The following article was written by John MacKenzie, M.D., Chief of Radiology at Mission Bay Hospital and Section Chief of Pediatric Radiology, Associate Professor in Residence at UCSF.
In this country close to 16,000 children under the age of 21 are diagnosed with cancer every year; approximately one-quarter of them will not survive the disease. Families, caregivers, charities and research groups across the United States observe September as Childhood Cancer Awareness Month.
It is timely, then, to point out that communication between parents and the doctors who are diagnosing and treating their children with cancer is crucial. In that spirit, I offer the following questions for parents to consider asking in guiding their discussions with caregivers:
- Are there dedicated pediatric radiologists, not just adult radiologists, to help in the performance and interpretation of my child’s imaging study?
- Is there a team that can help my child get through the imaging exam?
- What are the radiologists doing to lower the exposure to radiation that my child will receive?
- What working relationship do you have with your pediatric radiologist?
It is very important to have a team helping to get a child through an imaging exam. For example, Child Life Services is a specially trained group at UCSF that understands children’s special needs and can guide parents and children through the procedure. This dedicated team is focused on the child and family and allows the doctors and imaging technologists to concentrate on the imaging study. That way, the imaging team can focus on one thing and allow Child Life Services to assist with helping the child and family through the imaging examination and attend to their special needs in greater detail.
Children are usually squirmy during an imaging study, so in order for them to remain still it is often necessary to administer anesthesia for children up to age six. Because we have special imaging techniques and have a team approach to working with children, we are minimizing and eliminating the need for anesthesia with more and more of our young patients. For example, we recently managed a three-year-old on a scanner without anesthesia because our Child Life Services team was so good at keeping the child calm.
Children with cancer usually need multiple imaging studies every three to six months in order to track their disease and help in treatment decisions. With that frequency, it is very important to minimize radiation exposure because the cumulative exposure is what we want to avoid when we can. We at UCSF have instituted a number of processes and protocols to minimize the amount of radiation that children will be exposed to. For example, we have an advanced super computer that allows us to process the images and get better image quality while dramatically reducing the exposure to radiation. UCSF is one of only a very view places in the world with this capability. Also, we are setting up a PET/MRI scanner, which will image with much greater sensitivity through positron emission tomography (PET), while reducing the dose well below the exposure we get from background radiation.
Any parent would want to know that there is good communication among the teams attending to his or her child. At UCSF the pediatric radiologists meet with treatment teams and discuss the imaging of their patients on a daily basis. Because we hold ten different interdisciplinary team meetings with different subspecialists, we not only know our pediatric patients inside and out from their imaging studies, but we also know in great detail the patient histories and medical management. So, when I greet families and their children being treated at UCSF, I let them know that we literally know their child inside and out—and that’s not only from the imaging that we do. I then tell them that I also work with a team of at least 10 really smart people – doctors, nurse practitioners, students – who help in different aspects of their child’s medical care, and that we’ve worked closely together and discussed the various options for treating their child. In addition, we often work with referring physicians or pediatric oncologists to think about what tests would be the best imaging options for the clinical question at hand. Sometimes it will be ultrasound and sometimes it will be MRI, neither of which requires radiation.
These aspects of my job at UCSF give me great satisfaction, working with a talented interdisciplinary team focused on helping children The questions above should help families pose good questions, whether they be to a pediatric oncologist in the treatment of cancer or to a primary care pediatrician who has decided the child needs an imaging study to figure out what is going on. These questions should help parents better understand the level of detail we go into when helping children at UCSF as well as help parents understand what is happening with their child. I look forward to continuing the good communication that exists between parents and those of us who provide imaging based care for children at UCSF.
For more information on pediatric radiology at UCSF, please click here.