Image Gently

A lot of people think radiologists are the technologists who take the images when they have diagnostic tests like X-rays, CT scans and MRIs. They don’t realize there’s a physician behind the scenes who generally makes the diagnosis of the patient for their doctor. That’s why radiologists are sometimes referred to as the “doctor’s doctor.”
Pediatric radiology is a challenging field in many respects. For one thing, you’re working with smaller anatomy, so your imaging equipment has to have higher resolution. With children you’re often dealing with different diseases than in adults, and the pediatric radiologist needs to understand these differences.
I’m particularly interested in interventional radiology, in which we employ minimally invasive diagnostic and therapeutic procedures using imaging guidance to treat certain conditions at their source. Children’s is the only facility in the Chicago area that offers pediatric interventional radiology, with physicians specially trained in these techniques. For example, we can use ultrasound to direct a needle into a tumor to take a sample instead of doing it surgically. We can use a CT scanner or ultrasound to guide a needle into the pocket of an abscess to drain it. And, we can use angiograms to treat vascular anomalies, including disfiguring congenital birthmarks and skin lesions.
One of the things we feel passionately about at Children’s is minimizing the exposure to radiation children receive when undergoing imaging procedures, because children are more sensitive to radiation than adults. That’s why we’re part of The Alliance for Radiation Safety in Pediatric Imaging’s “Image Gently” campaign.
We’re leading the charge in changing radiologists’ practices and educating community physicians who refer patients to us. As an example, most CT scanners are calibrated for adults, not children. Because of that, children can get huge doses of extra radiation if the standard equipment settings are not properly adjusted to the child’s size. Over time, too much exposure to radiation can lead to an increased risk of developing secondary cancers. That’s why over the years we have reduced the doses of radiation of our CT scans, and image only the specific areas we need to.
We need to educate both doctors and the public that there may be other diagnostic options that are less harmful and are equally effective, like ultra sound and MRIs. It’s important to remember that what we do today can last a child’s lifetime.
James Donaldson, MD, is chairman of the Department of Medical Imaging and is the Earl J. Frederick Professor of Radiology.
This article first appeared in the Winter 2009 issue of Heroes magazine.