Introduction

Pediatric radiology is the application of diagnostic radiology to the understanding, prevention, diagnosis, treatment, and follow-up of diseases of infants and children. The history of pediatric radiology is based on the emergence of pediatrics and radiology as medical specialties, the growth of these two parent specialties, their fusion into pediatric radiology, and the explosive growth of pediatric radiology as a subspecialty of diagnostic imaging. It must be emphasized that pediatric radiology is a unique subspecialty of diagnostic radiology with specific knowledge and expertise required. The child and its parents need special care, examination methods must be adapted to the pediatric patient, and radiologic findings as well as disease entities are frequently different in infants and children from adults.

In the past, radiologists have simply attempted to improve the accuracy of various imaging techniques. They have only been interested in the ability of a specific diagnostic modality to detect patients with disease (sensitivity) and to exclude patients without disease (specificity). However, the many imaging modalities as well as increasingly limited medical resources available require problem-oriented decisions to determine which techniques should be used or omitted in any given clinical situation. Radiation exposure, delay in diagnosis and therapy, and costs must be minimized. We must be aware of what we are doing to the pediatric patient (risk) as well as what we are doing for the child (benefit). The radiologic procedure must be tailored to the specific clinical problem; this problem-oriented approach is based on history, physical examination, laboratory data, clinical diagnostic considerations, and potential yield of various imaging techniques. Throughout this chapter, we will point out our approach to problem-oriented pediatric radiology.

The purpose of this chapter is to provide an overview of imaging of the respiratory system, cardiovascular system, gastrointestinal tract, and genitourinary tract of infants and children. The constraints of an overview prevent detailed discussion of radiological and imaging techniques. Pediatric neuroimaging and imaging of the musculoskeletal system of children are discussed in other chapters.

Donald R. Kirks and Sven Laurin