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Study day goes back to basics

21 August, 2012
Building blocks

In 1973, the Association of Paediatric Radiographers, then informally known as the Paediatric Radiographers Interest Group, began co-ordinating national study days for all radiographers to specifically raise standards in all aspects of children’s imaging.  The ‘Back to Basics’ study day held on 21 April brought the APR to a grand total of 70. Held in the Marriott Hotel Maida Vale, it proved extremely popular and was attended by 120 delegates from throughout the UK who enjoyed an informative and thought provoking day.

Faith Constantine, APR Chairperson, began the day with a welcome to all delegates, especially the 65 who have elected to become new members of the APR. Faith outlined the aims and recent work of the Association, which has been working with the SCoR to raise paediatric radiography standards and awareness through the formation of the Children’s Imaging Taskforce.

Jude Hardwick, APR committee member, chaired the morning session which began with ‘Paediatric CT’ from Dr Alistair Calder, Consultant Paediatric Radiologist at Great Ormond Street Hospital for Sick Children. Dr Calder presented an informative overview of how paediatric CT imaging differs from adults. Key areas included increased radiation sensitivity with longer life expectancy; lack of co-operation; significantly higher doses of IV contrast are required and children have radically different pathologies plus congenital abnormalities. These factors all combine to highlight the importance of dose reduction linked to choice of appropriate exposure factors, scan protocols and knowledge of paediatric disease processes. An entertaining talk which offered food for thought to all radiographers involved with children’s imaging, including those without direct CT experience.

The next topic was ‘Basic Bones!’, from Jenny McKinstry, Supt Radiographer Royal Belfast Hospital for Sick Children and APR Secretary. Jenny gave a comprehensive overview of how to approach imaging of the appendicular skeleton. Emphasis was made on the importance of the right approach to imaging distressed children and their often anxious parents. Preparation should encompass provision of child friendly surroundings; adapting techniques appropriate to age and severity of injury; knowledge of child skeletal development and mechanisms of injury. Jenny presented much practical and helpful information, including specific requests which may be inappropriate for children and an excellent mnemonic for Salter-Harris classification of growth plate injuries.

Coffee break was followed by ‘The Radiographer’s Responsibilities When Imaging Suspected Abuse’, presented by Kate Parkes, Clinical Systems Manager, Birmingham Children’s Hospital, APR advisory committee member. As Birmingham is one of the UK’s centres of expertise in the Radiological diagnosis of suspected Non Accidental Injury (NAI), Kate has much clinical experience and gave a detailed account of the many aspects of this difficult and sometimes harrowing topic. Points to remember included NAI skeletal survey is a forensic examination and images may be presented in legal court proceedings; images must be of the highest quality; parents/guardians must be fully informed prior to attending x-ray; radiographers have a duty of care to all children, therefore, must report any safeguarding concerns appropriately, should be experienced and follow an agreed protocol. Further documentation and links are available on the APR web page of the SCoR website.

The morning session ended with the APR Annual General Meeting and an excellent lunch, followed by a Foreign Body Quiz from Donna Dimond, Senior Lecturer in Diagnostic Imaging, University of the West of England.  There was also time to collect information regarding recommended text books and immobilisation aids; and view the Complications of Umbilical and Peripheral Neonatal Catheters poster from Judith Hobson and colleagues from the Royal Victoria Infirmary, Newcastle upon Tyne – many thanks to all concerned.

The afternoon session was chaired by Barrie Pilkington, APR Treasurer, and began with ‘Back to Basics - the paediatric chest x-ray’ from Michael Scriven, Supt Paediatric Radiographer, Southampton General Hospital. Children are treated here from birth to adolescence with premature babies weighing as little as 500grams at 23 weeks gestation presenting a wide range of medical and radiographic challenges. Michael stressed the need for a coordinated team approach between radiographers and clinical staff, as well as having standardised protocols. Particular attention must be paid to radiation protection, as these children have a whole lifetime in front of them. An essential requirement for a chest x-ray was that it was taken on full inspiration and without any rotation. With premature babies, the radiographer had to be able to complete the examination as quickly as possible to avoid distressing the baby.

The next presentation ‘The Limping Child’ was given by Ami Cook, final year radiography student, Sheffield Hallam University. While observing radiography of a young girl with the common limping child history, Amy became aware of the many issues around questioning young girls from 11 to 16 years of age regarding LMP and pregnancy status. She devised a questionnaire for staff and quickly discovered the implementation of the 10 and 28 day rules are many and varied for this age group. Main areas of concern centre around checking the pregnancy status of girls up to the age of consent; who, when, where and should parents be present. There are no specific guidelines to help answer these points and it proved to be an area of concern for all radiographers.

Following on was ‘Imaging Paediatrics – a guide to radiation protection’ from Faith Constantine, Lead Paediatric Radiographer, Derriford Hospital, Plymouth and APR Chairperson. Faith reminded us that radiographers’ responsibilities as a Practitioner and in Justification when adhering to IR(ME)R and ALARP principles are even more crucial when x-raying children. These include correct primary beam filtration, use of grids, collimation, age appropriate exposure charts and lead shielding. Correct paediatric settings for CR and DR equipment is essential, along with choice of fluoroscopy and mobile units.

The final topic of the day was ‘Child Psychology’, given by Jude Hardwick, APR committee member. Jude began with a child’s eye view of the hospital experience and how daunting this can be, especially in the very strange world of x-ray equipment. There followed an amazing photographic collection of devices which could have been dreamed up by Roald Dahl but were, until relatively recently, used to restrain unsuspecting children. Jude expanded upon the many factors which have an effect on how children behave during a range of different examinations carried out in the x-ray department. These included hospital/department environment, parental anxiety, understanding of medical terminology, confidence in the radiographer and knowledge of child development – a thought provoking presentation from the child’s perspective.

The day ended with a review of the Foreign Body quiz and prize giving – congratulations to the winner Jane Giles from the Queen Alexandra Hospital, Portsmouth.

Many thanks to all our speakers, Paula Smith, Birmingham Children’s Hospital, administration; Sandra Pilkington, reception/administration; and the hotel staff who all contributed to a very successful day. Final thanks go to all the delegates who participated and made the day so enjoyable.

The next APR study day will be held on 13 October at Royal Manchester Children’s Hospital. For further details please contact Christine.Salthouse@cmft.nhs.uk.

Liz Hunter
Membership Secretary APR

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