One of the statements that you will often hear when performing pediatric radiology is the following, “Children are not just little adults.” And, nothing could be further from the truth. Many of the rules and diseases you have learned for the adult population do not apply to kids. You will find a whole new vocabulary and subset of conditions that are unique to this population. So, what does this mean for residents trying to learn pediatric radiology? Well, there is a lot to learn! So, as in the other “how to be successful” series, let’s go through some of the reading materials you will need to know, and then we will delve into what you should be doing and learn on a year-by-year rotation basis.
Reading Materials For Pediatric Radiology
Reading, like in other modalities, is critical to performing well. Therefore, I wanted to give you what I think are some of the best resources. Overwhelmingly, our residents recommended the Cleveland Clinic Pediatric Modules. And, having checked out the site myself, I have to agree. It is an excellent resource with useful summaries and pictures. Moreover, at the moment, it is free! So, I would recommend you to take a look at the site.
If you are interested in a more traditional book, you can try the Pediatric Requisites. However, having seen the website and the online information’s high quality, I am more biased toward the modules. Plus, the modules give you excellent pre-and post-test questions. What more can you ask?
Year-By-Year Summary: What You Need To Do
Year One
Pediatrics has more procedures than you may have thought. Of course, you will need to know how to do the basics such as VCUGs, barium work, intussception reductions, and g-tube placements. Plus, you need to complete all these procedures on babies and children, some of which are very scared. And you must also deal with their parents. All this is part of your first year’s introduction to pediatric radiology. So, get familiar with these procedures and learn how to handle the interpersonal situations you will encounter. The attendings will want to have a “go-t0* resident that can help them out during the day. Learning these skills is what it takes to become part of the team. It is all key to having a successful first month.
Also, you will need to learn the basics of pediatric chest and abdominal x-rays. The litany of diseases and findings markedly differs from the adult population. Moreover, there are tons of these films you will need to interpret. So, get cracking! Also, be sure to read lots of pediatric trauma films. Fracture patterns in pediatrics do differ from adults. So, make sure to learn these. Most residents will spend the majority of their time on these plain films.
However, also get to know the disease entities in other modalities that you will encounter on-call that you will need to interpret. These include ultrasound and CT scan for pediatric appendicitis, ultrasound for intussceptions, and ultrasound for pyloric stenosis. Indeed, you don’t want to miss these pathologies at night time. So, you will need to know these entities and findings cold.
Years Two And Three
Now that you know some of the basics, concentrate on other pediatric radiology areas, you will need to know. Start getting to know the other critical disease entities that you may encounter on CT scan and MRI. I’m talking about hepatic tumors, pediatric cancers such as neuroblastoma, Wilm’s tumors, lymphomas, and more. You will need to know these disease entities for the boards.
Become more adept at pediatric ultrasound. For kids, pediatric ultrasound is a critical tool for making all sorts of diagnoses. Why? Because kids are much smaller than adults, it’s a lot easier to see delicate structures that you cannot penetrate in an adult. Pediatric radiologists, therefore, tend to play a more hands-on role than ultrasound in adults. So, be sure to watch how some of the more senior radiologists do their exams and make their more complex diagnoses.
Year Four
Esoterica should be the theme for this last year. Make sure to try to see and participate in cases that you may never see again. Maybe it is brain ultrasounds or pediatric neurointerventional workups. By the way, if there is a pediatric interventionalist, stop by the interventional radiology department and follow some of the compelling cases you started to work up in pediatric radiology. Hang out with the pediatric surgeons for a bit, especially when they workup unusual congenital abnormality cases. You may also learn a lot about new and fascinating disease entities from these folks.
Make sure to also learn about some of the other areas you may have skipped over the years. Check out the unusual congenital abnormality cases. Pediatric radiologists love them. And, most pediatric departments have collections of these either on film or on PACS. Bottom line. You should fill this year with all the gaps that you would have missed out on otherwise.
Learning Pediatric Radiology: Like Starting From Scratch!
Learning about pediatric radiology differs from the rest of radiology because the disease entities are so different. But, all with the online resources, procedures, and hands-on experiences, you will be sure to learn most of them. Additionally, clinical acumen and bedside manner will go hand in hand on this rotation. It is more critical than ever. So, don’t expect only to sit by the PACS workstations. Instead, roll up your sleeves and be prepared to get up and work. Only this way will you succeed in this excellent rotation experience!
