Pediatric radiology today Newest data and challenges in imaging at the "Agios Loukas" Clinic

There is a general confusion, both in the non-medical population and in the medical world, about the subject of paediatric radiology.

According to the European Society of Paediatric Radiology (ESPR), children are not small adults. They should be treated as children, with age-related characteristics (common variations, congenital or developmental disorders). And this applies both to their approach in paediatrics and in paediatric radiology.

Paediatric radiology is therefore the branch of radiology that deals with the imaging study of children, from the time they are still in the foetus until around the age of 16. It includes a wide range of examinations, from simple radiological examination, ultrasound examination, more complex examinations using CT and MRI scanners, and interventional radiology.

Paediatric radiology, like radiology in general, is evolving alongside technology. The rapid development of the latter has significantly improved both the resolution and speed, but also the diagnostic capabilities across the whole spectrum of radiological imaging.

As paediatric radiologists, we must emphasise our sensitivity to the radiation protection of the paediatric patient being examined. Wherever possible, the use of ultrasound is recommended and preferred, with which we avoid irradiation altogether. But also in cases where the use of ionizing radiation is necessary (X-ray, CT scan), imaging techniques and methods are selected and protocols are appropriately adapted to limit exposure as much as possible [ALARA, as low as (is) reasonably achievable, Image Gently ®].

The investment in modern equipment, with integrated cutting-edge technologies, by the "Agios Loukas" Clinic, contributes significantly to the upgrading of the health services provided and to the better diagnostic approach of pediatric patients. This does not only concern the X-ray department, where, in addition to simple X-rays and radioscopic examination, it is now possible to better study and measure the child's bone age (hand limb X-ray), but also the possibility of radiological imaging of the entire spine (full spine X-ray) for the study of scoliosis.

The contribution of modern CT (with selection and adaptation of the protocols) and MRI machines in the performance of the entire range of examinations and in the imaging of the organs and systems of the paediatric patient is also a given.

In addition, the possibilities offered by the "St. Luke's" Clinic with the use of the latest generation of ultrasound in the diagnostic approach of young children should be emphasized. The latter is considered particularly important, as in many cases ultrasound examination (due to its high sensitivity, non-invasiveness, sufficient cost, speed, dynamic nature and repeatability) is considered at least the first line or even the only necessary examination ("one stop shop") for the pediatric patient.

Below are some of the modern applications of ultrasound in the "Agios Loukas" Clinic.

In recent years we have organized - in collaboration with a specialized pediatric orthopedist as a team - and developed in the Clinic the ultrasound examination for the control of developmental dysplasia of the hip, applying the Graf method. The information and systematic population-based screening of newborns/infants leads to early and appropriate treatment and limitation of surgical interventions.

With ultrasound we can check both the hip joint and other joints in older children for fluid collection - hymenitis.

As a team, with fellow paediatricians, we study the urinary system in children using ultrasound. Most commonly after prenatal dilatation or after an episode of urinary tract infection, but also in the context of investigating cystic lesions - congenital anomalies, palpable masses, haematuria, acute renal failure, neurogenic cyst or dysfunctional disorders.

We even have the possibility, in collaboration with fellow pediatric surgeons, to perform upward ultrasound cystography (Voiding urosonography-VUS) as a method of highlighting and monitoring cystoureteral reflux using special sound-enhancing contrast agents for ultrasound. It is a diagnostic, completely safe and reliable method, and most importantly without ionizing radiation, in contrast to upwardly fluoroscopic cystourethrography (VCUG), which until recently was considered the test of choice. In this way we avoid the additional burden and risks of irradiating the ovaries and testicles adjacent to the bladder.

Ultrasound imaging of both the testicles, in terms of position (in case of cryptorchidism) and size, possible twisting or inflammation, and the ovaries (size; position; congenital abnormalities; tumours) or investigation in case of precocious puberty or amenorrhea, is also possible.

We have the possibility of imaging the neonatal brain ultrasonographically through the open sources (mainly the anterior), which is considered a simple, well-established, non-invasive technique for the intracranial evaluation of the premature neonate, the demonstration of congenital structural abnormalities or a simple screening method for the exclusion of major intracranial pathology.
The possibility to check the depth of the cranial sutures ultrasonographically is considered a safe, first method to investigate possible craniosynostosis, limiting the need for simple skull radiographs and thus avoiding again the corresponding radial burden.

Ultrasound examination of swollen cervical lymph nodes allows us to reliably and quickly differentiate intense inflammatory reaction or infiltration from abscess formation.

By monitoring the cardio-oesophageal confluence by ultrasound after a meal, we check for possible gastro-oesophageal reflux, while in case of rocket vomiting, by monitoring the pyloric duct in a newborn, we can exclude or confirm hypertrophic pyloric stenosis.

We can also not only detect possible intestinal ulceration in case of localized focal severe abdominal pain, but also intervene with a special ultrasound technique to resolve the intestinal ulceration.

We can study the small bowel helices ultrasonographically (Small bowel Intestinal Utrasound), in case of idiopathic inflammatory bowel diseases and with the use of special ultrasound contrast agents and special software available in the Clinic, we can highlight and quantify the degree of inflammation activity and the response to the appropriate treatment.

By using special ultrasound contrast agents we can also study vascular behaviour and characterise lesions located in various organs, especially in the liver.

Finally, in addition to checking for possible fatty infiltration of the liver parenchyma and focal or diffuse lesions, we can now calculate the degree of hardness-fibrosis of the parenchyma by elastography.

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