Paediatric radiology training in the UK: a national trainee survey by the British Society of Paediatric Radiologists (BSPR).

AIM: To survey current UK radiology trainee experiences and opinions regarding the quality of paediatric radiology training encountered in their core years, and assess their career ambitions with regards to paediatric radiology. MATERIALS AND METHODS: A 22-question online survey, approved by the BSPR committee, was promoted over 12 months (1 February 2022 to 31 January 2023) across current radiology trainees and fellows via regional radiology training programme directors (TPDs), Junior Radiology Forum (JRF) trainee representatives, at BSPR Junior Forum webinar teaching sessions, and via social media/word of mouth. RESULTS: Eighty-three UK survey responses were received from 17/19 (89%) training schemes. Sixty of the 83 (72%) had taken or were due to take a 2-4 month core paediatric radiology placement partly at tertiary centres (66/83, 80%), with 67/83 (81%) receiving dedicated didactic teaching. Only 26/83 (31%) reported fulfilling core curriculum competencies and 32/83 (39%) reported not receiving enough paediatric radiology training. Almost a quarter (18/83, 22%) reported <2 months of paediatric radiology rotation during core training and 12% (10/83) across six training schemes, reported no dedicated paediatric teaching sessions. Respondents who left negative comments around their experience were more likely to reject paediatric radiology as a future career option (p<0.05). CONCLUSIONS: Only 31% of UK radiology trainees reported having enough paediatric radiology training to achieve core competencies. Standardised training, teaching, and increased on-call support could improve confidence in dealing with emergency cases and encourage interest in paediatric radiology beyond junior years.

Ultrasound as the first line investigation for midgut malrotation: a UK tertiary centre experience.

AIM: To present the first 22-months experience of transitioning to an ultrasound-first pathway for suspected midgut malrotation. MATERIALS AND METHODS: An "ultrasound-first" imaging pathway was initiated in October 2021. Twenty-two-months later, a search was undertaken of all <1-year-old patients with "bilious", "malrotation," or "volvulus" as the imaging indication. Reports and images from upper gastrointestinal fluoroscopy (UGI) and ultrasound were reviewed, and diagnoses and outcomes were documented. RESULTS: The search yielded 101 eligible cases between October 2021 and July 2023. Of the patients, 63/101 (62%) had both ultrasound and UGI: 47/63 (75%) ultrasound first, 16/63 (25%) UGI first. Thirty-one per cent (31/101) had ultrasound only and 7/70 (10%) UGI only. The pathway diagnosed 7/8 (88%) infants with midgut malrotation with or without volvulus and one infant who had an inconclusive ultrasound examination with a suspected an internal hernia and who was found to have malrotation volvulus at surgery. Twenty-one infants who had confidently normal ultrasound examinations and who also had UGI all had a normal duodenojejunal flexure position. Ultrasound detected alternative pathology in eight children. Duodenal visualisation improved with time: 6/15 (40%) in the first 6 months to 23/34 (68%) after the first year. CONCLUSION: The transition to ultrasound as the first diagnostic test for midgut malrotation can be done safely and effectively in a UK centre, which previously relied solely on UGI.

Imaging characteristics of infantile fibrosarcoma.

AIM: To highlight the imaging findings in a case series of histologically confirmed infantile fibrosarcoma (IF) and identify any features specific to this entity. MATERIALS AND METHODS: Retrospective identification was undertaken of patients with histologically confirmed IF from the electronic patient databases of two institutions between 1 January 2010 and 1 May 2021. Available pre-treatment imaging, histopathological reports, and clinical records were reviewed. RESULTS: Eighteen patients with IF met the inclusion criteria. There were 10 male and eight female patients with a mean age at presentation of 3 weeks. All patients had the t (12; 15) chromosomal translocation. Eleven (61%) tumours were located in the extremities, three were in the craniofacial region, two were intrathoracic, one abdominal and one paraspinal. A single patient had extensive metastases. The tumours were generally isointense to skeletal muscle on T1-weighted sequences and hyperintense on T2 with heterogeneous enhancement and high cellularity seen as diffusion restriction. Fifteen of the 18 lesions were evaluated on ultrasound and appeared as heterogeneous, hypervascular solid or mixed solid/cystic masses, mimicking benign vascular lesions in two cases. CONCLUSION: The present two-centre, retrospective study of the largest case series described thus far demonstrates that IF is always highly cellular on magnetic resonance imaging but has no other specific imaging features. It should be considered in the differential diagnosis of any enlarging soft-tissue, solid mass arising in the limbs or neck at birth or in infancy.

Value of additional lateral radiographs in paediatric skeletal surveys for suspected physical abuse.

AIM: To determine the added value of lateral limb radiographs in suspected physical abuse (SPA), particularly with regard to fracture detection and reporter confidence. METHODS AND MATERIALS: A 3-year (October 2017 to November 2020) retrospective study was conducted. Two blinded paediatric radiologists independently reviewed the appendicular radiographs for the presence of fractures, first by reviewing just the frontal projections, then both frontal and lateral radiographs. The additional yield of fractures and changes in reporting confidence scores were recorded. RESULTS: One hundred and thirty-eight skeletal surveys (29 live, 109 deceased children) were assessed, consisting of 16 appendicular fractures imaged in two projections (six wrist, five knee, five ankle). In the majority of cases (14/16) the fractures were already visible on the frontal view with only two fractures (one distal radius, one distal tibial) identified only by lateral projection on the blinded review. One fracture (distal tibia) was visible only on the frontal radiograph (not lateral view). The addition of lateral projection did not lead to overcalling of fractures in the remaining normal studies. Radiologist confidence scores showed an improvement with the addition of a lateral projection when a study was thought to be normal (p=0.001-0.003), but not when a fracture was identified (p>0.05). CONCLUSION: The addition of lateral radiographs improves reporting confidence in normal skeletal surveys, but only rarely helped to detect additional fractures given that most were visible on frontal projections. Larger multicentre studies of clinical practice are required to confirm these findings.