The session on radiologic modalities in paediatrics at the European Congress of Radiology explored cutting-edge imaging technologies and safety strategies in paediatric radiology. Experts discussed advancements in interventional radiology, cardiac CT and photon-counting CT, focusing on optimising diagnostic accuracy while minimising radiation exposure in young patients.
Interventional radiology
Kevin Fung from Hong Kong addressed the challenges and advancements in paediatric interventional radiology (IR), highlighting its increasing role in procedures typically performed by surgeons, including central venous access, biopsies and complex vascular interventions. He emphasised the unique challenges in paediatric cases, stating, "Children are not small adults", as they possess high radiosensitivity, differing physiological characteristics and varying levels of cooperation.
Fung underscored the risks of radiation exposure in children and the importance of balancing diagnostic and therapeutic benefits. He discussed stochastic risks of radiation-induced cancers and the need for effective dose monitoring. He noted technological advancements, such as Monte Carlo simulations and the use of ultrasound to minimise radiation exposure, adding, "Ultrasound is my best friend," to illustrate cases where ultrasound replaced CT or fluoroscopy.
In closing, Fung called for the development of dose reference levels and improved radiation monitoring practices, advocating for collaborative data sharing to refine standards and ensure the safety of paediatric patients.
Cardiac CT
Thomas Robert Semple from Hatfield (UK) discussed the role of cardiac CT in paediatric imaging, covering its justification, optimisation strategies and the importance of data management. He emphasised that CT is valuable when it is the best available test, particularly for high-resolution imaging of small structures like coronary arteries in newborns.
Semple outlined CT’s advantages, including fast imaging without sedation and its utility in complex cases such as vascular rings and congenital heart defects. He categorised scans by difficulty, from simple anatomical assessments to complex coronary angiography. He stressed the importance of tailoring imaging protocols to individual patients, saying, "Individuals are the ones that we treat, we don't treat populations."
For optimisation, he recommended revisiting the entire scanning process, ensuring proper contrast delivery and leveraging modern monitoring systems. He highlighted the need for multi-disciplinary collaboration, particularly in dose reduction efforts, which have significantly improved through equipment upgrades and process refinements.
Photon-counting CT
Pierluigi Ciet discussed the impact of Photon Counting CT technology in medical imaging, especially for paediatric and pulmonary cases. His team began using this technology in 2021 and expanded it to Sofia Children’s Hospital in March.
Photon Counting CT provides four times the spatial resolution of conventional scanners while maintaining spectral information, enhancing tissue differentiation and reconstructions like iodine mapping and lung perfusion. The technology features smaller, more efficient detectors that convert photons to electrical signals, leading to reduced noise and improved image clarity.
A significant advantage is the reduction of radiation dose, achieving up to 70% less exposure in paediatric craniosynostosis cases without sacrificing diagnostic accuracy. The system also offers spectral flexibility for various imaging needs, allowing for tailored adjustments in radiation dose, contrast enhancement and resolution.
Ciet concluded by inviting attendees to an advanced imaging course in Rotterdam and highlighting ongoing collaboration with Siemens for post-processing improvements.
Speakers highlighted the need for tailored imaging protocols, dose reduction strategies and interdisciplinary collaboration to enhance paediatric radiology. With ongoing technological advancements and improved safety measures, the field continues to evolve, ensuring better outcomes for paediatric patients while mitigating radiation risks.
Source & Image Credit: ECR 2025
