Pediatric Musculoskeletal Interventional Program at Lucile Packard Children’s Hospital (LPCH)

Posted 11:10 AM, October 26, 2009, by jaruiz

CT guided imaging at LPCH for treatment of juvenile idiopathic arthritis. The arrow shows the trajectory of the needle for placement of steroid medication into the temporomandibular joint.

By Julie Ruiz, PhD

“I was hoping my scar would be bigger,” remarked one of our pediatric patients with some disappointment as she undid her bandage. Several days earlier her bone tumor had been successfully treated through a CT-image guided ablation procedure at Lucile Packard Children’s Hospital (LPCH).

To treat children with bone tumors, our Chief of Pediatric Musculoskeletal Imaging at LPCH, Dr. John MacKenzie, has teamed up with Drs. Larry Rinsky, James Gamble, and Meghan Imrie, pediatric orthopedics at LPCH. Because CT-guided RF ablations for osteoid osteoma tumors require a very small incision and leave virtually no scar, other parents have also

expressed their gratitude for the work done through our Pediatric Musculoskeletal Interventional Program. One mother was ecstatic that her daughter had the first "good night’s sleep in years" the day after the team had eliminated her bone lesion with CT-guided RF ablation.

These are just a few of the many success stories from the Pediatric Musculoskeletal Interventional Program at LPCH, which is helping to expand the minimally invasive options for our smallest patients. Dr. MacKenzie says he enjoys the interventional part of his work at LPCH because it gives him a chance to work directly with the patients, "Often the role of the pediatric radiologist is as the doctor's doctor, seeing the patient for the most part by how they look on the imaging study." But he says the interventional component of his work is very rewarding because he gets a chance to do something that may help while meeting the kids and family at the same time.

Along with the pediatric orthopedists, Dr. MacKenzie has also teamed up with rheumatologists and oncologists at LPCH in order to offer other image-guided diagnostic and treatment procedures to children, such as bone and soft tissue biopsies, joint aspirations, and diagnostic and therapeutic joint arthrograms.

Prior to the Pediatric Musculoskeletal Interventional Program, children were treated with a larger incision or transferred to the adult hospital. The smaller body parts of pediatric patients present a particular challenge for successful image-guided procedures, but the Program is adapting smaller tools made to fit children as well as special techniques to minimize the CT dose delivered to radiosensitive tissues.

These image-guided therapies help shorten the recovery time, reduce pain, and increase the chance for recovery. Since the Program began two years ago, they have treated over 60 children for various minimally invasive procedures with excellent response. Imaging guidance includes fluoroscopy, CT, and ultrasound and the approach varies depending on what imaging strategy works best for an individual child.