AJR 2001; 176:1371-1373
© American Roentgen Ray Society
The Lure of Pediatric Radiology
Richard B. Gunderman1
1
Department of Pediatric Radiology, Indiana University, 702 Barnhill Dr., Rm.
1053, Indianapolis, IN 46202-5200.
Received November 15, 2000;
accepted after revision December 4, 2000.
Address correspondence to R. B. Gunderman.
Introduction
To see a world in a grain of sand, And a heaven in a wild flower—
Hold infinity in the palm of your hand, And eternity in an hour.
William Blake [1]
At a time when the demand for pediatric radiologists exceeds the supply and
the number of radiology residents electing to take fellowships in pediatric
radiology is unusually low, it is vital that pediatric radiologists find ways
to attract outstanding medical students and radiology residents
[2]. To achieve this goal, it
is not sufficient merely to offer them good training in pediatric radiology.
Although quality education is surely a powerful selling point, it is also
important to provide students and residents with broader perspectives that
help them to make well-informed career choices. Pediatric radiologists can
ensure that students and residents see what the field truly has to offer by
showing them its distinctive appeal. Pediatric radiologists should provide
each potential recruit with an opportunity to reflect on the pros and cons of
a career in the field.
Recruiting could be couched in immediate and tangible terms, such as the
current shortage of pediatric radiologists. The great need for additional
pediatric radiologists in North America should persist for years to come, yet
trainees should not enter pediatric radiology primarily because jobs are
readily available. A better strategy would be to help medical students and
residents identify intrinsic features of the field that appeal to them and to
reflect on its future [3].
Recruitment should be based on features that will continue to characterize
pediatric radiology for many years to come, through many peaks and valleys in
the employment cycle [4]. The
purpose of this article is to describe some of the special features that
distinguish pediatric radiology from other radiology subspecialties. Taken
together, these features constitute the distinctive lure of children's
imaging, the special characteristics that drew many people into the field in
the first place and continue to sustain their commitment and enthusiasm after
many years of practice.
The Care of Children
Part of the lure of pediatric radiology arises from the fact that children
are especially vulnerable. In debates over health care policy and finance,
ranging from the hospital ward, to the corporate boardroom, to the halls of
congress, children cannot act as their own advocates. Unlike other vulnerable
populations, such as the elderly, they have no direct voice. Yet our children
are our future. It is through children that we experience the world anew and
learn to recognize many of the wonders to which we may otherwise soon grow
inured. Much can be said about a community or a society by how it cares for
its weakest members, its children. Nothing touches the human heart quite like
a child in distress. In committing their professional lives to the care of
children, pediatric radiologists answer a special call of tender mercy toward
our most fragile creatures and play an important role in fostering our
future.
The Family Connection
Another appeal of pediatric radiology is its special invitation to interact
not only with individual patients but also with parents and families. No case
is ever merely a disease, but a patient with a disease. Similarly, the patient
is never merely a patient, but a patient situated in a larger familial and
social context. Frequently, it is only family members, and not the patient,
who can understand the radiologist's procedure. Because pediatric patients are
so strongly embedded in a social context, the pediatric radiologist enjoys a
distinctive opportunity to interact with and care for families on a daily
basis.
Tending children invites a special commitment to personal interaction,
through helping families prepare for imaging examinations, care for their
child during examinations, and understand the results at completion. Most
patients and families assume that their images are being interpreted
correctly. In their minds, a great radiologist has a sincere commitment to
communication and a caring attitude, qualities that the practice of pediatric
radiology draws on and fosters to a special degree.
The Resilience of Children
Pediatric radiology also proves especially rewarding because of the great
resilience of children. Children heal quickly, and they frequently recover
completely from insults that might leave an adult devastated. Even children
suffering from chronic and incurable diseases often exhibit extraordinary
strength of character, coping cheerfully with difficult and sometimes dire
circumstances. Seeing children live gracefully with serious illness and mount
extraordinary recoveries offers an unparalleled glimpse into the natural
nobility of the human spirit. The life force pulsates with special vigor in
these small bodies, and participation in their struggles provides the
pediatric radiologist a glimpse of life's larger possibilities. In these
children's extraordinary sagas, even those ending sadly in death, lie deeper
insights into what it really means to live.
The Whole Organism
One of the most distinctive characteristics of pediatric radiology is the
fact that it encompasses the whole human organism. Most radiology
subspecialties address only a particular anatomic part or organ system. By
contrast, pediatric radiology encompasses all anatomic parts and organ
systems. Moreover, pediatric radiologists are privileged to behold more of the
manifestations of multiorgan system processes, such as HIV and AIDS or
Langerhans' cell histiocytosis, and to use and develop a wider range of
expertise in human anatomy, physiology, and pathology than physicians in most
other radiology subspecialists. Simply put, pediatric radiologists enjoy the
opportunity to study the whole human gem, rather than focusing on only one or
two of its facets.
A general radiologist could, of course, make the same claim. Yet within
academic radiology proper, pediatric radiology arguably represents the last
bastion of generalism, in which one can both study the whole patient and
thrive in the distinctively academic missions of research and education. The
American Board of Radiology offers a Certificate of Added Qualification in
pediatric radiology. At the moment, pediatric radiology is one of only four
radiology subspecialties to offer this certificate; the others are nuclear
medicine, neuroradiology, and vascular or interventional radiology. This
professional recognition testifies to pediatric radiology's standing as a
distinct and integrated field of medical practice.
All Imaging Techniques
A further distinctive feature of pediatric radiology is its routine
reliance on all imaging techniques. The pediatric radiologist uses unenhanced
radiography, fluoroscopy, CT, sonography, MR imaging, and nuclear
medicine—in short, the entire armamentarium of the contemporary
radiologist. Radiologists in other fields, such as nuclear medicine, also
image the whole patient, using a single technique. Moreover, as new imaging
techniques are introduced, they are certain to be used in the imaging of
children. This potential will give the pediatric radiologist an opportunity to
keep abreast of the latest technologic developments in the wider world of
diagnostic imaging.
Certain imaging techniques enjoy special opportunities for success in the
pediatric context. For example, sonography is especially advantageous in
children. Areas of adult anatomy that are difficult to see on sonography, such
as the chest and brain, prove exquisitely accessible in pediatric patients.
Certain diseases of children are especially amenable to sonographic diagnosis,
such as intraventricular hemorrhage and pyloric stenosis. Likewise, the
pediatric radiologist enjoys special opportunities not only to diagnose but
also to treat disease. For example, intussusception represents a common
condition in which the radiologist can usually cure the patient through
imaging-guided reduction, sparing the patient the risks, costs, and morbidity
of general anesthesia and laparotomy.
Human Development
Another integrative feature is the focus of pediatric radiology on human
growth and development. Because hereditary, congenital, and developmental
disorders play a more prominent role in pediatric radiology than in other
imaging subspecialties, the pediatric radiologist is likely to have a strong
grasp of such foundational medical disciplines as genetics and embryology. The
pediatric radiologist can understand the human body plan from its ontogenic
roots. Understanding the embryologic blue print provides special insights into
normal structure and function, as well as into diseases. For example, by
virtue of daily contact with congenital heart disease, the pediatric
radiologist is likely to have a strong understanding of cardiac anatomy and
pathophysiology.
Behind this focus on growth and development lies a deeper philosophic
insight: to understand the condition, it is important to understand its
source. To understand a fundamental gastroenterologic condition such as
malrotation, it is helpful to understand how the gut normally rotates; to
understand skeletal dysplasias, it is helpful to understand normal bone growth
and development; to understand holoprosencephaly or spina bifida, it is
helpful to understand the embryology of the central nervous system. Among
diagnostic imagers, pediatric radiologists stand out for their understanding
of normal development and, by extension, abnormal development.
With this kind of understanding comes the opportunity to cultivate a
special appreciation for the miracle of human life, in all its beauty and
complexity. The emergence of the human form in each infant and child invites
communing with something larger, to gaze in wonder as the eternal slowly
unfolds itself in space and time. Beholding this remarkable process on a daily
basis constitutes one of the most sublime prerogatives of the pediatric
radiologist. In addition, it opens up distinctive opportunities for radiology
research, focused on the unique afflictions of children. Contributing to
biomedical knowledge is especially rewarding when children stand to
benefit.
Congenial Environment
Another attractive feature of pediatric radiology is the fact that
pediatric wards and children's hospitals are among the nicest places to work
in the health care system. The physical plant is usually bright and cheerful,
and employees are generally upbeat. The physicians, nurses, and allied health
professionals involved in children's health care are among the most congenial
and pleasant. Moreover, they seem more likely than other health professionals
to truly value the contributions of radiologists and to develop good
consultative relationships. Even community spirit tends to be higher in
pediatric health centers, as reflected in high levels of charitable giving and
volunteer activity. Medical students and residents may tend to regard the
quality of work environment, collegial relationships, and community support as
relatively minor concerns. Yet over the course of decades, they can exert a
huge effect on professional commitment and satisfaction.
One major reason that children's hospitals are such pleasant places to work
is that the health professionals share an unusually strong commitment to the
patients in their care. Pediatrics is not attractive because of the money or
prestige, but because of a special calling to serve the health of children.
The touch of a tiny baby's hand and the expression of trust in a parent's
smile mean something special to these professionals. Commitment to the care of
sick children is an especially philanthropic calling, manifesting a special
degree of generosity and compassion. The opportunity to behold such good works
is like having good seats every day at a symphony of human excellence. We
encounter some truly exceptional people in this line of work, who fill our
hearts with joy, hope, and admiration.
Great Colleagues
Like other radiology subspecialties, pediatric radiology is made up of many
exceptional individuals whose mutual dedication to children's imaging nurtures
lifelong collaborations and friendships. The annual meetings of the Society
for Pediatric Radiology and the European Society of Pediatric Radiology are
characterized by an unusually high level of camaraderie, which extends across
national boundaries. This strong fellowship is grounded not only in a shared
commitment to children but also in the rich traditions and history of
pediatric radiology. The tone of excellence for pediatric radiology, one of
the first areas to become a distinct subspecialty society, was set by such
giants as John Caffey, Edward Neuhauser, and Frederic Silverman, among
numerous others.
In my own institution, this spirit of dedication is embodied by Dr. Eugene
Klatte, a founding member of the Society for Pediatric Radiology in 1958; a
long-time chairman of the departments of radiology at Vanderbilt and Indiana
Universities; and recipient of the Gold Medals of the Radiological Society of
North America, the American Roentgen Ray Society, and the Association of
University Radiologists. Despite a rich family life and a career of radiology
achievement that would provide accolades enough for a number of academic
radiologists, Dr. Klatte continues to work full-time as a pediatric
radiologist at James Whitcomb Riley Hospital for Children, providing a living
testament to what this field means to its best practitioners.
Human Excellence
The practice of pediatric radiology draws on and refines a number of human
excellences. Dealing with sick children requires compassion, generosity, and
unselfish concern for the welfare of patient and family. Yet caring for
children is anything but a purely selfless activity. The great pediatric
radiologists know that caring for children is profoundly good for the soul. It
reminds us that our lives have purposes that extend far beyond the price of
our possessions. It reminds us that nothing lives for itself alone. It reminds
us of the fragility of life and helps us to appreciate the preciousness of
each moment. It reminds us that we are but parts of a larger whole and helps
us see the nature of that larger whole more clearly. It brings out the best of
the compassion, understanding, and courage we have in us. In short, it
provides us ample opportunity to become better human beings.
In summary, pediatric radiology represents a vital radiology subspecialty.
It offers a challenging and rewarding career that directly serves the health
care needs of infants, children, and adolescents. There is great demand for
fellowship-trained pediatric radiologists, both now and for the foreseeable
future. This manpower shortage will persist for at least the next few years
because of the growing demand and the small number of trainees currently in
the training pipeline. All radiologists, particularly those in academic
centers, must help meet this need. However, we should not encourage residents
to enter the field on the basis of current labor conditions, but on the
intrinsic strengths of pediatric radiology. We need to do a better job,
especially in the area of articulating these strengths.
References
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Blake W. Auguries of Innocence. In: Selected
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1996: 173
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Slovis Tl. New horizons in pediatric radiology.
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Friedenberg RM. The future of pediatric radiology.
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Goske MJ, Lebowitz RL, Lieber M, et al. Pediatric radiologists: Who
are we and what do we do? Pediatr Radiol
2000;30:581
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Introduction
The Care of Children
