09
AUG
2016

Pediatric IR

by Saumya Gurbani, G1, MD/PhD Program, Emory University

The history of pediatric interventional radiology (IR) is more recent than the evolution of the field in adult procedures. Dr. James Donaldson, a radiologist at the Children’s Hospital of Chicago, discusses how much of the equipment used in IR was too large for use in the smaller vasculature of children. However, as demand for smaller and more flexible catheters arose with the concurrent increase in the use of minimally invasive procedures in the small coronary arteries, the field of pediatric IR took off. [1]

Pediatric IR, of course, has analogous procedures to those seen in the adult world. Young children who are unable to take food and fluids by mouth can have a G-tube placed. Minimally invasive biopsies of internal organs are similar those performed in adults, albeit using smaller gauge catheters. Central venous catheters may be placed for children who are in the hospital for chemotherapy, major infections, or other procedures.

However, much as is the case in the world of internal medicine, there is much more to pediatric IR than just working with smaller patients. It’s about working within the unique anatomy of pediatric patients, and tackling a wide range of procedures for conditions that manifest during childhood. I had the opportunity to attend a seminar last year on pediatric IR hosted by Dr. Matt Hawkins of the Children’s Healthcare of Atlanta. He described performing angioplasties on patients with May-Thurner syndrome, a genetic condition in which the left common iliac vein is compressed by the right common iliac artery, leading to edema, pain, and recurrent deep venous thrombosis later in life. New advances in pediatric IR technology has led to treatments which prevent these dangerous effects.

Safety is of utmost importance in the world of pediatric interventions. Many studies have been published on minimizing radiation exposure to children during IR procedures, with a 2009 clinical guidance article in Pediatric Radiology encouraging interventionalists to adapt their workflow, including “using ultrasound when possible,” using “pulse rather than continuous fluoroscopy [with] as low a pulse rate as possible,” and planning thoroughly the “number and timing of acquisitions” with the team. [2]

Pediatric IR is a rapidly growing field, as many children’s hospitals continue to establish programs. The training path is similar to that of adult IR, with a handful of changes to develop a skillset tailored for the pediatric population. First, the transitional year may be done in pediatrics (as opposed to medicine or surgery). While many pediatric interventionalists have no subspecialty training beyond IR, a fellowship in Pediatric IR can be done to subspecialize in the field. Others may choose to complete a fellowship in pediatric imaging. More information on training and the procedures performed in pediatric IR can be found on the RFS website, including an interview with Dr. Ahmad Alomari, the fellowship director at Boston Children’s Hospital.

References

[1] JS Donaldson, “Advances in Pediatric Interventional Radiology,” The Child’s Doctor, Spring 2011, Children’s Hospital of Chicago. https://www2.luriechildrens.org/ce/online/article.aspx?articleID=258. Accessed 3 November 2015.

[2] M Sidhu et. al., “Image Gently, Step Lightly: increasing radiation dose awareness in pediatric interventional radiology,” Pediatric Radiology, 2009.

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