|
Basic philosophy Paediatric radiology is a subspecialty of diagnostic radiology, essential for paediatric patient care, and it can contribute considerably in the management of a great deal of sick children. With the improvement of medicine in the near future in Rumania, to be expected on the basis of the changing political situation bringing about socio-economic and financial developments, more refined anatomo-pathological diagnosis is needed, especially in children. This should not go on the expense of too much additional ionising radiation (roentgenology and computed tomography (CT)). Therefore, the overall quality of radiographic technique together with the knowledge of indication and film interpretation should be maximized. In addition, the multiplanar imaging capabilities of ultrasonography (US) and magnetic resonance imaging (MRI) should be more generally exploited and used. MRI is of only limited value in all day paediatric practice because of its high costs and limited availability, and the need for general anaesthesia to prevent movement artifacts (Contrarily to CT, MRI demands the patient to stay immobile during the acquisition of a whole series of images). The advantages of US are well known: it is quick, safe, relatively cheap, well tolerated, and it uses no radiation. In addition, US images in children are much better than those in adults because children have less fatty tissue and less calcified bone. As shown in my thesis, the disadvantages of US, including its operator dependency and lack of standardisation, can be compensated by the close cooperation of all specialists concerned. In fact, the process of refinement of indications, improvement of radiographic techniques and interpretation, and of promotion of additional and substitutional use of US is a continuous one, and should keep up speed with the improvements obtained in the paediatric field as a whole. Otherwise, paediatric radiology would be a limiting factor in the development of paediatric patient care. This process needs a continuous surveillance and improvement on a professional level taking into account the local situation. This should be carried out in an academical setting, combining patient care, teaching, and research. Even highly qualified general radiologists lack the essential knowledge and skills for this task. Like paediatrics, diagnostic radiology is becoming more and more subdivided in subspecialities, including neuroradiology, skeletal radiology, mammographic radiology, ORL-radiology, GI-radiology, etc. So, in fact every medical faculty needs a well trained paediatric radiologist. And even then, full coverage is not warranted, since already paediatric radiology is being subdivided as well (think of paediatric neuroradiology, the sub-subspecialty of the recently deceased Canadian Derek Harwood-Nash, who wrote a standard work in three parts about it).
Options Within a few years, the young local generation should be on level with modern radiographic technology, film interpretation, and use of US, and should be able to initiate further developments as well. To obtain this goal… what should be done? |