Point-of-care ultrasonography in pediatrics

Dear Editors, We read with interest the position statement of van Rijn et al. [1] and respectfully disagree with the conclusions, especially the need for further oversight from our radiology colleagues. Historically, diagnostic radiologists have been our imaging experts with limited patient interaction. Point-of-care ultrasound is not radiology but an enhancement of physical examination that can make a significant real-time difference for patients. With more specialties using point-of-care ultrasound, radiologists seem to be asking to direct the training of clinicians performing ultrasound. Just like the stethoscope, ultrasound belongs to all specialties [2]. In paediatrics, the rationale for point-of-care ultrasound is even more compelling to minimize exposure to radiation and to improve procedural accuracy, speed and safety. We believe the current state of paediatric point-of-care ultrasound on the international platform is positive and growing exponentially. There have been countless published papers with evidence demonstrating the benefit of point-of-care ultrasound to our patients, physicians and health systems and documenting structured curriculums and competency standards [2]. Additionally, the authors reported concerns for unnecessary additional studies based on their personal experience and for missed diagnoses. Fortunately, the only lawsuits regarding point-of-care ultrasound concerned failure to perform the procedure, rather than its misuse [3]. There have been no published reports of point-of-care ultrasound causing harm (and only anecdotal reports from radiology). The document of van Rijn et al. [1] does not represent the most recent status of paediatric point-of-care ultrasound in Europe and does not express the spirit of mutual collaboration. However, we do recognize there are no standards for paediatric point-of-care ultrasound in Europe and, as a discipline, we have to do better and implement a consistent working model for all use of point-of-care ultrasound. Currently, point-of-care ultrasound training in Europe is provided at major conferences and within various institutions with structured training protocols [4]. Without doubt, collaborating with radiologists in the early phases of program development can foster a relationship of partnership and understanding, hopefully allaying fears of increased work/delays and leading to more effective program development. Even though we are a young discipline, we aim to always reach for the highest standard. We will continue to educate in a deliberate and responsible way to assure that each clinician practices with thoughtfulness and care with the intention of bringing the absolute best medicine to our families and children. We thank you for the opportunity to express our concerns and perspective.