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Background Burnout in the field of healthcare is among the most important challenges encountered across our workforce. Provider burnout increases the risk of personal manifestations of stress, impaired job performance, and provider turnover. There is limited evidence that suggests that pediatricians are less prone to burnout than other physicians, and that pediatric subspecialists (PSPs) had been more prone to burnout than primary care pediatricians (PCPs), though there is some evidence that the relative prevalence of burnout among PCPs and PSPs changed in recent years. In response to the aforementioned factors, our large suburban pediatric multispecialty practice instituted a wellness program in 2021 with the goal of assessing the prevalence of provider burnout, and in turn developing strategies and processes aimed at improving provider wellbeing. The goal of this study was to analyze data obtained during the first three years of our wellness program, and specifically, to compare PCPs and PSPs for evidence of burnout and stress at work; and to identify triggers which contribute to burnout. Methods Following exemption from our local IRB, a retrospective review was performed of all anonymized data obtained from 2021 to 2024. All PCPs and PSPs were requested to complete the Maslach Burnout Inventory (MBI) and the Mini-Z 2.0 Survey, as the initial data point of a phased roll-out, as part of the organization’s provider wellness program. The goal was to use this data to inform next steps in the organization’s provider wellness plan. This data was then analyzed for differences in wellness, burnout, and drivers of burnout between PCPs and PSPs. Results 106 PCPs and 100 PSPs completed the surveys, which represents 75% of all providers in our practice. 30% of PCPs and 28% of PSPs met our predetermined definition of exhibiting signs of burnout, p  = 0.711. This rate appears to be lower than those reported in recent national survey data of all physicians. Despite these rates of burnout and feeling stress at work, only 9% of PCPs and 16% of PSPs scored low for the MBI’s personal accomplishment subscore. In addition, in the PSPs, there was a statistically significant difference in prevalence of low personal accomplishment in those who are experiencing at least one manifestation of burnout (36%), compared to those who are not experiencing at least one manifestation of burnout (8%). That difference was not significant in the PCP cohort (13% in burnout cohort vs. 8% in non-burnout cohort). Conclusions The results have already proven useful in shaping our approach to improving provider wellbeing and mitigating burnout. It is important that healthcare organizations measure rates of provider burnout and develop strategies to tackle this vital issue.

Thoracic computed tomography (CT) is the imaging reference method in the diagnosis, assessment and management of lung disease. In the setting of cystic fibrosis (CF), CT demonstrates increased sensitivity compared with pulmonary function tests and chest radiography, and findings correlate with clinical outcomes. Better understanding of the aetiology of CF lung disease indicates that even asymptomatic infants with CF can have irreversible pulmonary pathology. Surveillance and early diagnosis of lung disease in CF are important to preserve lung parenchyma and to optimise long-term outcomes. CF is associated with increased cumulative radiation exposure due to the requirement for repeated imaging from a young age. Radiation dose optimisation, important for the safe use of CT in children with CF, is best achieved in a team environment where paediatric radiologists work closely with paediatric respiratory physicians, physicists and radiography technicians to achieve the best patient outcomes. Despite the radiation doses incurred, CT remains a vital imaging tool in children with CF. Radiologists with special interests in CT dose optimisation and respiratory disease are key to the appropriate use of CT in paediatric imaging. Paediatric radiologists strive to minimise radiation dose to children whilst providing the best possible assessment of lung disease.

Atopic dermatitis (AD) is one of childhood’s most common skin conditions. Although pediatricians often diagnose and manage it, more than half refer even mild cases to dermatologists. In this study, we aimed to evaluate pediatric residents’ and pediatricians’ self-confidence regarding their ability to diagnose and manage AD. A cross-sectional questionnaire study was conducted with Israeli pediatric residents and pediatricians in 2022. The questionnaire was designed to distinguish participants with high vs. low self-confidence characteristics regarding their ability to diagnose and treat AD. In total, 171 participants completed the questionnaire (59.4% women; age, 41.1 ± 10.6 years); 39.1% of the participants were residents, while 60.9% were board-certified pediatricians. Overall, 64.4% of the responders reported below or average confidence (score ≤ 3, on a scale of 1–5) in diagnosing and treating AD in children. The group with higher self-confidence was significantly older (44.39 vs. 39.14 years, P  = 0.003), had more years of experience in evaluating pediatric AD ( P  = 0.004), had trained in dermatology during their residency ( P  = 0.02) with a longer training period ( P  = 0.01), and with more than three training methods ( P  = 0.009). Multivariable logistic regression analysis showed that high self-confidence was associated with age older than 40 years and training in dermatology during residency (odds ratios = 5.63 [ P  = 0.04] and 3.36 [ P  = 0.05], respectively).   Conclusion : Most pediatric residents and pediatricians were not particularly confident in treating children with AD. Those with high self-confidence were older, had been exposed to more patients, and had been trained in dermatology during their residency with various methods and for longer periods. Therefore, we encourage the implementation of a training program in dermatology during pediatric residency programs. What is Known: • Atopic dermatitis (AD) is one of childhood’s most common skin conditions and often presents to pediatricians for diagnosis and management. • Many pediatricians refer children with even mild cases of AD to dermatologists. What is New: • Most pediatric residents and pediatricians report low confidence in diagnosing and treating pediatric AD. • Physicians with high self- confidence were older, exposed to more AD patients, and had been trained in dermatology during their residency with various methods and for longer periods. Therefore, the implementation of a training program in dermatology during pediatric residency programs is warranted. 

Children account for nearly half the population of Nigeria yet the capacity for effective imaging of children is unknown. In order to determine clinical resources for and challenges of paediatric radiology in Nigeria, certified radiologists at an exit examination in radiology for resident doctors, and resident doctors in radiology attending an update course, completed a semi-structured questionnaire detailing personal information, radiology training, practice and perceived priorities of paediatric radiology in Nigeria. Of 100 questionnaires, 80 were returned, completed (80%) by 46 (58%) certified radiologists, 14 (18%) senior and 20 (25%) junior radiology residents. Only 1 (2.2%) certified radiologist received dedicated albeit short training in paediatric radiology. Nine (20.0%) certified radiologists and 1 (2.9%) resident doctor target their practice to paediatric imaging. Only 2 (4.4%) certified radiologists devote at least half of their time to paediatric radiology. Forty-two (91%) of the certified radiologists are not aware of any radiologist primarily affiliated with a dedicated children’s hospital or who practices in a dedicated paediatric unit of a mixed hospital. Eight (19%) radiologists work in a facility with a consultant who has some training in paediatric radiology. Surgeons (64%), neonatologists (53%) and neurologists (45%) were the other paediatric specialties usually available where the respondent works. Fourteen (4.9%), 4 (2.1%), and 1 (1.3%) ultrasound, X-ray and magnetic resonance imaging (MRI) units, respectively, were reserved for paediatric imaging while no fluoroscopy or computed tomography (CT) unit was dedicated to children. Lack of dedicated equipment (44%) and trained paediatric radiologists (24%) were the main challenges to paediatric imaging as perceived by the respondents. Substantial deficits in human and material resources require informed investment in dedicated equipment and training to boost capacity for paediatric radiology in Nigeria.

Medical imaging is foundational in the care of children, and much of the medical imaging province depends on ionizing radiation: radiography, fluoroscopy, CT and nuclear imaging. Many considerations for this imaging in children are distinct in the domains of appropriate radiation use, other factors that determine examination quality, the opportunities to engage and educate through networking, and the translation of research efforts. Given these needs, it is worth approaching the contributions and their impact by the pediatric radiology community, especially to the enhancement of this value in the care of children.

The value of obtaining second-opinion interpretations by specialty radiologists has been established. In pediatric radiology, this has primarily been explored in general terms, comparing tertiary pediatric radiologists’ interpretations to referral reads. In adults, second reads by subspecialty radiologists have been shown to yield changes in patient management, including in neuroradiology, musculoskeletal radiology and oncological radiology. Here, we examine second-opinion reads by pediatric radiologists by reviewing the pediatric and adult subspecialty literature. We also present our experience in providing subspecialty outside reads, summarizing lessons learned in implementing a system for outside interpretations into a pediatric radiology practice.

We describe the advent of pediatric radiology in Nigeria and the challenges associated with establishing the subspecialty. Nigeria has very few radiologists with a special interest in pediatric radiology caring for more than 82 million children. One major challenge is the lack of interest in the subspecialty owing to the lack of remuneration when compared with others like interventional radiology. The majority of the radiologists also do not have specialized training in pediatric radiology. With very few children’s hospitals, where to work after graduation is also a deterrent for pediatric radiologists. Put simply, Nigeria needs help. We also suggest ways to overcome these challenges.

Italy is the sixth most populous country in Europe and has the second highest average life expectancy, reaching 79.4 years for men and 84.5 for women. However, Italy has one of the lowest total fertility rates in the world: in 2018 it was 1.3 births per woman, with the population older than 65 comprising more than 30%, and those younger-than-19 less than 15%. Older people are the main concern of the Italian health system. Weighted coefficients for the allocation of funds favour older adults. As confirmed by our study, paediatric radiology is expensive, and the reimbursement based on Italian adult rates is not sufficient. The negative impact on the budget discourages the diffusion of paediatric radiology both in the private practices that provide services paid for by the state government and in the public hospitals. The 501 paediatric hospital units in Italy are not homogeneously distributed throughout the national territory. Furthermore, in Italy there are 12 highly specialised children’s hospitals whose competences were defined in 2005 by the Ministry of Health. Paediatric radiology is not included among the highly qualified specialties. The quality gap in paediatric radiology between children’s hospitals and general hospitals, the latter often without paediatric radiologists, is evident in daily practice with misdiagnoses and investigations not carried out.

We present the case for subspecialisation in paediatric gastrointestinal and hepato-pancreatico-biliary radiology. We frame the discussion around a number of questions: What is different about the paediatric patient and paediatric gastrointestinal system? What does the radiologist need to do differently? And finally, what can be translated from these subspecialty areas into everyday practice? We cover conditions that the sub-specialist might encounter, focusing on entities such as inflammatory bowel disease and hepatic vascular anomalies. We also highlight novel imaging techniques that are a focus of research in the subspecialties, including contrast-enhanced ultrasound, MRI motility, magnetisation transfer factor, and magnetic resonance elastography.