pediatric patient with ALL these in mind to provide a meaningful radiology experience for their patients.

Radiologists at The Radiology Clinic have decades of experience in Pediatric Radiology. Each pediatric examination at the practice is scrutinized to provide a diagnostic study with a reduced or eliminated radiation dose. If your child needs a radiology exam, please call us today! The Radiology Clinic has the experience and compassion to make your child’s radiology visit efficient and effective! Call us today at 301-217-0500, or email us at info@theradclinic.com.