We have, in pediatric IR, effected this change many times over—we’ve changed the approach to vascular malformations and now treat malformations by the hundreds. Blunt trauma is now largely treated with minimal invasion. We’re now seeing certain kinds of tumors, like osteoid osteomas, which we can remove or kill them with image-guided techniques. When you compare today to the 1970s, it’s so different that it just makes you want to smile. It’s a good thing.


LK Where do you think pediatric RT I think the next step is entering the


IR needs to go next? era of multidisciplinary therapies in


offers that. On neonate or ward rounds, a student will see 500 kids with respiratory distress, for example, and when they leave that immersion they know the difference between a neonate and a 6-year-old and what respiratory distress looks like in all ages. Our training also puts an emphasis on ultrasound for guidance—if an IR isn’t skilled in ultrasound, they can’t do pediatrics.


LK What do you think is the solution to these recruitment


and training difficulties? RT It is my hope that in the future


there will be a dedicated pediatric


IR fellowship pathway. IR has so many subspecialties that require in-depth knowledge and specialized training, and pediatrics is absolutely one of those. I think people would be willing to do another year.


Additional resources


Youth meets experience: Taking an educated approach to the pediatric patient: bit.ly/irqyouth


Society of Pediatric Interventional Radiology: spir.org


Society of Interventional Radiology pediatric standards: bit.ly/3zLGXig


24 IRQ | SUMMER 2021 JD If we can get people interested, we can figure out the pathway


to get them there. Pediatric IR is so interesting right now. We’re not just doing aspiration drainages and biopsies or acting as a PICC line service. Except for oncology or stent grafting, we do pretty much everything an adult-patient IR does, and we have an interesting practice that isn’t confined to baseline procedures.


LK Tell us about the work. What makes IR a crucial part


health system, so too has pediatric IR. One place we’re truly integral is vascular anomalies and lesions. When we review lesion cases every month at my institution, I’d say that two-thirds of the cases that come through get referred into IR, because it offers an option for difficult vascular lesions. Without IR there’s no option but to cut, which means cutting things and places you shouldn’t.


of pediatric care? JD Just like IR changed the adult


RT Our goal is to make open surgery go away. That won’t happen, but


the fact remains that image-guided, minimally invasive procedures are better for your health. IR is not the only specialty to understand that, and it’s only a matter of time until no one will choose an open procedure if there is a minimally invasive procedure available that is just as effective.


an organized way. In general, the medical and surgical specialties have done a wonderful job of evolving, so if we want to evolve to solve the next generation of problems, we need an augmented toolbox to deal with the residual problems that haven’t been solved. For example, a few years ago we


worked with orthopedic surgeons to put a pin in a very specific location to reduce a complex pelvic fracture dislocation. On their own, surgeons would perform an operation and open the person up around the pelvis. My team did this without an operation and put a pin in the right spot, as guided by the orthopedist, and with one pin we reduced the fracture dislocation. The technical procedure was easy for me—but I couldn’t have done it as smoothly without the orthopedist pointing where to go.


JD In my opinion, we do advanced procedures and have bridged the


gap with our adult-patient colleagues, but a lot of practices aren’t as clinical as they ought to be. We need to behave like a surgical service where we consult on patients, see them in clinics, round on them and have a team of supporters—a whole staff that takes ownership of our patients. We have to be an active clinical service, because it raises the visibility and credibility of the IR service when you are treated like a clinical colleague who has primary care of the patient.


is key, because we have caught up with the medical advances. We’re an uncontainable force at this point.


RT I agree. Patient and clinician care


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