Four breakthrough innovations in pediatric imaging: getting care right for the youngest patients

My close friend who works in the pediatric echo lab at the University of California, Los Angeles, recently celebrated the 17^th birthday of her first heart transplant patient. As she told me about the celebration, I was moved beyond words – not just because I am also a parent myself, but because it’s the ultimate culmination of what we aspire to do to improve pediatric imaging.

This journey toward a 17^th birthday started with an ultrasound scan of this child’s heart more than a decade ago. These can be challenging scans because, as any parent knows, when children come to the doctor’s office they are scared, squirmy, maybe even crying. Parents are also anxious to get their kids back home, so any imaging procedure needs to be quick and done right the first time. And it needs to be done with specific tools that are tailored to the unique anatomies of younger patients. Kids aren’t just small adults, after all.

Innovations in ultrasound and echocardiography since that initial scan have no doubt led to more stories such as this one. And across pediatric care, breakthroughs in other methods of imagining are helping provide the best possible care for our youngest patients. Improving pediatric imaging is critical because it’s increasingly popular today. Healthcare organizations’ investment in pediatric imaging exceeds $6B worldwide and is projected to grow 7% by 2027.[1] Higher incidences of premature births, pediatric diseases, and injuries (all requiring specified imaging devices), as well as more demand for preventive care, are all pushing the need for continued innovation in pediatric imaging.

As a sonographer with an abiding interest in our youngest patients, I truly believe that the pediatric imaging industry is up for the challenge. In fact, I see the industry already innovating to meet this demand by developing new and unique pediatric imaging systems and tools that can quickly, safely, and precisely visualize and diagnose complex conditions in pediatric patients based on their unique needs.

Here are four innovations that I’m most excited about.

Ultrasound image demonstrating a fetal heart at 28 weeks

If a prenatal ultrasound finds something that warrants further investigation, or if the fetus is at a higher risk for a heart defect, then fetal heart echocardiography is warranted to screen for these defects. Fetal echo, which uses transducers and applications designed specifically to detect anomalies in the fetal heart, is used for the diagnosis of the most complicated congenital anomalies. During the fetal echo, clinicians can evaluate the structure and function of the baby’s heart, examining an almond-sized object beating about 150 times per minute, for small holes and connections. As the technology has matured, we’re seeing innovations in fetal echo create higher accuracy scans, while also optimizing the workflow so that the transducers are easier for clinicians to use.

We are continuing to innovate in this area and have even developed solutions that incorporate MRI to address congenital abnormalities in the womb. This fetal cardiac imaging innovation is helping to image complicated pathologies before a baby is even born. This can allow treatment planning to begin while the baby is in the womb, giving them the best chance at the best possible outcome.

These innovations are so exciting because if an anomaly is detected early, some surgeries today can even be done in utero to fix heart defects, which improves outcomes because kids recover better while still immersed in amniotic fluid.[i]^,[ii],[iii] Catching cardiac abnormalities early also helps prevent complications at birth because moms can then plan to give birth at hospitals that are equipped to handle any expected complications, which gives their baby the best chance at survival.

Before undergoing an MR exam, children can play with an educational app (at home) and a toy scanner (in the hospital) to get an idea of what to expect

Pediatric patients often experience high levels of stress in uptake rooms, such as when oncology patients visit the hospital for a PET/CT scan. We’ve also worked closely with Phoenix Children’s Hospital to develop an Ambient Experience environment in PET/CT uptake rooms that calms patients to help relieve their stress, which can lead to better imaging results. 

In an exciting potential development for pediatric imaging, Philips recently partnered with the Walt Disney Company EMEA on a research collaboration to test custom Disney themes within Philips Ambient Experience in select hospitals across Europe. If the project moves into a commercial phase, MR patients would be able to select their favorite Disney story and character to provide them with a sense of control and comfort.

Special ultrasound technology, designed specifically for pediatric care, has been a breakthrough innovation to monitor pediatric liver health. We’ve created an ultrasound solution designed for pediatrics, for example, that is tailored to provide quick and confident, yet gentle imaging specific to the needs of children, elevating their care as never before. With specialty transducers and elastography optimized for children, it delivers a 30% improvement in penetration when compared to the previous generation of pediatric transducers.[i] It also has functionality that provides real-time large field of view assessment of tissue stiffness, which is ideal for the pediatric patient who may be challenging to image; this innovation may prevent the need for liver biopsy.

At Phoenix Children’s Hospital, this solution for whole liver imaging is helping kids improve their liver health.[ii] For example, an 11-year-old overweight male with elevated liver enzymes and concerns for non-alcoholic steatohepatitis (NASH) was referred for ultrasound of the liver with Doppler and Shear Wave Elastography. The ultrasound revealed signs of hepatic steatosis, an accumulation of fat in the liver that could lead to NASH. The patient could then be referred to a registered dietician for weight loss without the need for further imaging or biopsy.

Radiography, or X-ray, is still the most common modality in pediatric imaging and can be administered in a way that delivers a calm and safe experience even for the youngest patients

Another example of a designing for pediatrics is a tube head that was designed with pediatric patients in mind. By incorporating a large touchscreen monitor, technologists can work right next to the patient, helping calm their nerves. And before taking an exposure from the control room, the technologist can verify that the patient hasn’t moved thus avoiding unnecessary retakes.

Other innovative tools are helping drive workflow efficiency in radiography, allowing technologists to see more patients per day and shorten wait times by decreasing the time to diagnosis. For example, because a pediatric patient ranges from newborn to 18-year-old, defining the patient properly for protocol adherence can be a time-consuming task. The interface on our digital radiography systems allows technologists to quickly select from multiple different patient profiles. There are three profiles for pediatric patient that the system can determine automatically according to date of birth. Each profile optimizes for low dose and high image quality for that specific patient. 

[1] https://www.grandviewresearch.com/industry-analysis/pediatric-imaging-market#:~:text=b.-,The%20global%20pediatric%20imaging%20market%20size%20was%20valued%20at%20USD,USD%207.3%20billion%20in%202020.&text=The%20global%20pediatric%20imaging%20market%20is%20expected%20to%20grow%20at,USD%2012.1%20billion%20by%202027.

[i] https://www.heart.org/en/news/2018/12/17/halfway-through-pregnancy-their-baby-needed-in-utero-heart-surgery-should-they-risk-it

[ii] https://give.brighamandwomens.org/fetal-cardiac-surgery/

[iii] https://www.nationwidechildrens.org/specialties/fetal-cardiac-program/fetal-cardiac-intervention

[i] https://journals.sagepub.com/doi/full/10.1177/0218492317694248

[i] 20 – 30% of scans need to be repeated due to motion (Field strength MRI Magazine, June 2016)

[ii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6078876/

[iii] IMV 2019 MR Market Outlook Report

[i] ^*Internal measured comparison on calibrated tissue phantom between mC12-3 and C8-5 transducers on EPIQ Elite ultrasound system.

[ii] “Diagnosis and management of pediatric steatosis using ultrasound,” Philips Clinical Case Study, 2021