Posted on Sep 01, 2021
For injuries and disorders of the brain, spine, neck, and nervous systems, neuroimaging helps ensure accuracy. But these types of scans are complex, requiring a very specific skill set that neuroradiologists spend years learning. Pediatric neuroimaging involves yet another layer of specialization, as there are many intricacies involved with the developing brain.
Unfortunately, pediatric scans are often not read by a pediatric neuroradiologist. This presents a serious risk for misdiagnosis. We spoke with Pediatric Neuroradiologist, Dr. Michael Rozenfeld, to discuss how a subspecialty second opinion can help parents ensure their child’s neuroimaging is read by the correct subspecialist.
[DocPanel] It’s estimated that only 15-25% of pediatric imaging is read by the correct specialist. What are the reasons behind this and how does it affect patient outcomes?
Radiology studies of all types are often interpreted by non-subspecialized radiologists or by radiologists from different subspecialties. This may be due to numerous factors, including limited subspecialist availability and after-hours interpretation. With pediatric imaging specifically, there’s currently a big shortage of pediatric specialists. One study found that in the US, only about 3%of radiologists specialize in pediatric radiology. Globally, the disparity is even wider.
One contributing factor to the shortage of pediatric radiologists is that fewer and fewer residents are choosing a career in pediatrics. So, as you can imagine, it’s very difficult for smaller hospitals and facilities to provide 24/7 pediatric specialty coverage.
Studies do, however, show that subspecialty radiologists can provide improved accuracy when reading studies within their subspecialty.
Unfortunately, it’s just not always possible for facilities to provide that level of expertise during the initial read. This presents a great risk for misdiagnosis, missed diagnosis, or delayed misdiagnosis - all of which can have a devastating impact on patient outcomes. One study that compared pediatric neuroimaging initial opinions with subspecialty second opinions found a discrepancy rate of 34%. Over one-third of the disagreements were considered major, most often pertaining to the presence of fracture and hemorrhage.
[DocPanel] What can parents do to ensure their child’s neuroimaging is read by the correct subspecialist - a pediatric neuroradiologist?
While subspecialized interpretations are not always possible in the moment, with advancing technology, these exams can now subsequently be submitted from anywhere in the world for academic level interpretation by US fellowship-trained subspecialized radiologists, who are experts in their respective fields. These second opinion reads can reveal missed diagnoses, misinterpretations, and overdiagnoses.
Exams can now subsequently be submitted from anywhere in the world for academic level interpretation by US fellowship-trained sub-specialized radiologists, who are experts in their respective fields.
[DocPanel] What differentiates a pediatric radiologist from a pediatric neuroradiologist?
Many radiologists, including neuroradiologists, spend an additional year in fellowship training to specialize in an area of the body. Neuroradiologists often choose to spend a second additional year to subspecialize further, whether it be in neck imaging, spine imaging, or pediatric neuroimaging. Pediatric neuroradiologists will focus specifically on the way neurological conditions and diseases present and appear on imaging in infants and children. These additional 1-2 years of training and the subsequent focused experience on the job is invaluable in providing accurate reads for our patients.
[DocPanel] What advice would give to a parent whose child is having medical imaging done to evaluate a neurological condition?
My advice would be to always ensure your child’s imaging is being interpreted by a pediatric neuroradiologist. I’d also advise them to get a second opinion, to ensure accuracy and get peace of mind.
Pediatric patients are not just small adults. They have unique diseases such as congenital malformations, genetic disorders, and unique brain tumors.
In addition, they also present with diseases that can also affect adults, such as strokes and traumatic brain injury, but these diseases often have unique causes and presentations. Pediatric patients often require specialized imaging techniques and protocols. Many of these diseases are quite rare, dedicated pediatric neuroradiologists have the experience required to accurately diagnoses these young patients.