Despite the prevalence of high-resolution CT and MRI, real-time fluoroscopic examinations remain a mainstay for diagnosis and treatment in the pediatric population. Fluoroscopic imaging provides timely and cost-effective diagnostic evaluation, often at a lower radiation dose with added benefits of real time/functional diagnostic testing. While fluoroscopic rotations are mandated by the ACGME for radiology resident training, dedicated fluoroscopic imaging rotations are typically scheduled in the early years of diagnostic radiology training and usually in the adult population. Likewise, many training programs lack exposure to disparate/conflicting techniques in fluoroscopy.
Educational Goals / Teaching Points
The process of standard fluoroscopy is outlined with the included necessary images for these procedures. Anatomic correlation is provided using medical illustrations that correspond to the fluoroscopic projections. Pathologies targeted using fluoroscopy are depicted. The pros and cons of using a restraining device are described. The use of sedation during fluoroscopy is explained in addition to its limitations.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit presents a standard step-by-step approach to performing a fluoroscopic exam on a pediatric patient such as a voiding cystourethrogram or an upper gastrointestinal series. Illustrative representations of the underlying anatomy and how it appears on the screen accompany each step to serve as a visual roadmap. Medical illustrations demonstrate the intra-abdominal relationships of the highlighted structures within the patient as it relates to the patient’s position. Accompanying pathologic cases highlight the usefulness of various steps with accompanying imaging and diagnostic pitfalls. An additional dedicated tips and tricks section discusses specific concepts when performing a fluoroscopic exam on pediatric patients. These include discussions on how we perform cases at our institution incorporating services of Child Life specialists, appropriate use of restraint devices such as an Octopaque device, and the use of anesthesia.
There remains broad use of fluoroscopic exams throughout radiology and especially in the pediatric population. Current training and experience in this modality are limited during residency, resulting in decreased provider comfort with this modality generally upon entering independent practice, especially with pediatric patients. This current state is not only suboptimal for those entering a pediatric radiology fellowship where skills must be relearned, but more importantly, can be catastrophic for those tasked with performing these studies in the community where there is often limited colleague and technologist backup. This exhibit will provide a guide and refresher to trainees entering pediatric rotations, fellowship training, and most importantly those tasked with performing these studies outside a tertiary pediatric hospital environment.