Little Patients, Big Decisions
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Little Patients, Big Decisions
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Paediatric radiology is a distinct subspecialty with its own disease patterns, safety principles, and imaging protocols - not a scaled-down version of adult radiology. This episode is for radiologists, radiographers, and radiology registrars who want a rigorous, clinically grounded understanding of why children require their own imaging standards and how to apply them safely in practice.
Dr. Nonceba Koranteng, specialist radiologist and holder of the European Diploma in Paediatric Radiology and a Diploma in Paediatric Neuroradiology, explains the core principle that children are not small adults: their tissues are still developing, they are more radiosensitive, and their anatomy changes significantly across age groups - from neonates to adolescents. She unpacks the ALARA and ALADA principles (as low as reasonably achievable vs. as low as diagnostically achievable), the Image Gently campaign, and why every paediatric protocol must be dose-optimised by age and size rather than extrapolated from adult weight-based calculations.
The episode covers unique paediatric disease patterns including congenital abnormalities, exclusively paediatric tumours, normal anatomical variants (growth plates, vascular channels, terminal myelination zones), and the critically important topic of non-accidental injury (NAI) - where radiologists may be the first clinicians to raise the alarm. Dr. Koranteng walks through clinical decision-making frameworks for head trauma, including the PECARN algorithm for risk stratification, and discusses when to image, when not to image, and how to choose between CT, MRI, and ultrasound to balance diagnostic value against radiation risk and contrast agent exposure.
Practical guidance covers sedation protocols, the feed-and-wrap technique for neonates, distraction tools such as movie goggles and noise-cancelling headphones, and the role of parental consent and communication in reducing anxiety and improving cooperation. The episode also addresses the South African context: the work of SASPI (the paediatric subcommittee of the Radiology Society of South Africa) in standardising skeletal survey protocols, the radiologist-to-population ratio challenge, and how tele-radiology with AI support - including AI-assisted detection of pneumothorax and NAI - plus low-field portable MRI and photon-counting CT represent the near future of safe, accessible paediatric imaging. · PECARN Paediatric Head Trauma Decision Rule · Image Gently Campaign - Radiation Safety in Paediatric Imaging · Radiology Society of South Africa (RSSA) - SASPI Subcommittee
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