One of the highlights of ECR 2020 was supposed to be the special ‘Children in Focus’ programme, exploring a range of healthcare and social topics affecting children and young people.

In preparation for this programme, for the final part of our interview series with the Editors-in-Chief of the ESR Journals family, we asked Professors Yves Menu (professor of radiology at the University of Paris and Editor-in-Chief of European Radiology), Luis Martí-Bonmatí (professor of radiology from La Fe Hospital in Valencia and Editor-in-Chief of Insights into Imaging), and Francesco Sardanelli (professor of radiology at the University of Milan and Editor-in-Chief of European Radiology Experimental) about the presence of paediatric radiology in the three journals and their own experiences with paediatric imaging.

Yves Menu from Paris is Editor-in-Chief of European Radiology.

While both Menu and Sardanelli cite a very low percentage of studies published in their respective journals (less than 10% of all articles), Martí-Bonmatí is thrilled to report more than two hundred papers dealing with children’s imaging in the last ten years. “This is a very positive sign, as paediatric imaging is an area of high importance,” he said.

On the topic of conducting research involving children, all three editors name the question of radiation dose as the number one priority, with ethical issues coming in as a close second. “The doctors must be careful as they are dealing with both children and their parents and, therefore, a tighter control of protocols is a must, not only in research but for daily practice as well,” Menu explained. Sardanelli added that “managing the informed consent is an area that, if addressed properly, can make a significant difference in enabling more studies.”

Martí-Bonmatí highlighted paediatric oncology as an area that must require more research in the future. “Cancer, unfortunately, remains a leading cause of child morbidity and, as such, it demands more attention,” he said. Menu, in addition, highlighted the importance of imaging during pregnancy and points out that there are fertility issues related to imaging that should be taken care of. He also cautions against environmental questions with late consequences, such as pulmonary diseases in urban areas, that we have the tendency to overlook.

Luis Martí-Bonmatí from Valencia is Editor-in-Chief of Insights into Imaging.

A part of Martí-Bonmatí’s own institution is a reference centre for rare and complex paediatric diseases, and a large section of the imaging department is dedicated to paediatric radiology. “There, the biomedical engineers and research assistants are coordinating a large H2020 project that supports personalised in-silico diagnosis, prognosis, therapy selection, and treatment follow-up in paediatric cancer, focusing on artificial intelligence and multi-scale models with a leading imaging component,” he explained.

Menu’s institution tries to keep child and adult populations separate, as treating children cannot be standardised in the same way treating adults can. “In order for both populations to receive the best care possible, research and treatment for adults and children remain distinct,” Menu added.

“The future of paediatric radiology has two issues to tackle,” said Sardanelli. “The first being the improvement of x-ray-based imaging, which should allow for images of diagnostic quality with very low radiation doses.” He sees photon-counting CT as a possible solution to this problem. The second issue is the possibility of using ultrasound or MR fast sequences instead of CT in as many clinical settings as possible. “This should be aided by the use of E-FAST protocols and an increased 24-hour availability of MR imaging in the emergency setting,” he added.

Francesco Sardanelli from Milan is Editor-in-Chief of European Radiology Experimental.

Martí-Bonmatí echoed this call to reduce radiation dosage, advocating for safer imaging techniques and higher use of targeted image-guided treatment procedures. He also added that more precise stratification and prognosis of children by advanced computerised imaging and radiomics will most probably change the way paediatric radiologists carry out their research studies and clinical duties.

Menu once again emphasised the importance of prenatal imaging and predicted further developments of foetal morphological and functional imaging. “The emerging issue of imaging of the placenta has been established as an important one, meriting an entire editorial in European Radiology,” he explained. Another topical concern that has been the subject of research is age evaluation in children, particularly due to the rise in migrant populations. This remains an important topic as it highlights the importance of proper transition from child-care to adult-care. All editors agreed that these are two different worlds, and everything must be done to make sure that older children grow into young adults without any setbacks, either in healthcare or life in general.