Chest radiograph (pediatric)
Updates to Article Attributes
The chest radiograph is one of the most commonly requested radiographic examinations in the assessment of the paediatric patient. Depending on the patients age, the difficulty of the examination will vary, often requiring a specialist trained radiographer familiar with a variety of distraction and immobilisation techniques.
Indications
Performing chest radiography on paediatric patients can be for a number of indications 1:
- 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. PICC, ETT, NGT etc.)
Projections
Standard Projections
As paediatrics vary in their level of cooperation, various projections can be utilised to suit the patient's needs and age:
- PA erect
- AP erect
- AP supine
- AP supine (neonatal)
Additional Projections
- lateral
- not often performed in paediatrics
- can be used to highlight pathology in the mediastinum, costophrenic recess and localise lesions 2
Patient preparation
Patients should remove any clothing and jewellery from waist up; particularly clothing with metal or shiny decorative material. Plaited hair should be untied.2.
Tips for paediatric chest radiography
Often difficulties in imaging the paediatric chest include:
- motion artefact
- insufficient inspiration
To overcome these, a variety of techniques can be used:
- distract the patient with toys, games and/or conversation
- perform immobilisation with blankets and velcro straps
- use child appropriate language (e.g. "stand still like a soldier" and "breathe in, you are about to go diving underwater!")
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