Interventional Radiology… for Kids! – PediaCast 494
- Dr Leah Braswell visits the studio as we consider pediatric interventional radiology. Discover the ins and outs of this fascinating field where imaging, medicine and surgery collide. Also covered: prevention and treatment of mosquito bites. We hope you can join us!
- Interventional Radiology
- Mosquito Bites
- Interventional Radiology at Nationwide Children’s Hospital
- Society for Pediatric Interventional Radiology
- RadiologyInfo.org – Professions in Interventional Radiology
- Choosing an Insect Repellent for Your Child
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from Nationwide Children's Hospital. We're in Columbus, Ohio.
It's Episode 494 for June 30th, 2021. We're calling this one "Interventional Radiology… For Kids!". We have another interesting and hopefully fantastic episode of PediaCast for you this week, as we explore the field of pediatric interventional radiology.
And this is a topic particularly interesting for me, as both a general pediatrician and as an emergency and urgent care pediatrician, because I've personally seen this field of medicine benefit kids and families in remarkable ways. And I'm eager to explore and perhaps share my enthusiasm for this field of medicine with all of you.
We're going to explore interventional radiology with Dr. Leah Braswell. She is an interventional radiologist at Nationwide Children's Hospital. And interventional radiologist, in my opinion, are real cool people. They're radiologist, yes, so they use technology and they look at images. But they also have to know the ins and outs of many medical conditions and possess the skills of a surgeon. So interventional radiology kind of lives at the crossroads where radiology and medicine and surgery all intersect with one another.
So, it's an uber cool field and one that is growing in popularity among medical learners who are making career decisions and among practicing physicians who use their services, and among patients and families who benefit from the skill and expertise of interventional radiologists. Much more to come once we get Dr. Leah Braswell connected to the studio.
Before we get to her, it is summer. And as we spend time outdoors, especially in the early evening after the heat and humidity of the day have faded away, that's the time we are most likely to encounter mosquitoes. Now, it turns out mosquito serve a purpose in the grand scheme of earth's ecosystem. Some species serve as pollinators of plants and others are a significant food source for fish, birds, bats, and frogs.
They're less loved by us humans. Their bites leave itchy sores, contribute to skin infections, and sometimes even spread disease among us.
And since we're smack dubbed in the middle of mosquito season, I thought this would be a good opportunity to remind you how to prevent and treat the bites of these pesky insects. First, it's important to note, well, I guess it's not really important to note this, but it's of interest to note, how's that, that only female mosquitoes bite, okay? The boys don't bite. So not every mosquito that you see is going to bite you, only the females.
They do eat because they need a blood meal to produce their eggs. And they may bite 20 times before they find a small blood vessel. And then, they typically sip blood for about 90 seconds. So not every mosquito is going to bite you, the ones that do bite you may bite you a bunch of times as they try to find a little blood vessel to get blood from.
Then they're going to sit there for quite a while. So, if you slap it, that seems mean, because now, I'm talking about killing a mosquito, but these things must be said. So, if you slap it, well of course, it's going to die and not be able to use that blood. So, you've kind of halted its life cycle, I guess.
But it's going to sit for about 90 seconds to get enough blood, to dig around, find the blood vessel, get enough blood to produce those eggs and hopefully get off of your skin in time before you kill the insect.
Regardless of whether they get a blood meal or not, anytime that a mosquito bites you, mosquito secretions enter your skin where it bit you. And then, you're going to have an immune response which that actually what results in that itchy bump. And some folks are more allergic to mosquito bites than others. So, the mosquito can bite you and you hardly ever knew it was there, and you don't get a bump at all.
And then other folks get an itchy bump. The surrounding skin can become red and swollen. And it can be pretty itchy. And that allergic reaction can last a few days. Really, whether you have an allergic reaction to mosquito bites or not really depends more on you as an individual and your immune system.
So, what do you do when you get a mosquito bite? And by the way, it is important to treat these and watch them because surface bacteria can get into the mosquito bite and actually cause a bacterial infection. So that's one complication of mosquito bite.
Also, if you're really scratching and itching a lot, your fingernails can scratch the skin more and that can also introduce bacteria into the skin. So, you can get bacterial skin infections after the mosquito bite, kind of as a complication. But if you treat it and are careful not to scratch too much and watch for infection, then things will go better for you.
So how do you treat mosquito bites? The big thing is to control the itch, because again, you really don't want to scratch it up and introduce bacteria.
So how do you control the itchy mosquito bites? One is cool compress that can serve as ice pack, not ice directly on the skin, but through a washcloth or an ice pack. That coolness can help with the itch.
Also, there's some medication you can use. For example, 1% hydrocortisone cream that you can get over the counter, using that topically. So, on the skin can help control the itchy mosquito bites.
And then, also cetirizine, also as known as Zyrtec, that's the brand name. There's plenty of generic ones out there, that can also help control the itch. That's the medicine by mouth.
And of course, for recommendations for your child and exact dosing and all that, you do want to talk to your pediatrician or other pediatric provider to figure out exactly what medicines to use and what dose when those mosquito bites are particularly itchy.
Really, better than treating mosquito bites is to prevent them in the first place. And the best way to do that is to avoid exposure to mosquitos. Remember, they're going to be in wooded areas and near standing water. They're going to mostly be out in the early evening time.
There are things you can also do to prevent exposure from a chemical standpoint. There are yard treatments that some folks provide that service where they come, and they fog your trees and such. There are also patio products that you can use like citronella candles. There's also allethrin products which you have a little flame in, and it heats it. There's a little pad on top and that releases a material that can prevent the mosquitos from finding you and coming around.
So, there are ways to avoid exposure. Also, you can wear long sleeves and long pants so that the mosquitoes do not have access to your skin. And then, there's insect repellents. You want to use one with DEET, up to 30% for kids. You don't want to use more than that when you're using insect repellant with DEET.
By the way, the higher percentage insect repellant is not stronger, they just last longer. So, the higher percentage that you use, the longer that's going to last. So, if you're just out for an hour, you can use a low percentage one.
If you're going to be hiking in the woods for a long time, you're going to want to use a higher percentage one. And then wash that off when you go inside. Wash with soap and water. It'd be a nice time to take a shower if you had used an insect repellant.
And then there's also creams with the same kind of medicine that you can use. It's not DEET. There's one with permethrin that you can use on clothes and gear, if you're camping in an area that's going to have a lot of insects and mosquitoes around.
For more information on insect repellents, there's an article from healthychildren.org from the American Academy of Pediatrics called Choosing an Insect Repellant for Your Child. And I'll put a link to that in the show notes so you can learn more about insect repellents and what your choices are and when to use those.
I mentioned skin infections as a complication. Those can actually progress from a really mild skin infection to cellulitis which is deeper and an abscess which then collects pus in it.
So, if you do have a mosquito bite that's getting more red, more swollen, more tender, there's any drainage, any fever, definitely you want to see your pediatric provider for that.
And then, diseases spread by mosquitoes to humans are actually pretty rare in the United States of America. But some of those are malaria, West Nile virus, and there is some viral encephalitis, so viruses then that cause brain inflammation that you can get. So, there are risks of more illness than just the skin reaction from mosquitoes. But the good news is that those are pretty rare in the United States.
So, there you have it, everything you need to know about mosquitoes and the prevention and treatment of their little bites which sometimes grow quite large and can be very irritating.
Let's move on with our usual quick reminders. Don't forget, you can find PediaCast wherever podcasts are found. We are in the Apple and Google Podcast apps, also iHeartRadio, Spotify, SoundCloud, Amazon Music and most other podcast apps for iOS and Android. If you like what you hear, please remember to subscribe to our show so you don't miss an episode.
Also, please do consider leaving a review wherever you listen to podcasts, so that others who come along looking for evidence-based child health and parenting information will know what to expect.
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We also have that Contact link over at pediacast.org if you would like to leave a suggestion or a comment regarding the program.
Also, I want to remind you, this information is presented for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your healthcare provider.
So, let's take a quick break. We'll get Dr. Leah Braswell connected to the studio. And then, we will be back to talk about interventional radiology. It's coming up right after this.
Dr. Mike Patrick: Dr. Leah Braswell is a pediatric interventional radiologist at Nationwide Children's Hospital and an assistant professor of Radiology at the Ohio State University College of Medicine. Interventional radiology is a field of medicine that uses images such as X-rays and ultrasound to guide needles and catheters in an effort to diagnose and treat a wide variety of medical conditions in a manner that is less invasive than many traditional surgical options.
It's a rapidly growing in popular and interesting field in adult and pediatric medicine. That's what she's here to talk about today, interventional radiology for kids.
So, let's give a warm PediaCast welcome to Dr. Leah Braswell. Thank you so much for joining us on the podcast.
Dr. Leah Braswell: Thank you for having me. I'm really excited to have a chat.
Dr. Mike Patrick: Yeah, really appreciate you taking time out of your busy schedule to spend a few minutes with us. So, I gave a little teaser about interventional radiology. Tell us more about this field of medicine.
Dr. Leah Braswell: I really like your description. Those of us in pediatric IR for sure, we have to sort of explain ourselves sometimes. I think one good way to think of what we do is that we're minimally invasive surgeons. We do a really really wide variety of procedures. And what's in common with all of those is that we're using images to show that we're in the right place at the right time and they'll help us make decisions.
And that's X-ray, like you said. It's ultrasound sometimes. It's CT scans sometimes. All the things we do are image guided.
Dr. Mike Patrick: Great. And the other type of radiology that folks hear about is diagnostic radiology. How does that differ from interventional radiology?
Dr. Leah Braswell: There are a lot of overlap. All of us who are interventional radiologists are also radiologists. So, we interpret images that babies and kids get in all forms which is X-rays, ultrasounds, MRIs. So, we have extra training, we do the background and diagnostic and imaging, where we're looking at the images and interpreting those. But we do get extra training on top of that about how to perform our procedures.
Dr. Mike Patrick: So, in interventional radiology, you actually spend more time with the patient and the families than necessarily in diagnostic radiology, right?
Dr. Leah Braswell: We do. it’s a good field for people who liked the imaging but can't imagine the thought of interpreting images in a dark room with a screen all day for the rest of their careers. So, it's a good mixture of both of those sets of skills for those of us who choose it, yeah.
Dr. Mike Patrick: How did this get started? So, when you think of the traditional radiologist, it is sitting in that dark room looking at the films, calling the doctors who ordered the films and discussing results. How did radiologists then get started doing procedures?
Dr. Leah Braswell: There are some interesting history, really, in 1950s and 60s. And a lot of the skills that were developed were developed about the same time that angiography was coming on board in cardiology. So, the first image-guided procedures were X-ray guided catheters that is just if you have heard someone getting a catheter angiogram in the cath lab for cardiology. And it really grew from there.
So, some radiologists were helping the cardiologists and vice versa. And they discovered that they could get to pretty much any blood vessel in the body through artery access and it grew from there.
So, it's been a new field. It didn't happen in kids until probably the early 80s. So, we still think of it as a new field of medicine.
Dr. Mike Patrick: There's a lot of excitement I feel in interventional radiology amongst some medical students. So, when I interact with medical students and engage with them, it seems like there's more people mentioned it. There's more awareness about it as a field. So that's pretty exciting too.
Dr. Leah Braswell: It's really popular. I think one or two years ago, it was the most competitive specialty in the specialty match for medical students choosing a profession. So that's been a big change in our field as they've actually developed their own training program for interventional radiology. So, it's combined. You become an interventional radiologist and a diagnostic radiologist in the same training program. It's been really popular over the past few years.
Dr. Mike Patrick: So just so our listeners are aware, there may be someone out there after they listened to this podcast. They get really excited about the field and share it with their teens or maybe some teenagers hear it. Kind of walk us through how you become a pediatric interventional radiology, starting with high school graduation. Where do you go from there?
Dr. Leah Braswell: It's so many words, which means, it's so many years to get from point A to point B. So, you finish high school. You enter college and you need a college degree before you go to medical school. So that's typically four years to go to college here in the States. Then, you go to medical school for another four years.
And then you choose your specialty. So, some pediatricians that you're most familiar with, they choose a specialty. They go to become a pediatrician. It takes about three years.
And we choose to become a radiologist and that takes anywhere from five to six years. And then, you can get even more subspecialized like I did, which means that I was really a glutton for punishment and wanted more training years, the better. So, I have extra training in pediatric procedures on tops of that.
Dr. Mike Patrick: So, it's many years, a minimum of 11. If you want to be a pediatric interventional radiologist, we're probably talking more, 15 years of so after high school?
Dr. Leah Braswell: It's a really long time. I was in my 30s before I had my first real job, so it's a commitment.
Dr. Mike Patrick: But after medical school, you do start making some money as a resident.
Dr. Leah Braswell: Right.
Dr. Mike Patrick: So not like forever that you're truly a student, you're kind of working and training and learning as you go.
Dr. Leah Braswell: Yeah.
Dr. Mike Patrick: And then, the benefits of this field, of course, are many for kids and families. Just kind of walk us through why interventional radiology is a good alternative to some traditional surgical procedures.
Dr. Leah Braswell: Yeah, I think that, basically, everything we do have a surgical alternative or a surgical history. And so, it's almost always something that a parent can understand that I'm not creating any incisions. So, a surgeon is typically opening the body, creating incisions and having actually a hands-on approach.
All of our procedures happen through a pinhole. So, if I'm inserting a needle or inserting a drain, I can do that through a small hole in the skin, and 99% of the time, that means a much shorter recovery, fewer scars, a lot less pain afterwards. And the level of complexity varies for our procedures but in general, we're replacing and really pushing the boundaries for what can be the most minimally invasive.
Dr. Mike Patrick: So really a good deal and an alternative and is very helpful for kids and families. Of course, then, there's other times when traditional surgery is the better route to go even when it possibly could be done by interventional radiology. And so, on a case-by-case, kid-by-kid, family-by-family basis, you really come together and make that decision with the family, right?
Dr. Leah Braswell: Absolutely. That's one of the things that we like, but I should speak for myself, that I enjoy about my practice, is that I work closely with surgeons, I work closely with families. So, if you're a candidate for my procedure, you and your parents or your caregivers come to my clinic and we talk. So, we discuss whether it's a good option for you.
We look at your X-rays together. We discuss what the surgeons would recommend and what I can recommend. We make those decisions together. We spent a lot of valuable time.
So those relationships are important to me. And it's one of the reasons that I really enjoy interventional practice, instead of, like you were saying, instead of only reading films. It gets me a lot of family interaction time.
Dr. Mike Patrick: Yeah, really terrific, especially for not getting burned out. I would imagine that, like any of us, when you do the exact same thing over and over and over again, after about ten years, you're really tired of it. So, it really does give you a lot of variety in terms of practice and engaging folks.
Let's talk about the imaging procedures themselves and then we'll get to a little bit more about the actual interventional part of it. So just the technology, walk us through the different forms of imaging that you guys use. I think a good place to start would be just plain X-rays. How do those work? Kind of demystify the X-ray machine for us.
Dr. Leah Braswell: Yeah, so we have special rooms in the hospital dedicated to interventional radiology. We have three of those rooms. And when you walk into one, it looks a lot like an operating room. We can make it sterile. We can close the door and their equipment, and some ways looks like an operating room.
We also have machines in that room that are X-ray or fluoroscopy machines. And they move around the room and move around the patient to get in the exact right spot. And with a pedal that I use with my foot, I can turn that machine on and off again. And it provides a real time movie picture of what we're seeing inside the patient's body.
We calibrate those really carefully so that the X-ray does as well. We are a pediatric hospital. We're always thinking about dose reduction and keeping our patients safe over time. So even though we're using X-ray energy and radiation, it's in tiny doses that are safe for babies.
But I can actually watch as my needle goes into a blood vessel or goes into a bone that needs to be sampled or anywhere, actually watch that on the screen. And so, there are a lot of hand-eye coordination in real time.
We talk a lot about how the next generation is going to be better than we are because they grew up playing video games and having a lot of simulated techie-type experience. It's exciting to see those skills evolve in people at large.
Dr. Mike Patrick: When you're talking about those, the X-ray machines, whether it's a picture in time like a plain X-ray or whether it's a moving picture because it's a continuous stream of that, like with the fluoroscopy. In either case, it's a radiation that is going through the body and some of it goes through easier and some of it gets stopped like by bones.
And so, on the other end, where you have kind of a plate or a receiver, it depends on how much of that radiation gets through with regard to whether it's white or whether it's black or some great picture in between, right?
Dr. Leah Braswell: Exactly, and there's a lot of physics in how those images are generated. There's just a lot of science that goes into that. You explained it really well.
And it's all based on technology that was discovered in the 1870s. And we're still using it to this day, that the X-rays are hugely powerful tool. And based on different densities of body tissues and that's why you see broken bones on X-rays, all of that is based on the density of those tissues and how they transmit the rays from one generator, where they're created, to the receiver that you're talking about.
Dr. Mike Patrick: When you say low doses in pediatrics and that these things are safe, we also know radiation is involved with turning regular cells into cancer cells. And in fact, I think it was like a long time ago, if memory serves me, when a shoe store had boxes that you could put your shoes in and see what your bones look like. And then they started to notice that there was an increase in cancer rates of skin and bone because those are pretty high doses of radiation.
But kind of address the importance of this low-dose radiation in terms of how safe that is.
Dr. Leah Braswell: Yeah, we're using… Compared to those types of units that weren't calibrated and weren't monitored back in the mid-20th century, we're probably using in the order of a thousand of that doses. So, we go as low as we can and still have the benefit of a diagnostic quality image. So, we go just to that threshold of it's good enough for us to see and to make a good diagnosis and good treatment planning. But we don't give any more X-rays than we need to.
And the machines actually are making those decisions real time. They're giving as low as possible based on how many protons of X-ray energy are coming through. They turn it down and they keep it down low for our patients. Because our patients are going to live a long time. It takes a generation or so to accumulate enough radiation to cause a radiation-induced cancer. And we want to keep that remarkably low for our patients.
So, I feel comfortable with any family coming to ask that question. I feel really comfortable saying your risk is tiny. And you're getting more background radiation sometimes even walking outside or riding in an airplane.
And that's a really comforting thing for people to hear and understand, is that we're mindful. It's on our brains. We trust our physicists. They're calibrated, they're monitored, they're inspected every year. Because it's a really good question and we want to make sure that we stay on top of that.
Dr. Mike Patrick: I love that you put it's you get exposed radiation in an airplane ride. And so, when you look at risk versus benefit, the benefit of getting somewhere quickly is often greater than the risk of something bad happening in an airplane, including radiation exposure. And just that in that same way, these procedures, the benefit of them likely outweighs the risk for the majority of kids.
One alternative that does not involve radiation is ultrasound. Tell us about that mechanism and how ultrasound works in interventional radiology.
Dr. Leah Braswell: Ultrasound's really really cool because we're not using radiation. And again, it's that hand-eye coordination. So, I'm right-handed. I can be holding an ultrasound probe, the transducer that the technologists are using. I can use that on different body parts, looking at a patient's liver or patient's joint. And I can actually watch on my screen when I'm using my right hand to place a biopsy device within that same organ.
Or I'm injecting medication into a tumor, I can watch on the ultrasound screen as it's happening, just like we talked about with X-ray. Ultrasound gives us so much detail and that internal structures, the internal organs we can see as we're injecting that medication. And it all happens real time up close and personal.
And then, the benefit is no X-rays at all. No X-rays at all. So, we use it probably even more often than X-ray on a day-to-day basis. It depends. It varies, but we use it all day every day.
Dr. Mike Patrick: And so, this is a little different in that it uses sound waves instead of radiation. And instead of the sound waves passing through something to a receiver, they bounce off of things and just go back to the same unit that sent the soundwave, right?
Dr. Leah Braswell: Exactly. And that's also known to be safe. So, it's the exact same technology that ultrasound is useful when a woman is pregnant, and the structures are evaluated on the inside of a pregnancy. That's sometimes the most familiar example to families because they've had an ultrasound for that purpose. But it's all done inside that probe that's sending out, transmitting soundwaves, and receiving them as well. And the computer interprets it to put it on the screen for us.
Dr. Mike Patrick: And then, just how well those bounce back gives the difference of what the image looks like, whether it's dark or light or something in between.
Dr. Leah Braswell: And if you do want to be radiologist, you have to study physics and you have to know how all those computers make those images. It's really fascinating and there's no way we could do what we do without those technologies on the backend.
Dr. Mike Patrick: You also mentioned CT scans or CAT scans, and since we have a radiologist here with us and these are terms that people hear often, CAT scans, MRIs, what are those and how do they differ from the imaging techniques that we have already discussed?
Dr. Leah Braswell: So, CT scan, that stands for computer tomography. It's basically an X-ray machine on steroids. So, it's using the exact same X-ray physics that we've already talked about, sending X-ray photons through a structure through the human body. But it's creating a more three-dimensional image, so instead of one image to look at, you are taking slices through the body that you can even create 3D images of.
So, it's like going from black and white to color in a sense, to go from X-ray to CT scan. You're adding a lot more spatial information about the inside structures of the body.
Sometimes, we need that to get in really precise locations. If I need to place a needle in a small area and I need to work my way around the spine or around the blood vessel and make sure that I'm in the right place, I use CT scan to show that we're in the right place for treatment.
Dr. Mike Patrick: And then how is that different from an MRI?
Dr. Leah Braswell: MRI is actually its own category. So, it's ultrasound, it's not X-ray. It’s actually magnet generated images. And I have passed my physics boards and I'm completely qualified to read MRI images. But I'll tell you that it is pretty complicated to try to explain how the magnet generates those images.
It actually listens. The machine listens. It makes a lot of noise in that machine. You go inside a tube type scanner. But the magnet actually spins the protons in a way and listens to how they spin in order to get detailed that can be turned into an image so that you can see precise locations in the human body.
Dr. Mike Patrick: Really amazing technology, but somewhat difficult for kids, right? Because the MRI procedure takes a lot longer than a CAT scan. And it's noisy and it's a dark tube. And you won't be able to see moms standing there with you. And so, this provides more challenges in pediatric radiology compared to the adult world, right?
Dr. Leah Braswell: Definitely, and even me as an adult, I think it would be pretty intimidating. It can make you feel claustrophobic to be inside that tubes. So, we do work closely with our anesthesia colleagues.
Some patients need some sedation medicine or some anxiety medicine. And little kids even need anesthesia in order to do that procedure safely and in the shortest amount of time possible.
Dr. Mike Patrick: So let's move on to actually some of the conditions that you treat through interventional radiology or diagnostic procedures that you do that go beyond just looking at the images, but actually physically doing something in the body using those images. What are some of the conditions that you treat?
Dr. Leah Braswell: This is a really broad topic. And we can run through a few examples. It's true, in a given day, I can actually do procedures anywhere on different patients from head to toe. So, and even within pediatric interventional radiology, some of us have specialty areas that we work and provide more common care for certain conditions.
So, one of those that's a good example is we treat different types of bone tumors that can arise. One in particular that I'm interested in is called an aneurysmal bone cyst. And it's where a bone, for whatever reason, develops a lesion on the inside of it, and instead of hard firm bone, that bone becomes weakened and the inside turns into like a cystic space, more of a cyst. And the bone outside is almost like an eggshell. And it can crack. It can fracture easily.
So, a procedure that we can provide as an alternative to surgery. Typically, those were treated with a surgical removal that was fairly invasive. And some still need that but one alternative we provide is injecting medications through bone needles. And so, using the X-ray machine, we can show the X-ray where the bone cysts are. We see that on the screen.
We can inject needles into that and target that placement. So that it's right where we need to be and avoiding all the nearby structures and inject medications to help heal those from the inside. We can actually cure those for patients who never need a surgery. We say it's a minimally invasive procedure. And when it works well, after a series of treatments, it's almost as if it never existed.
So that's a huge one for us. That's an area of particular interest of mine. But there are more common procedures. There are everyday procedures for patients in the hospital who needs specialized IV lines and intravenous catheters. And some of those, you may have heard of PICC lines or ports. All of those in our hospital are placed most of those in interventional radiology using a combination of X-ray and ultrasound. So, some of ours are everyday common procedures, too.
Dr. Mike Patrick: Yeah, in my work in the emergency department and our urgent care centers, either some instances when we refer folks to interventional radiology. For instance, skin foreign bodies. You may have a piece of glass or something that's lodged in the skin and the wound is already closed up around it, and so you'd really be digging and fishing around to try to find it. You guys are able to get those out a lot easier with the imaging.
Dr. Leah Braswell: Yeah, kids get splinters, right? It's very common. They step on glass. They step on sewing needles or they get splinters in their fingers. Those are common procedures.
They are really rewarding for us because we can see them on ultrasound. And if you can see it, you can almost always get to it and grab it with small little tools. And when you can pull something out, it's been causing patient's pain for several days. That's actually really, really rewarding. So common things are common. Those are fun to do.
Dr. Mike Patrick: And we also send folks over if you need a joint tap. So, if you have some fluid in the joint, whether it's been an injury or there's inflammation. And we want to see if there's an active infection in that joint, that's something else that's easier to do through interventional radiology.
Dr. Leah Braswell: Yeah, it's almost like cheating because we can see it on the screen, and you don't have to guess. You know exactly where that fluid is. You can watch as you're sampling it and you can see it reduced in real time and go away. And that really helps you guys decide if patients need another procedure and antibiotics or hospital admission. We really help assist the doctors in finding the answers more quickly.
Dr. Mike Patrick: And spinal taps, sometimes they can be difficult. Sometimes they're easy to do without imaging and sometimes they're very difficult. But again, you guys cheat.
Dr. Leah Braswell: That's another really good common day-to-day example for us. So, if patients have had spine surgery or they have difficult anatomy for scoliosis or whatever reason, we can help by watching on X-ray to show that we're in the right place.
And it's fun because as the procedure get more complex and the skill set becomes a little more specialized and specific, there are other procedures that we did that are more complicated and, in some instances, life changing. If a patient is bleeding from an artery after a car accident or some other kinds of trauma, sometimes, we're the first stop. We're a better alternative than surgeons.
And if I can find that artery and go in through a catheter, thread that catheter teeny tiny down to the branch muscle and make it in exactly the right spot, we can plug that up sometimes and save a life. Those are not every day but they're super rewarding with skills that we use every day to help change a kid's life.
Dr. Mike Patrick: Absolutely. You also mentioned biopsies. So, if there is a tumor and we're not quite sure what it is and we need a sample of it, that's another instance where interventional radiology can be used.
Dr. Leah Braswell: Absolutely. And that's we work closer with the surgeons to decide who's an appropriate candidate for that. The pathologists are often in the room to say that yes, these are good samples and they begin their microscope study. Sometimes, even in the room to get kids a quick diagnosis so that their treatment can begin with the oncology doctors.
Dr. Mike Patrick: Yeah, really incredible work and things that you guys do. We know when we talk about benefits, we also want to consider risks. We talk about radiation as a risk. What other risks are involved with interventional radiology?
Dr. Leah Braswell: I tell families that anytime a doctor comes near you with a needle or equipment, that there's always a risk of bleeding. There's bruising at the site that we're entering. Always a risk of infection. We do a lot of our procedures with full sterile techniques. Or if it looks like the patient is an operating room and undergoing an operation, so we're very careful about those.
We have to know. And we tend to be anatomy specialists because we know on the scans where every nerve and artery and muscle is in the organ that we're working on. So, injury to any of those nearby structures can happen. If I'm placing a drain near the appendix, that means that I'm near bowel loops. And that means that those could potentially be injured because I'm working nearby. So, we always talk about risk to nearby structures, in addition to those more basic risk of bruising or infection at the site.
Dr. Mike Patrick: You'd mention sedation when we talked about MRI. Are there other instances in your work when you do have to use sedation? And talk about the risks and benefits there.
Dr. Leah Braswell: Sure, sure. It's case-by-case basis. It's very individual but most little kids and babies can understand that a procedure is happening, and they need to stay still in order to stay safe. So, compared to an adult practice or an adult interventional radiology practice, our kids need more sedation in general. So, what an adult might tolerate awake, a child needs medication to do safely.
Many of our procedures are done with general anesthesia. And we work closely with anesthesiologists day in and day out, and so they're a part of our team. And we're a part of their team. And then, it's important that families know that anesthesia has risks, too. So if you're an adolescent and you might be able to do a minimally invasive procedure awake, a lot of our conversation in clinic ahead of time is educating the family about what to expect and what to be aware of that might happen during a procedure.
So, along those lines, we work really closely with Child Life who can be in a room for some of our awake or mildly sedated procedures. So, every case is different, but we have the full range of options to keep kids safe.
Dr. Mike Patrick: And I think it's such an important thing to walk families through risks and benefits. And certainly, you're going to do everything that you can to minimize the risks that are there. You can't eliminate them 100%. But the benefits of what we're doing, we want to make sure that that outweighs any risk that are there. And since these are important procedures and you're able to do it in a less invasive ways that saves time and saves money, is more comfortable for patients, especially afterward in terms of their healing and such, those benefits really do outweigh most of the risks that would be involved.
Dr. Leah Braswell: And I tell families pretty often. My team might think of it as a broken record. It's such a privilege to be involved in the care of your child. We know that you're trusting us, and we appreciate that and it's every single day a privilege.
Dr. Mike Patrick: So then, how can doctors and families connect with your services in interventional radiology at Nationwide Children's Hospital?
Dr. Leah Braswell: So, if you ever need us, we're 24/7 through the main Radiology number which the operator can send you right over. So, we do have a website active on the NCH website. But anytime you need us, the operators can get you in touch with interventional radiology. And all of us are, of course, available on email or personal conversation on cases that you might have questions about.
Dr. Mike Patrick: Absolutely. And we'll put a link to the website, Interventional Radiology at Nationwide Children's Hospital, so both families and pediatricians and other pediatric providers can look that up and find out and read more about what you guys do.
Couple other resources that I came across in searching for material on this, one is the Society for Pediatric Interventional Radiology. They actually have a pretty complex website with lots of information about this specialty. And then radiologyinfo.org does have a section on there about professions in interventional radiology.
So again, if your child is really technology oriented and also interested in medicine, this would be an interesting field for them to learn more information about. And we'll put those link in the show notes as well.
Dr. Leah Braswell: Excellent.
Dr. Mike Patrick: So, Dr. Leah Braswell with Interventional Radiology at Nationwide Children's Hospital. Once again, we really appreciate you stopping by and chatting with us today.
Dr. Leah Braswell: It's been a pleasure. Thank you so much for letting us talk a little bit more about my favorite field in medicine.
Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.
Also, thanks again to our guest this week, Dr. Leah Braswell, interventional radiologist at Nationwide Children's Hospital.
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