guide the procedures, we could copy the procedures performed on adult patients but also innovate. We started with 20–30 cases a year and, by the mid-’80s, we finally broke 1,000, which was a milestone I never thought we would reach.


There aren’t many pediatric IRs, so we don’t focus on organs or certain procedures— we have to be generalists, which is why our training pathways are so important.


James S. Donaldson, MD: I was exposed to IR earlier in my career because I trained in the ’80s at a residency that had some Charles Dotter proteges and a rich special services program on the adult patient side. But when I started working at a children’s hospital, there was almost no IR. Phillip Stanley, MD, FACR, FSIR, was there doing a few things, but it was nothing compared to what had been done on the adult side. Then I went to Chicago as a diagnostic pediatric radiologist and saw even less IR—so there was no IR going on in at least two major children’s hospitals. Children’s hospitals isolate


themselves a bit in their training, so I was working at facilities where all the surgeons had trained at other children’s hospitals, presumably without IR, and they only knew one thing: A chance to cut is a chance to cure. It was hard to convince people,


intellectually—we knew what was being done on the adult patient side and knew these techniques worked, but I didn’t have the techniques or skills to prove it at the time, and I had to convince them to trust me and trust the technique. And with pediatric surgeons and staff, they treat these young patients like their own kids. If they don’t trust you, they won’t let you try. It took a long time to change the culture. We faced the same barriers that the pioneers of IR faced—we just faced it a little bit later because of the


different. Their differential diagnoses and sensitivities are different. Neonates, for example, can’t get cold or wet. They’re only 700 grams—the size of a big mac. And there isn’t much space to work with in smaller patients, so you have to be extremely good at ultrasound guidance and very precise with sizing, because many sheaths are bigger than the blood vessels we work in.


JD Also, I will work on a neonate, and then switch to a teenager as big Richard B. Towbin, MD, FSIR


Former director of pediatric radiology Phoenix Children’s Hospital


as I am. RT Exactly. Weight is the key


difference. We know the whole


body and have a command over all disease states and procedures at various ages and weights. There aren’t many pediatric IRs, so we don’t focus on organs or certain procedures—we have to be generalists, which is why our training pathways are so important.


LK What does training look like JD Pediatric specialists in general—


for a pediatric IR? beyond even IR—do not work


James S. Donaldson, MD Professor of radiology Northwestern University Feinberg School of Medicine


isolated culture of children’s hospitals. Today, we’ve gotten past that cultural barrier, and now our largest challenges are training and recruitment.


LK What are some of the key differences between


pediatric and adult IR? JD Mostly it’s technical. There is the


concern over radiation levels


for imaging. In addition, our small patients have to be put to sleep even for relatively simple procedures, which raises the difficulty. Some pediatric procedures are difficult because of smaller areas and organs, and some tools aren’t appropriately sized for this population.


RT Young children are unique, and their disease spectrum is totally


on adults or get trained in adult medicine. That doesn’t always hold true for IR. We need to do what those other specialties have done and get at medical students early. When we’re able to talk to medical students about what we do, we’ve then had students get to their radiology training and know they want to focus on pediatric IR. If students get interested early enough in the training program, we can modify the path they take to make sure they’re getting a pediatric- focused education. For example, if we have one fellow interested in pediatrics, we can adjust rotations so they’re getting more pediatric IR than the rest of their classmates, and I feel they come out very well trained. They get the breadth and scope of an adult- patient IR practice, but can work in the pediatric world.


been able to have one program filled with pediatric students. We do a year of pediatric diagnostics followed by a year of IR. You can’t be an IR if you don’t know the diseases, and the best way to get that knowledge is to see repetition. Diagnostic radiology


RT At my former institution we’ve sirweb.org/irq | 23


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