Medical imaging at The Children's Hospital at Westmead

Meeting the unique needs of children

Our mission is to provide a safe, caring, comprehensive, cost effective and quality medical imaging service to our patients with the best possible outcome.

Medical imaging, also known as Radiology or Diagnostic imaging, uses non-invasive imaging methods to assist your doctor in diagnosing and treating your child’s illness.

We use X-rays, CT scan (CAT scan or Computed Tomography), MRI (Magnetic Resonance Imaging) and ultrasound to produce images of the body. These images are interpreted by diagnostic radiologists and a report is provided to your child’s doctor.

At The Children's Hospital at Westmead, all we do is children’s imaging. We're skilled at addressing their needs—our child-friendly waiting room has plenty of toys to entertain, and our technicians are savvy with the scared, the squirmy, and the very sick.

Our radiologists undertake specific training in the diagnosis of children’s illness and have the know-how to obtain the best diagnostic images.

We accept referrals from the community.

Computed Tomography: CT or CAT scans

What is a CT scan?

CT stands for "computerised tomography".  CT scans are sometimes called CAT scans. 

The CT scanner is a large doughnut-shaped x-ray machine. It is used to see internal structures of the body in great detail. The images are displayed as thin slices of the body on a computer screen (much like the slices of a sliced loaf of bread.) Your child will be exposed to some X-Ray radiation during the procedure. Please consult your doctor if you have any concerns.

Preparing your child for a CT scan

It's useful to explain the CT scan to your child before coming to the scan room. Here's a few suggestions:

• the scan usually only takes a few minutes
• it's painless
• It's important the child stays still for the scan
• parents and carers can stay during the scan. Pregnant mothers can't.
• sometimes an injection might be required
• the scanner makes a soft fan-like noise and clicks as the pictures are taken.
• for chest and abdominal scans, the child might need to hold a breath

Medical preparation                       

If your child needs a contrast injection they need have to fast for 2 hours, which can make them feel queasy on a full stomach. CT scans of the abdomen will require your child to drink an oral contrast.

If your doctor has decided your child will need sedation or general anaesthesia in order to lie still enough for the scan, they'll give you additional information.

What is intravenous (IV) contrast?

IV contrast is a clear liquid that shows on the CT images. It's helpful in clearly visualising the blood vessels and is very important in some CT scan examinations. The IV contrast is given via injection into a vein mostly found in the patient’s arm.

You'll be asked questions about allergies or to fill in a questionnaire.

What is oral contrast?

Oral contrast is a drink your child will need to have before a CT scan of the abdomen. It's used to tell the bowel apart from other abdominal structures that lie very close to the bowel. The oral contrast is very safe and does not require a formal consent.

Please inform the scan room staff if your child has any allergies, asthma, or kidney problems.

Important safety considerations

There is a small chance of an allergic reaction to the IV contrast. For this reason, the parent/guardian will be asked to sign a consent form. Please ask any questions concerning the contrast before you sign. Also be sure to mention any known allergies.

As a parent/guardian who may be pregnant, you will not be able to stay with your child. It is advisable to bring someone else who is not pregnant to stay with your child.

Read the CT scan factsheet

Magnetic Resonance Imaging: MRI scan

MRI stands for Magnetic Resonance Imaging. This is a procedure which uses a powerful magnet and radio waves to produce detailed images of any part of the body. The entire scan usually takes between 20 mins and 2 hours depending on which area is being examined.

What do I bring?

• a copy of the original referral letter and the MRI screening questionnaire
• other X-rays, CT scans, Nuclear Medicine scans or Ultrasound scans for comparison
• a favourite CD/DVD—we can play it through headphones for them during most scans.

What happens before the MRI scan?

You will be asked to complete and sign a questionnaire on your child's behalf. It is important that you fill out the form accurately and ask any questions before going into the scan room. It is necessary to advise staff of all surgery prior to the examination.

Unless your child is having an anaesthetic for the scan, you can stay with your child during the examination but you'll need to complete a screening questionnaire.

In some circumstances, your child may require a cannula (needle) to be inserted for an injection of contrast. If you would local anaesthetic cream to be applied to reduce some of the discomfort, please come 60 minutes before your appointment time. We'll let you know if contrast is required.

Your child will be changed into a hospital gown to ensures that no metallic items are present within the scanner.

If your child is having a general anaesthetic for the scan, you will be sent a letter by the hospital giving specific instructions with regards to fasting your child and when to come to hospital.

What happens during the MRI scan?

The MRI examination is not painful. Your child lies on the scanner table. Depending on which part of the body is being examined, a frame will be placed and secured around your child. This allows the pictures to be taken. The table will then slide inside the scanner and occasionally move during the scan.

During the examination, several sets of pictures will be made, usually taking between 30 seconds and 7 minutes each. A lot of different loud tapping and buzzing sounds will be heard while the machine takes pictures. It's important that your child does not move at this time, otherwise the pictures will be unclear and the scan may need to be repeated. Earplugs and/or headphones will be provided for hearing protection. Your child can listen to their own music, or watch a favourite movie whilst inside! 

Some children don't need their parent with them during the scan and they are given a buzzer to squeeze if they need the scan to stop for any reason. When a support person is in the room with them they may also signal the operator if there is a problem. Between scans, the radiographer talks to your child through a microphone to make sure they are OK and encourage your child to lay still.

Each set of scans will appear different, but all combine to give an overall picture of the area being examined. In some cases, it is necessary to give a small injection of MRI contrast media into a vein. It is used to help highlight tissues, vessels and structures more clearly which can help with making a diagnosis. It is very safe, well-tolerated and passed out of the body in urine and faeces. Reactions are unusual, however, it is important, to let us know if your child has any problems with their kidneys, allergies or if your child experiences any strange feelings during the injection.

For chest and abdominal examinations, the patient will be asked to hold their breath (for approximately 10-15 seconds per set of pictures). For these scans your child may be asked not to eat prior to the examination or required to drink oral contrast. These instructions will be given by our staff when booking the appointment.

What happens after the scan?

Once the scan is finished, your child is free to resume all normal activities unless your child required an anaesthetic. In this case following the MRI they will be taken to a recovery area and when they are awake transferred back to the ward.

A Radiologist will send a report to the referring doctor, which usually takes four to five working days. If you are seeing your doctor straight after the scan, he/she can phone the Radiology Department and talk to the Radiologist. In this department, no hard copies are made of the examination. The images are stored on computer and can be viewed on monitors at the hospital. If you require films of the scan, then a fee will be charged.

Please be aware the MRI unit is in the public hospital and occasionally there are delays to appointment times due to unforeseen emergency or additional procedures. We will endeavour to let you know of the delay as soon as possible to limit any inconvenience.

Remember

• As a parent you can help you child to prepare for their MRI by explaining the following important points to them before their test:
• Although the machine makes lots of strange noises, the examination itself is not painful and does not hurt.
• Encourage your child to practise keeping still for a few minutes at a time, and explain in age appropriate terms why they must try to stay still for clear pictures. Some children even fall asleep.
• Help your child to choose a CD/DVD to listen/watch to during the scan.

If your child requires frequent procedures and experiences anxiety please contact the Child Life Therapy Departments.

• Read the MRI scan factsheet

Fluoroscopy

Fluoroscopy is an imaging technique that uses low-dose X-rays to create 'real-time' or moving images of the body. Fluoroscopy is used in a variety of diagnostic and therapeutic procedures. A radiologist (X-ray doctor) and radiology nurse perform the procedures together.

Fluoroscopic exams require the child to lie on a table while the x-ray machine is passed over the child.

Contrast material is often used in fluoroscopy examinations. Contrast material can be swallowed, injected intravenously, infused into the bladder or given by an enema, depending on what part of the body is being studied.

The radiologist moves the X-ray machine around to follow the contrast material. The child may be asked to move around in different positions so that we can take pictures of the exact area of interest. The images are then viewed on a television monitor in the room.

Fluoroscopic procedures include:

• Barium enema
• Barium swallow
• Upper GI series
• Micturating cystourethrogram (MCU)

While fluoroscopy uses X-rays to generate the images, all steps are taken to limit the radiation dose. The aim is to use the lowest radiation dose required for an accurate diagnosis. Fluoroscopy procedures are generally ordered when it is the only imaging technique available to make an accurate diagnosis.

You are welcome to accompany your child into the exam room, but you'll need to have someone stay with siblings in the waiting area where there are toys and activities to occupy them.

Women who are pregnant, or may be pregnant, need to leave the exam room during the procedure.

Ultrasound

Ultrasound uses sound waves to produce images of the organs and soft tissues inside the body. These sound waves are emitted from a transducer and reflected by the bodies tissues back to the transducer. The returning sound waves are processed by the ultrasound machine to generate an image on a screen.

Ultrasound is performed by a sonographer who will take a series of still images to represent the findings. Occasionally a radiologist will be asked to come into the room to view the study in real time. The sonographer will ask about any prior imaging and will ask questions related to the study being performed. These questions are an important part of targeting the ultrasound study to help reach a diagnosis.

Please bring any prior imaging studies performed outside of Children’s Hospital Westmead so comparisons can be made if required.

Pre-test preparation

Some ultrasound examinations require special preparation as listed on the chart below.

Abdominal ultrasound

• Fasting is required. Fasting means nothing to eat, although your child can drink water.
• If your child is diabetic, they can drink apple juice to stabilise insulin levels.

Renal and pelvic ultrasounds

• Children are required to have a full bladder. They can drink apple juice or water only.
• It can be difficult to monitor a full bladder especially when your child is not toilet trained but please try to achieve this as the ultrasound is dependent on adequate fluid in the bladder.

No special preparation is required for the following exams:

• Spine
• Brain
• Thyroid
• Scrotum
• Soft tissue masses

Other instructions

• Dress your child comfortably in clothes that can be easily removed. Your child might be dressed in a gown for the procedure.
• Your child will be lying down on a bed during the ultrasound. You are welcome to bring a stuffed animal or special blanket for your child to hold during the procedure.
• Parents are welcome to accompany their child into the exam room. Siblings need to be supervised in the waiting where there are toys and activities to occupy them.
• There are no special instructions for your child to follow when the exam is over.
• The images from your child's exam are interpreted by a radiologist a report is sent to the referring doctor.

Fellowship opportunity

Paediatric Radiology Fellowships at The Children’s Hospital at Westmead

We offer paediatric radiology fellowships to advanced trainees and recent graduates on an on-going basis, usually starting in July and February. The fellowship positions run for 12 months and are well-suited best to radiology trainees considering a career in paediatric radiology or intending to spend a significant proportion of their time reporting paediatric imaging.

The Children’s Hospital at Westmead is the largest referral centre for paediatrics for the state of NSW with approximately 300 beds. The Radiology Department at The Children’s Hospital at Westmead offers all radiology modalities and trainees are exposed to a wide variety of paediatric imaging studies.

The Radiology Department at The Children’s  Hospital at Westmead has two MRI scanners (3T Siemens and 1.5T Phillips), one CT scanner (Siemens Force), four ultrasound machines, two fluoroscopy rooms, plain x-rays and bi-plane angiography.
 
While the paediatric radiology fellowship primarily concentrates on diagnostic radiology, there are options for pertaining to exposure to interventional procedures for trainees with an interest in IR.

Fellows at The Children’s Hospital at Westmead are fully supervised by consultant paediatric radiologist in and out of hours. All paediatric radiologists at The Children’s Hospital at Westmead are speciality trained in paediatric radiology and the majority have a sub-speciality interest.

Application for these positions is open with positions usually starting in either early August or early February (starting date is negotiable).

Interested?

Email Dr Neil Caplin, Director of Radiology at The Children’s Hospital at Westmead.

Our staff