The Reading Room

What Children's Healthcare of Atlanta wants you to know about interventional radiology

by Erin Lane

This is part of a weekly series on conversations we had with interventional radiology (IR) leaders who represent programs in a variety of settings, including health systems, children’s hospitals, AMCs, cancer centers, and more. Make sure you’re subscribed to follow along.

For the second post in this series, we sat down with Dr. Matt Hawkins, Children’s Healthcare of Atlanta (CHOA)’s Director of Pediatric Interventional Radiology, Medical Director of the Vascular Anomalies Clinic, and Medical Director of Telemedicine, to discuss his experience as a pediatric interventional radiologist.

Overview of Children's Healthcare of Atlanta's IR program

Setting: Children’s hospital, part of health system that includes an academic medical center

  • IR program type: Pediatric interventional radiology
  • Program oversight: Health system IR program within Department of Radiology Program development: The Division Chief of IR at Emory Health System, which CHOA is a part of, advocated for a dedicated IR suite at the children’s hospital. In 2014 he hired Dr. Hawkins as the first full-time pediatric IR, and in the first year volumes grew by nearly 200%.
  • Physician staffing: 1 employed full-time pediatric interventional radiologist, 1 adult IR from Emory that provides part-time coverage at CHOA, and 1 pediatric IR fellow
  • Dedicated IR space: The program has dedicated clinic space for pre- and post-procedure visits. Inpatient, CHOA has one IR procedure room. The organization is establishing a new vascular anomalies clinic this year and an additional hospital-based procedure room soon.

    Suite 1 (current): Advanced dose lowering algorithm equipment, including Conebeam CT, which lowers dose to 25%-33% of a regular 64-slice CT, and intravascular ultrasound; for more advanced procedures

    Suite 2 (coming soon): Philips EPIQ ultrasound and basic rotational c-arm technology; for ”bread and butter” IR procedures

Dedicated staff: CHOA’s IR program has 6 dedicated IR nurses and 4 IR technologists. Additionally, they have hired a nurse practitioner for the vascular anomalies clinic to coordinate outpatient care for these patients.

IR suite staffing: Procedures include at least 5 individuals:

  • 1 interventional radiologist to perform procedure
  • 1 anesthesiologist and 1 nurse anesthetist to manage sedation
  • 2-3 technologists: 1 to assist in procedure, 1 to circulate and operate equipment, and 1 to handle the images real-time

Typical daily volumes: 7-9 cases per day

Q: What are pediatric IR’s biggest differentiating factors from traditional programs?

Dr. Hawkins:

Undoubtedly the biggest difference between our program and a more traditional IR program is the focus on patient safety, specifically radiation dose management and sedation.

The effects of radiation exposure are much more pronounced in children than adults, making dose management even more important. Our equipment allows us to significantly reduce radiation dose, some down to just 25% of the radiation administered by regular machines.

Similarly, pediatric IR programs must effectively manage the added complexities of sedating children. Regardless of general anesthesia or use of moderate sedation, an anesthesiologist is necessary to control sedation for pediatric patients throughout the procedure, which allows interventional radiologists to focus on the procedure itself. Some pediatric IR programs actually employ anesthesiologists. At CHOA, we collaborate and work closely with the anesthesiology group, which provides one physician per day to the IR department to assist in all procedures.

Q: Are the services offered through a pediatric program different than traditional IR programs? For your program in particular, what services comprise your largest volumes?

Dr. Hawkins: Services offered at a pediatric IR program differ quite dramatically from adult IR programs. For example, endovascular procedures comprise a large proportion of adult IR services, but vascular disease (due to the lack of atherosclerosis) is much more rare in children. As another example, children with cancer rarely have solid extracranial tumors, so IR is less involved with cancer care in children than adults. Our oncology program follows COG clinical guidelines closely, and IR is typically a last resort for children with low life expectancies, such as patients with complex sarcomas.

Our largest volumes are vascular malformations, osseous ablations, thrombolysis, and renal artery stenosis angioplasty. Although we also do many percutaneous biopsies and central venous access procedures, due to limited procedure space, we focus on more complex cases and rely on other service lines to offer some basic procedures, such a PICC lines and tube exchanges. This optimizes the entire hospital’s service offerings.

Q: You’re the first full time pediatric interventional radiologist at CHOA. How has the program grown since you started in 2014?

Dr. Hawkins: Our pediatric IR volumes grew by 200% in my first year, and we expect them to again when we bring on our next full time pediatric interventional radiologists this year. One reason for this rapid growth is that pediatric IR is a largely underserved market; CHOA is the only pediatric IR program in Georgia. Unfortunately, the lack of knowledge in the pediatric community about IR often delays treatment until patients are older and can undergo IR procedures.

Q: One thing that’s surprised me throughout this research is the amount of patient self-referrals to IR. We hear that patients are commonly referred for more invasive procedures, and then essentially discover an interventional radiology alternative through searching online. Are self-referrals a trend you’ve seen at CHOA?

Dr. Hawkins: Absolutely. Most of my patients’ parents are my age. And this is an extremely savvy consumer population. Social media is a part of our daily lives, and this is no different in health care. Former patients and their parents add me to Facebook groups for different pediatric conditions and promote our program on their profiles. It is very common for new parents to contact me through Twitter or Facebook.

Q: And you’re also the Medical Director of Telemedicine, which is an interesting combination of titles. How is IR well suited for telemedicine?

Dr. Hawkins: Most follow-up visits are simply conversations to ensure the patient is recovering appropriately, but there is no physical exam. So why does the patient need to physically be in the room with me? Most parents are in their 30s and typically comfortable with technology. As we are the only children’s hospital in the state, and the only pediatric IR program, many patients travel for their procedure. Using telemedicine for follow-up visits allows patients to stay in school and parents to stay at work.

 

Next post on IR

What MedStar Georgetown wants you to know about interventional radiology

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