Chest Radiography for Pediatric Patients - Indications

• Chest Radiography for Pediatric Patients - Indications

  • Respiratory disease (e.g. respiratory distress syndrome)
  • cardiac disease
  • bronchiolitis
  • pneumonia
  • pulmonary tuberculosis
  • pneumothorax
  • trauma
  • foreign bodies
  • septic screen
  • confirming the location of line placement (e.g. peripherally inserted central catheter or PICC, ETT, NGT etc.)
• Chest Radiography for Pediatric Patients – Projections:

  • Posterior-Anterior (PA) erect
  • Anterior-Posterior (AP) erect
• Posterior-Anterior (PA) erect

  • performed on older patients (teenage years)

  • not advisable for younger patients due to their short attention span (easily agitated - looking away from the 'camera' and everyone else)
• Anterior-Posterior (AP) erect


  • ideal for cooperative younger children (i.e. between 3-7 years old)

  • ease of positioning and immobilization
• Chest Radiography for Pediatric Patients – Projections

  
• Chest Radiography for Pediatric Patients – LANDMARKS

  Familiarize

  
• Chest Radiography for Pediatric Patients – Projections:

  • AP supine-performed when imaging unconscious or uncooperative children
  • AP supine (neonatal)-performed mobile in the neonate unit
• Chest Radiography for Pediatric Patients – Preparations

  • Patients should remove any clothing and jewelry from waist up; particularly clothing with metal or shiny decorative material.
  • Plaited hair should be untied, for girls.
  • Younger children usually accompanied with adult.
• Chest Radiography for Pediatric Patients – Special Considerations:

  Often difficulties in imaging the pediatric chest include:

  1. motion artifact
  2. insufficient inspiration

  To overcome these, a variety of techniques can be used:

  1. distract the patient with toys, games and/or conversation
  2. perform immobilization with blankets and velcro straps; a parent or another radiographer
  3. use child-appropriate language (e.g. 'stand still like a soldier' and 'breathe in, you are about to go diving underwater!')
• Examples of CXR with Findings:

  Chest X-ray showing subcutaneous emphysema (upper arrow) and pneumomediastinum at the cardiac border (lower arrow)

  
• Examples of CXR with Findings

  Subcutaneous emphysema on X-ray: arrows show SE at right side of chest and at supraclavicular site.

  
• Examples of CXR with Findings

  Chest x-ray showing Kerley B line due to interstitial edema of primary pulmonary TB. Examples of CXR with Findings Kerley A lines – near hilar regions Kerley B lines – near basal areas

  
• Examples of CXR with Findings:

  Pulmonary edema (bilateral perihilar consolidation in a bat’s wing configuration).

  
• Examples of CXR with Findings:

  Pleural effusion in the right hemithorax.

  
• Examples of CXR with Findings

  • Chest x-ray of a child, with an acute asthma exacerbation.
  • Shows hyperinflation (abnormally lucent lungs).
  • The diaphragm is flattened; relatively small.
  • Air is present within the mediastinum (see arrows)

  
• Problems Encountered in Pediatric Patients During Procedure Applications:

  1. Separation anxiety and fear
  2. Communication and age gap
  3. Family background
  4. Past hospitalization/ medical history (trauma)