Pediatr Radiol (2014) 44:646–647 DOI 10.1007/s00247-014-2929-9
MINISYMPOSIUM
Sharing the caring: paediatric radiology in paediatric surgery outreach Padma Rao & Paddy Dewan
Received: 29 November 2013 / Accepted: 10 February 2014 # Springer-Verlag Berlin Heidelberg 2014
Kind Cuts for Kids, established in 1993, is an Australian-based, 100% volunteer, nongovernmental, not-for-profit international organisation focused on care and teaching related to paediatric surgical disease in developing countries. Similar organisations concentrate on the provision of surgery as a service; we focus on the development of the care through education, demonstration and skill enhancement of local health care professionals, including radiologists, radiographers and nuclear medicine specialists. Recognising that collaboration among health care personnel optimises the ability to achieve the goal of sustainability, we adopt a team approach to the care of children and it is important to acknowledge the differing requirements of the countries visited. Kind Cuts for Kids (Fig. 1) has assisted with improvement in surgical care for children in 18 countries in the last 21 years. We have been involved in the establishment of paediatric surgery in Papua New Guinea and Mauritius and the coming of age of paediatric urology in Cuba. In so doing we have come to understand the shortfall in both equipment and skills for pre-operative and post-operative radiologic investigations, but we recognise that enhanced clinical skills can fill some of the information collection gap. Through sharing the caring
P. Rao (*) Medical Imaging Department, University of Melbourne, Royal Children’s Hospital, Flemington Road, Victoria 3052, Australia e-mail: [email protected] P. Dewan Paediatric Surgeon and Urologist, Chair of Kind Cuts for Kids, Victoria, Australia
we optimise the value of a collaborative team approach to outreach and achieving sustainable health care. Different countries bring with them different experiences and challenges, depending on many factors including geographical constraints, population demographics and equipment and educational resources. A common challenge is a lack of radiologic equipment or use of equipment that is old and unreliable. Thus, an important part of the radiologic input for Kind Cuts for Kids involves reviewing current equipment and identifying equipment shortfalls and making recommendations to governments for equipment renewal and upgrades with a paediatric focus and with appropriate back-up services. In remote areas there may be very little or no provision of radiology services and thus the clinicians themselves are expected to perform and interpret their own radiographic, fluoroscopic and US studies. The participation of the visiting radiologist in ward rounds and case discussions with the clinical teams can be immensely valuable in reviewing the radiology and recommending investigations where needed (Fig. 2). Accessing portable US equipment and teaching clinicians how to perform and interpret their own sonograms can help address the equipment challenges in some environments. Sometimes there is no choice of equipment to use, but where possible choosing and using equipment with a paediatric focus, such as finessing paediatric sonograms by appropriate probe selection, is desired. However, radiology is not all about expensive equipment, and in some circumstances making use of natural resources, such as using a window as a light box, must suffice (Fig. 3). An important aspect of our program is identification and teaching of safe radiation practices. This includes, for example, ensuring that requests for radiology are appropriate,
Pediatr Radiol (2014) 44:646–647
647
Fig. 1 Kind Cuts for Kids logo
Fig. 2 Surgical rounds in Kosova involve case discussions and teaching by the radiologist with the surgical team
Fig. 3 The window of the theatre complex makes a more than adequate radiograph viewing box! Radiographs and fluoroscopy studies are taped to the window for viewing
reducing unnecessary exposures and fluoroscopic screening times, and teaching appropriate coning of areas to be radiographed. Some countries lack basic equipment such as lead aprons, which results in an unnecessarily high radiation dose exposure to the parent or caretaker holding the child for a radiograph or fluoroscopic study, or even sometimes to the staff performing the study. Kind Cuts for Kids welcomes equipment donations of new and used lead aprons. In many countries, paediatric radiology is not recognised as a separate subspecialty and, because of this, there is often suboptimal specialty training in the discipline. Thus, assisting the general radiologist in both the interpretation and diagnosis of conditions with a paediatric focus can be very valuable. In the same way, imparting both practical and theoretical knowledge to trainee radiologists is an important part of the information transfer process. This is often done on a caseby-case basis during one-on-one discussions. However on many of the trips, workshops or symposiums are organised whereby a variety of lectures, both radiologic and clinical, are delivered to audiences comprising a variety of specialty groups including radiologists, paediatricians, paediatric and general surgeons and specialist surgeons, doctors, nurses, physiotherapists and medical students. How can you get involved? Kind Cuts for Kids welcomes donations and participation in its fundraising activities and is keen to hear from those who wish to participate in current projects and those wishing to commence a project that would fit our mission statement. Further information can be found at www.kindcutsforkids.net. Conflicts of interest None
MINISYMPOSIUM
Sharing the caring: paediatric radiology in paediatric surgery outreach Padma Rao & Paddy Dewan
Received: 29 November 2013 / Accepted: 10 February 2014 # Springer-Verlag Berlin Heidelberg 2014
Kind Cuts for Kids, established in 1993, is an Australian-based, 100% volunteer, nongovernmental, not-for-profit international organisation focused on care and teaching related to paediatric surgical disease in developing countries. Similar organisations concentrate on the provision of surgery as a service; we focus on the development of the care through education, demonstration and skill enhancement of local health care professionals, including radiologists, radiographers and nuclear medicine specialists. Recognising that collaboration among health care personnel optimises the ability to achieve the goal of sustainability, we adopt a team approach to the care of children and it is important to acknowledge the differing requirements of the countries visited. Kind Cuts for Kids (Fig. 1) has assisted with improvement in surgical care for children in 18 countries in the last 21 years. We have been involved in the establishment of paediatric surgery in Papua New Guinea and Mauritius and the coming of age of paediatric urology in Cuba. In so doing we have come to understand the shortfall in both equipment and skills for pre-operative and post-operative radiologic investigations, but we recognise that enhanced clinical skills can fill some of the information collection gap. Through sharing the caring
P. Rao (*) Medical Imaging Department, University of Melbourne, Royal Children’s Hospital, Flemington Road, Victoria 3052, Australia e-mail: [email protected] P. Dewan Paediatric Surgeon and Urologist, Chair of Kind Cuts for Kids, Victoria, Australia
we optimise the value of a collaborative team approach to outreach and achieving sustainable health care. Different countries bring with them different experiences and challenges, depending on many factors including geographical constraints, population demographics and equipment and educational resources. A common challenge is a lack of radiologic equipment or use of equipment that is old and unreliable. Thus, an important part of the radiologic input for Kind Cuts for Kids involves reviewing current equipment and identifying equipment shortfalls and making recommendations to governments for equipment renewal and upgrades with a paediatric focus and with appropriate back-up services. In remote areas there may be very little or no provision of radiology services and thus the clinicians themselves are expected to perform and interpret their own radiographic, fluoroscopic and US studies. The participation of the visiting radiologist in ward rounds and case discussions with the clinical teams can be immensely valuable in reviewing the radiology and recommending investigations where needed (Fig. 2). Accessing portable US equipment and teaching clinicians how to perform and interpret their own sonograms can help address the equipment challenges in some environments. Sometimes there is no choice of equipment to use, but where possible choosing and using equipment with a paediatric focus, such as finessing paediatric sonograms by appropriate probe selection, is desired. However, radiology is not all about expensive equipment, and in some circumstances making use of natural resources, such as using a window as a light box, must suffice (Fig. 3). An important aspect of our program is identification and teaching of safe radiation practices. This includes, for example, ensuring that requests for radiology are appropriate,
Pediatr Radiol (2014) 44:646–647
647
Fig. 1 Kind Cuts for Kids logo
Fig. 2 Surgical rounds in Kosova involve case discussions and teaching by the radiologist with the surgical team
Fig. 3 The window of the theatre complex makes a more than adequate radiograph viewing box! Radiographs and fluoroscopy studies are taped to the window for viewing
reducing unnecessary exposures and fluoroscopic screening times, and teaching appropriate coning of areas to be radiographed. Some countries lack basic equipment such as lead aprons, which results in an unnecessarily high radiation dose exposure to the parent or caretaker holding the child for a radiograph or fluoroscopic study, or even sometimes to the staff performing the study. Kind Cuts for Kids welcomes equipment donations of new and used lead aprons. In many countries, paediatric radiology is not recognised as a separate subspecialty and, because of this, there is often suboptimal specialty training in the discipline. Thus, assisting the general radiologist in both the interpretation and diagnosis of conditions with a paediatric focus can be very valuable. In the same way, imparting both practical and theoretical knowledge to trainee radiologists is an important part of the information transfer process. This is often done on a caseby-case basis during one-on-one discussions. However on many of the trips, workshops or symposiums are organised whereby a variety of lectures, both radiologic and clinical, are delivered to audiences comprising a variety of specialty groups including radiologists, paediatricians, paediatric and general surgeons and specialist surgeons, doctors, nurses, physiotherapists and medical students. How can you get involved? Kind Cuts for Kids welcomes donations and participation in its fundraising activities and is keen to hear from those who wish to participate in current projects and those wishing to commence a project that would fit our mission statement. Further information can be found at www.kindcutsforkids.net. Conflicts of interest None
