Pediatrics at HSS
Pediatric Radiology and Imaging
HSS Pediatric Radiology and Imaging offers specialized care designed with the comfort and well-being of children and their parents in mind. Our child-focused environment and rigorously established pediatric protocols ensure the highest standards of imaging. Our board-certified radiologists and highly skilled technologists possess deep expertise in a wide range of pediatric conditions and their diagnoses. Crucially, we are committed to clear and open communication, proactively addressing concerns and minimizing stress throughout the imaging process.
We offer specialized pediatric imaging services, including Magnetic Resonance (MRI), Computed Tomography (CT), Ultrasound, conventional X-ray examinations (X-ray) and advanced low-dose X-ray or EOS imaging for children requiring frequent monitoring of conditions like scoliosis and other congenital bone disorders. EOS imaging is only available in certain hospitals and emits a third of the radiation of a conventional X-ray image.
Our highest priority is making sure your child is as comfortable and relaxed as possible. Pediatric patients are prioritized to avoid lengthy wait times. Flexible in-room examination protocols permit our youngsters to bring toys and items of comfort with them during their appointments. Extra soft toweling, specialized gowns and care is used to facilitate maximum comfort.
Imaging Guidance for Parents
The American College of Radiology's "Image Gently" campaign emphasizes using the lowest possible radiation dose for pediatric imaging to minimize the long-term risk of cancer. While essential for diagnosis, unnecessary X-rays and CT scans should be avoided, and alternative methods like MRI or ultrasound should be considered. HSS has a deep and thorough understanding of these principles and empowers parents to make informed decisions about their child's imaging care. Along with offering low-dose X-ray through EOS imaging, please use the following information to get the best care for your child:
General concerns to investigate
- When scheduling an appointment ask if the imaging center has professional and technical expertise for a patient of your child's age.
- Verify that the department's Radiologists, the physicians supervising the image acquisition and interpreting the imaging examinations, have specific sub-specialized training in your child's suspected problem or condition.
- Ensure that the provider has patient liaisons that can help to facilitate the process, and provide knowledgeable answers to questions and concerns from the patient and the parent.
- Ask about the examination gowns for the child. Do they have child-sized gowns?
- Inquire about the environment and availability of items to divert the child's attention during the examination.
- Inquire if imaging is digitally acquired so the images can be instantly distributed to the referring physician's office.
- Diagnostic accuracy can be enhanced if the technologist obtains information as to recent history or falls, prior surgery or any internal fixation devices or congenital anomalies that may be present. This information may negate the need for repeat examination. If the technologist does not inquire, volunteer the information.
- Inquire about the image retake rate. A facility focused on specific conditions typically has fewer image retakes, which means less time in the radiology center and less exposure to ionizing radiation.
Specific concerns to investigate regarding Ionizing radiation
- Inquire about protocols for pediatric patients – do they limit the number of x-rays required for the series?
- Do they limit the area exposed to ionizing radiation with collimation (i.e. only the targeted area is exposed).
- Do they routinely take the opposite link for comparison? In most circumstances, examinations of the extremity are not needed and exposes the youngster unnecessarily.
- Inquire about shielding. Do they have child size safety shields? Do they use breast shields for scoliosis studies?
- Ask if there is an alternative to an examination that uses ionizing radiation (X-ray, CT) such as MRI or ultrasound that is applicable for your child's specific condition.
- Ask if the MRI or ultrasound departments are equipped for the pediatric patient.
Specific concerns to investigate regarding MRI examinations
- Inquire if the child may need to be sedated. Ask at what age sedation is required.
- Ask how long the examination will take.
- Ask if you, the parent, will be allowed to remain with your child during the examination.
- If you think it would help, ask if you and your child can see the examination room before the actual procedure.
- Ask if the child can bring a toy or special music with them for the examination.
It is important to remember that imaging studies provide enormous information about medical diseases and conditions and these examinations should not be avoided because of the fear of radiation exposure. Paying attention to the above tips will help parents make a more educated choice as to where they should have their child's imaging performed.
Types of Imaging
The Department of Radiology and Imaging at HSS provides specialized pediatric and neonatal service for congenital orthopedic concerns, hip dysplasia, and spinal conditions. The division practices a "heart of excellence" mandate which involves warm introductions and friendly smiles, and a can-do attitude for both the staff as well as the young patient. Our younger patients are awarded with high-fives and stickers for a "job well done" as well as our appreciation of their good behavior.
Conventional X-rays
At HSS we have a dedicated separate Pediatric Center where children receive conventional X-ray services. The technologists are comfortable and experienced in interacting and positioning children for their X-ray examinations. Toys, stickers and coloring books are used to distract the child, and our staff provide a souvenir for them to take home with them after their hospital visit.
Customized shielding, pediatric gowns and customized positioning devices when needed are used for infants and children of all ages and sizes. Pediatric parameters are always applied with regard to ionizing radiation from an X-ray or CT examination. The technologists follow ALARA (As Low (a dose) As Reasonably Achievable) in determining dose parameters.
EOS Imaging - Low Dose X-ray
HSS was the first hospital in New York City to offer EOS, the imaging system that produces much less radiation compared to standard X-rays, and is the only hospital in the country with four EOS systems. Many of our pediatric patients who are treated for scoliosis need X-rays several times a year, and EOS produces high-quality 3D images.
Different types of imaging can often be used to make a diagnosis and plan treatment. But doctors must balance the need for accurate results with the need to minimize the amount of radiation exposure. This concept, known as ALARA (as low as reasonably achievable), is particularly important in children. .
A person does not need to be a patient of an HSS doctor to use the hospital’s EOS imaging system, as long as they have a doctor’s prescription. The test takes about 25 seconds and is generally covered by insurance. It is not used to diagnose broken bones. Regular X-rays are still the best way to diagnose a suspected fracture.
EOS is also used to assess leg length differences in children. These patients generally require frequent imaging tests to monitor growth, plan for surgery and determine the effectiveness of treatment. A previous study at HSS found that the lower-dose imaging system performed as well as a conventional CT scan to assess leg length.
Pediatric Ultrasound
Ultrasound is the method of choice to assess neonatal hips in children younger than 4 months of age. At HSS, we do about 10-15 hip examinations on babies a week. Ultrasound is also the method of choice to assess for joint effusion as well as performing joint aspirations to rule out infection. Additionally, ultrasound can be used for the evaluation of congenital anomalies of the hand or foot (e.g. evaluate congenital vertical talus). Recently we have started to perform ultrasound evaluations the neonatal spine to assess the location of the bottom of the spinal cord (conus medullaris).
Most often sedation is not required, however if anesthesia is recommended for an interventional ultrasound guided procedure, anesthesia is administered and monitored by pediatric anesthesiologists.
All our examinations are performed or reviewed by board certified radiologists who have special training in musculoskeletal ultrasound. Ultrasound studies are compared with prior ultrasound or other imaging studies at the time of the patient's visit via PACS. The ultrasound examinations are also immediately available in our PACS system so results are available for review by the referring physician and enable easy consultation between the referring physician and our radiologists.
Pediatric MRI
In the MRI Division at HSS, the pediatric patient is a special patient. For those patients who are of sufficient age that do not require sedation, one or both parents may accompany the child into the MR Suite following appropriate clearance for MR safety. In addition, a favorite soft toy may be brought into the MR unit, once it is cleared for safety and has no metal parts. Mirrored glasses are provided so that the child may view either the parent or the technologist behind them throughout the MR examination. For those children who require anesthesia, the child is placed under sedation and constantly monitored by a specialty trained pediatric anesthesiologist and nurse.
Each pediatric examination is specifically protocoled with dedicated surface coils and imaging is targeted for the area of clinical concern. The study protocols are modified (i.e., all pulse sequence parameters) in order to maximize the detail and image quality due to the smaller joints and body parts of a child. Every pediatric MRI is monitored by an attending MRI radiologist to ensure the exam addresses the clinical concern and will not have to be repeated. The child gets a small reward after they complete the exam.
The status of the growth plate in children is occasionally a clinical concern following trauma, infection or tumor. Through extensive research collaborations, proprietary 3-D modeling software developed at HSS has undergone rigorous validation for accuracy. This software allows for growth plate (physis) analysis and provides a reproducible assessment and quantification of the degree of closure or deformity, providing important information to the pediatric orthopedic surgeon.
Pediatric CT
Before scheduling the CT examination for a child at HSS, there is a consultation between the attending physician and the radiologist to ensure the need for the study and to discuss alternative examination. At the Department of Radiology and Imaging, CT is very child friendly. Every effort is made to establish a rapport with the child and the parents to ensure confidence and cooperation. We create an unhurried and pleasing atmosphere, combining patience and understanding to make the child feel at ease. The use of sedation is rarely required because examination can be performed so rapidly. Typically, sedation is only used if the physician radiologist requires absolute elimination of motion. When sedation is needed, a pediatric anesthesiologist administers and monitors the patient before, during, and after the examination.
To manage the dose of ongoing radiation, all exposure factors for the CT examinations are reduced, the area scanned is limited as much as possible and shielding is always used. Radiologists are involved in all pediatric cases in order to ensure that the protocol used for the scan will address the clinical concern the first time and the examination will not have to be repeated.