(L–R) Janice McDaniel, MD, Division Director of Interventional Radiology, and Michael Rubin, MD, Chairman of Radiology at Akron Children’s Hospital
Pediatric interventional radiology (IR) is a relatively new and evolving subspecialty. While adult interventional radiologists have been in practice for many years, the number of physicians fellowship trained in this subspecialty remains relatively low — less than 200 worldwide. For pediatric hospitals wanting to expand their IR services, this is a problem.
That was the case for Akron Children’s Hospital which, prior to 2014, partnered with a group of adult interventional radiologists from Akron General Medical Center (AGMC) to provide pediatric IR services on an as-needed basis. While the partnership made IR services available, it also had its limitations, according to Michael Rubin, MD, Chairman of Radiology at Akron Children’s.
“The AGMC IR physicians were not always readily available because of their busy schedules, so some procedures went to the operating room instead of being done by interventional radiology because it was more expedient for the patient,” he explains. “As the demand for these services increased, it became apparent that a children’s hospital of our size needed a dedicated and comprehensive in-house pediatric interventional radiology program.”
That need was met with the recruitment of Janice McDaniel, MD, two years ago and completion last year of a new IR procedure suite, remodeled OR space, and new equipment — a $4 million investment. Today, Dr. McDaniel directs Akron Children’s IR division.
“We are the only hospital in Northeast Ohio with a dedicated pediatric interventional radiologist,” says Dr. Rubin. “With Dr. McDaniel’s training, and the advanced technology of our new interventional radiology suite, we can now offer our patients a wide range of new treatment options that are less invasive.”
About Dr. McDaniel and IR
A native Ohioan, Dr. McDaniel received a BS degree in Biology from the University of Cincinnati and an MD degree from the University of Cincinnati College of Medicine. She completed fellowship training in Pediatric Interventional Radiology at Cincinnati Children’s Hospital Medical Center before joining Akron Children’s Hospital in July 2014.
Janice McDaniel, MD, joined Akron Children’s in 2014 to develop a pediatric interventional radiology program. Dr. McDaniel is a fellowship-trained pediatric interventional radiologist — reportedly the only one in NE Ohio and one of less than 200 in the world.
“I was really drawn to pediatrics, but I also loved the aspect of radiology that was about ‘reading the clues’ and ‘solving the case,’” she says. “Additionally, I really like working with my hands. Pediatric interventional radiology ties all these interests together — with the added rewards of helping kids feel better.”
Interventional radiology involves minimally invasive, image-guided procedures to diagnose and treat disease in nearly every system of the body, including pulmonary, vascular, musculoskeletal and gastrointestinal. It’s routinely used to perform needle biopsies and place feeding and drainage tubes and central venous catheters.
“Among the most common IR procedures are arthrograms of the hips, shoulders, elbows and wrists, as well as joint injections for patients with juvenile idiopathic arthritis or sports injuries,” says Dr. McDaniel. Last year, joint injections accounted for about 27 percent of the procedures she performed.
Guided by imaging tools such as fluoroscopy, computed tomography and ultrasound, interventional radiologists also offer alternatives to traditional surgery. The benefits include less risk, less pain and shorter recovery times.
New IR suite, new technology
Advanced imaging technology in Akron Children’s IR suite makes it possible to more easily and less invasively insert abscess drains, access vasculature for catheter placement, place gastrojejunal (GJ) feeding tubes and perform ultrasound-guided biopsies that previously would have required open surgery.
Shown here in Akron Children’s new IR suite are (L-R) Karah Novince, CNP; Janice McDaniel, MD; Stephanie Simmons, RT; and Diane Taray, RN.
Perhaps the most impressive piece of equipment in the new IR suite is a $1.2 million angiography unit that provides the highest resolution images in even the tiniest patients. In addition, a new cone-beam CT scanner makes it possible to overlay images from an MRI to more precisely pinpoint and treat disease. And a new 60” monitor, which can be split into several screens, enables children and teens who are awake during a procedure to watch a cartoon or favorite TV show.
It is often the most difficult cases, however, that are best served by the advanced capabilities of the IR suite. “I needed to biopsy a mass that was nestled between the aorta, inferior vena cava, spine and the kidney,” Dr. McDaniel explains. “I had a one-centimeter window in which to get a needle into the mass. The CT guidance and image overlay technology allowed me to reconstruct in 3 dimensions and plan my needle path. I then superimposed a graphic onto live X-ray and lined up my needle exactly where it needed to be.”
The new equipment in the IR suite was selected, however, not only for accuracy and precision, but also for its significantly low radiation dose.
Minimum radiation, maximum safety
“We all are concerned about radiation safety and the effects of radiation, even with medical imaging, and we want to minimize that as much as possible,” says Dr. McDaniel. “This dedicated unit is built to minimize radiation and uses built-in pediatric protocols to ensure that the absolute lowest dose of radiation needed is used to get the job done.”
This fluoroscopic image was obtained during sclerotherapy of a lymphatic malformation in the chest wall of an infant, which would have otherwise required extensive surgery to remove the entire lesion.
This CT image taken during a treatment procedure shows a needle probe going through the tumor, which was then cryoablated, causing cell death in the tumor.
Dr. McDaniel also maximizes safety by using ultrasonography whenever possible, eliminating all radiation exposure. She also often performs procedures, such as joint injections and GJ tubes, without sedation. In 2015, 50% of Dr. McDaniel’s procedures were performed without sedation, 20% required sedation, and 30% required general anesthesia.
With her pediatric training, Dr. McDaniel is also focused on the child’s and parents’ concerns and involves the parents as much as possible. “With joint injections and GJ tube placement, the parents can usually be in the procedure room,” explains Dr. McDaniel. “This results in less emotional distress for both the parent and child.”
When needed, child life specialists and a pediatric sedation team are also available.
Recently, Dr. McDaniel brought Akron Children’s Venous Access Team, which places peripherally inserted central catheters (PICCs), under the IR program umbrella. She also co-directs Akron Children’s Vascular Anomalies Clinic with Ananth Murthy, MD, Director of Plastic and Reconstructive Surgery at Akron Children’s. Nick Nguyen, MD, Dermatology, and Heather Sprouse, CNP, are part of this multidisciplinary program that is dramatically changing how vascular malformations are treated.
“IR has always been an innovative field that embraces new technology and pushes the envelope,” says Dr. McDaniel. “Our priority is always to make improvements in the way we treat our kids and get them back to being kids again as soon as possible. Having a dedicated IR suite allows us to grow our program and provide more options for minimally invasive techniques in children.”
Dr. Rubin agrees. “We have seen tremendous growth under Dr. McDaniel’s leadership and, with the opening of our dedicated interventional radiology suite, we are excited about future opportunities to grow our program and expand our reach.”
For more information about Akron Children’s Interventional Radiology Program, visit www.akronchildrens.org/cms/pediatric_radiology/index.html. To refer a patient, call 330-543-0834.