The American Academy of Pediatrics (AAP), founded in 1930 and boasting 68,000 members, is a leader in pediatric healthcare advocacy. Its Section on Radiology, in particular, stands out as a model for its relationship between a subspecialty and its larger specialty. The section, founded in 1979, is dedicated to improving the care of infants, children, and adolescents, and its primary mission is to educate general pediatricians and pediatric subspecialists about radiology in their practice.

Hansel J. Otero, MD, director of international pediatric radiology education and outreach at Children’s Hospital of Philadelphia, and Sarah Sarvis Milla, MD, professor in the pediatric radiology and neuroradiology department at Emory University and staff radiologist at Children’s Healthcare of Atlanta’s Egleston Children’s Hospital, spoke with the Bulletin about their work with the AAP, what’s unique about that work, and why it’s so important for radiologists to be involved in their larger specialty community.

How can pediatric radiologists support the AAP’s work to educate general pediatricians and pediatric subspecialties about the role of radiology?
HO: Every pediatric radiologist could and probably should join the AAP’s Section on Radiology (bit.ly/S_O_R) to help us inform the conversation around imaging in pediatrics. There are multiple avenues for education; we have virtual tools, the AAP annual educational conference, material that goes out to every pediatrician (which covers a radiology-specific topic every year or so), and a series of pediatric journals that, in addition to research, publish state-of-the-art reviews and timely editorials. But more input is always better and, by joining the group, our pediatric radiologist colleagues can help us decide on the agenda or propose topics.

SSM: Many pediatric radiologists already help educate local and hospital-based pediatricians about the appropriate ordering of imaging studies, including the ACR Appropriateness Criteria® (AC). Having said that, only 20–30% of pediatricians polled at the AAP’s 2016 National Conference and Exhibition knew about the ACs for pediatric imaging. We need to make sure that the pediatric radiology community is communicating effectively with our colleagues who need to understand what studies to order and when.

How can your efforts to highlight radiology within the larger specialty serve as an example for other specialties who want to prove their value?
HO: When you engage your colleagues and they experience the value you bring firsthand, then they are the ones telling the rest of the community how important you are for the team; they are the ones doing the advocacy for you. I think that every radiology subspecialty should have similar involvement with their referring physicians, so that they are the ones helping shape practice and convey the value that they bring.

Why should residents consider pediatric radiology as a specialty?
SSM: Pediatric radiologists love to answer this question. First, our patients: we are an active part of a team helping to diagnose and treat children in distress — which always feels like important work to be doing. Second, our field: our specialty allows us to continue multimodality imaging — plain radiographs, US, fluoroscopy, CT/MRI, nuclear — yet also supports subspecializations like neuroradiology and MSK. Third, our colleagues: pediatric radiologists work with kind, thoughtful pediatricians and pediatric subspecialists who are extremely dedicated, as well as excellent communicators.

HO: With the exception of emergency radiology, pediatric radiology is one of the only subspecialties where you can still have more than one interest. I think that variety is always welcome when it comes to how we practice. In addition, pediatric radiology is one of the few subspecialties that involves direct patient contact. Finally, and most importantly, pediatricians are the most committed clinicians. We all share a common goal of wanting the best care for children. That common goal prevents the escalation of many interdepartmental disputes because at the end of the day, all that matters is what’s good for the children.

How is the ACR’s Commission on Pediatric Radiology helping to establish the value of the subspecialty within the larger healthcare system?
HO: The Commission works as a liaison between the ACR and pediatricians. As members of the Commission, we bring the concerns of pediatricians — how to perform studies more appropriately, how to reduce the amount of radiation, or how to do certain practices more safely. The Commission on Pediatric Radiology and the Society for Pediatric Radiology are our doors to the rest of the radiology community, and the AAP is the door to the rest of the pediatric community.