November 05, 2020

Choosing a Career in Pediatric Radiology

By Arielle E. VanSyckel, MD, MS, radiology resident at Indiana University School of Medicine

Child holding xray imageOne of the real joys of pediatric radiology is the blissful absence of incidental age-related degenerative changes: “Mild” — no, better make it — “mild-to-moderate probable chronic microvascular ischemic disease.” We’re all familiar with the exhausting list, which includes white matter disease, incidental 3 mm pulmonary nodules, and low-density renal lesions, which are too small to accurately characterize — to name only a few.

It may seem silly to name this as a primary pleasure of pediatric radiology, but it seems to me that when everything is parsed, this lack of degenerative incidentals is sort of a lighthearted representation of the deeper rewards of the field. In pediatric radiology, most of your patients are either healthy or diseased — broken or whole — but not degenerative. When you read their images, you tell them that they are sick or well, but not that they are “well-ish for their age.” A youthful spine is really a delight to see; one might see it and marvel at the human body, at the intelligence of the forces of our evolution. A degenerative spine disheartens, reminding readers of their hunched postures and of the inevitability of decay. Brokenness can often be made whole, but no one can cure aging. In this regard, the images and purposes of pediatric radiology are inherently optimistic.

The absence of degeneration also corresponds to the imaging conditions. In pediatric radiology, people still care about indications. They care about radiation dose, appropriate imaging, and the clinical value of things. Of course, this isn’t universal, but it is a medical reality that because the body is growing, rather than breaking down, the effects are different and so the imaging rules have to be different. This difference prompts innovation and demands thoughtfulness, engaging your personal expertise as a radiologist rather than sidelining you to the effective functionality of an automated lab test. Referrers have questions, they need advice, and they need to be able to justify the risks of the scans. In pediatrics, it is still frowned upon to substitute ionizing radiation for a physical exam. What a relief.

The summative implication is that a pediatric radiologist has the marvelous privilege of reading scans that are likely to answer questions, an increasingly rare situation in today’s clinical reality of standardized order sets. The stereotype of a radiologist is a person mumbling quietly in the dark, avoiding responsibility and irritated with distraction, but I think our irritation with distraction goes deeper than the interruption, to the very heart of our being as physicians. We want to do good, to help patients, to perform our work excellently because we believe that it matters; we want it to matter. Pediatric radiologists have a real chance to matter by being more than a report factory, offering their expertise to referrers who are willing to listen for the sake of the still growing body of each patient. To me, that makes a difference.