Pediatric abdomen (lateral decubitus view)
Disclosures
- updated 4 Sep 2022:
Nothing to disclose
Updates to Article Attributes
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The lateral decubitus radiograph is an additional projection for assessing the paediatric abdomen. This view is ideal for displaying free air in the abdomen and/or if the patient is unable to lie supine 1. As radiation dose is an important consideration for paediatric imaging, the lateral decubitus view is not often performed; although this will vary based on the department.
Patient position
- patient is in a left lateral decubitus position with both knees bent up
- ensure no rotation of hips and shoulders
- remove any radiopaque items (e.g. ECG dots, nappy, shiny decorative clothing)
- take the x-ray in full inspiration
Technical factors
-
posteroanterior projection
- in order to reduce the radiation dose to radiosensitive organs 1
-
centring point
- the midsagittal plane (xiphisternum) at the level of the iliac crest
- collimation
- laterally to the lateral abdominal wall
- superior to the diaphragm
- inferior to the inferior pubic rami
- it is not advised to collimate too tightly laterally in case of missing bowel loops and/or organs 1
-
orientation
- portrait
-
detector size
- will vary depending on the child's body habitus
-
exposure 2
- 60-75 kVp
- 2-10 mAs
-
SID
- 100 cm
-
grid
- if patient thickness is above 10 cm, use of a grid is advisable 2
Image technical evaluation
- include the
- lateral abdominal wall
- inferior pubic rami inferiorly
- must include the diaphragm superiorly
- the abdomen should be free from rotation with symmetry of the:
- ribs (superior)
- iliac crests (middle)
- obturator foramen (inferior)
- no blurring of the bowel gas due to respiratory motion
Practical points
- it may be useful to position the patient so that they can see their parents in order to reduce anxiety
- paediatric patients may feel uncomfortable when bony landmarks are felt for, therefore an appropriate explanation to the patient beforehand is ideal for improving patient comfort
- to achieve sufficient inspiration, using child-appropriate language will be useful
- e.g. 'breathe in as if you are about to go diving underwater!', 'breathe in as if you are about to blow out a birthday candle!'
Immobilisation techniques
It is important for the image to be free from movement artefact and rotation to avoid repeated x-rays.
- it may be necessary for the parent or radiographer to stand with the patient or hold them in position
- sometimes it is only necessary to keep the child's arms away from the abdominal area; in these cases, asking the child to hold onto something to their side (e.g. toy, mother's hand, pole) may be useful.
- techniques will vary based on the department
-<p>The <strong>lateral decubitus radiograph</strong> is an additional projection for assessing the <strong>paediatric abdomen</strong>. This view is ideal for displaying free air in the abdomen and/or if the patient is unable to lie supine <sup>1</sup>. As radiation dose is an important consideration for paediatric imaging, the lateral decubitus view is not often performed; although this will vary based on the department. </p><h4>Patient position</h4><ul>-<li>patient is in a left lateral decubitus position with both knees bent up</li>-<li>ensure no rotation of hips and shoulders</li>-<li>remove any radiopaque items (e.g. ECG dots, nappy, shiny decorative clothing)</li>-<li>take the x-ray in full inspiration</li>-</ul><h4>Technical factors</h4><ul>-<li>-<strong>posteroanterior projection</strong><ul><li>in order to reduce the radiation dose to radiosensitive organs <sup>1</sup>-</li></ul>-</li>-<li>-<strong>centring point</strong><ul><li>the midsagittal plane (<a href="/articles/xiphisternum">xiphisternum</a>) at the level of the iliac crest</li></ul>-</li>-<li><strong>collimation</strong></li>-<li><ul>-<li>laterally to the lateral abdominal wall</li>-<li>superior to the diaphragm</li>-<li>inferior to the inferior pubic rami</li>-<li>it is not advised to collimate too tightly laterally in case of missing bowel loops and/or organs <sup>1</sup>-</li>-</ul></li>-<li>-<strong>orientation</strong><ul><li>portrait</li></ul>-</li>-<li>-<strong>detector size</strong><ul><li>will vary depending on the child's body habitus</li></ul>-</li>-<li>-<strong>exposure <sup>2</sup></strong><ul>-<li>60-75 kVp</li>-<li>2-10 mAs</li>-</ul>-</li>-<li>-<strong>SID</strong><ul><li>100 cm</li></ul>-</li>-<li>-<strong>grid</strong><ul><li>if patient thickness is above 10 cm, use of a grid is advisable <sup>2</sup>-</li></ul>-</li>-</ul><h4>Image technical evaluation</h4><ul>-<li>include the<ul>-<li>lateral abdominal wall</li>-<li>inferior pubic rami inferiorly</li>-</ul>-</li>-<li>-<strong>must </strong>include the diaphragm superiorly</li>-<li>the abdomen should be free from rotation with symmetry of the:<ul>-<li>ribs (superior)</li>-<li>iliac crests (middle)</li>-<li>-<a href="/articles/obturator-foramen">obturator foramen</a> (inferior)</li>-</ul>-</li>-<li>no blurring of the bowel gas due to respiratory motion</li>-</ul><h4>Practical points</h4><ul>-<li>it may be useful to position the patient so that they can see their parents in order to reduce anxiety</li>-<li>paediatric patients may feel uncomfortable when bony landmarks are felt for, therefore an appropriate explanation to the patient beforehand is ideal for improving patient comfort</li>-<li>to achieve sufficient inspiration, using child-appropriate language will be useful<ul><li>e.g. 'breathe in as if you are about to go diving underwater!', 'breathe in as if you are about to blow out a birthday candle!'</li></ul>-</li>-</ul><h5>Immobilisation techniques</h5><p>It is important for the image to be free from movement artefact and rotation to avoid repeated x-rays.</p><ul>-<li>it may be necessary for the parent or radiographer to stand with the patient or hold them in position</li>-<li>sometimes it is only necessary to keep the child's arms away from the abdominal area; in these cases, asking the child to hold onto something to their side (e.g. toy, mother's hand, pole) may be useful. </li>-<li>techniques will vary based on the department</li>- +<p>The <strong>lateral decubitus radiograph</strong> is an additional projection for assessing the <strong>paediatric abdomen</strong>. This view is ideal for displaying free air in the abdomen and/or if the patient is unable to lie supine <sup>1</sup>. As radiation dose is an important consideration for paediatric imaging, the lateral decubitus view is not often performed; although this will vary based on the department. </p><h4>Patient position</h4><ul>
- +<li>patient is in a left lateral decubitus position with both knees bent up</li>
- +<li>ensure no rotation of hips and shoulders</li>
- +<li>remove any radiopaque items (e.g. ECG dots, nappy, shiny decorative clothing)</li>
- +<li>take the x-ray in full inspiration</li>
- +</ul><h4>Technical factors</h4><ul>
- +<li>
- +<strong>posteroanterior projection</strong><ul><li>in order to reduce the radiation dose to radiosensitive organs <sup>1</sup>
- +</li></ul>
- +</li>
- +<li>
- +<strong>centring point</strong><ul><li>the midsagittal plane (<a href="/articles/xiphisternum">xiphisternum</a>) at the level of the iliac crest</li></ul>
- +</li>
- +<li><strong>collimation</strong></li>
- +<li><ul>
- +<li>laterally to the lateral abdominal wall</li>
- +<li>superior to the diaphragm</li>
- +<li>inferior to the inferior pubic rami</li>
- +<li>it is not advised to collimate too tightly laterally in case of missing bowel loops and/or organs <sup>1</sup>
- +</li>
- +</ul></li>
- +<li>
- +<strong>orientation</strong><ul><li>portrait</li></ul>
- +</li>
- +<li>
- +<strong>detector size</strong><ul><li>will vary depending on the child's body habitus</li></ul>
- +</li>
- +<li>
- +<strong>exposure <sup>2</sup></strong><ul>
- +<li>60-75 kVp</li>
- +<li>2-10 mAs</li>
- +</ul>
- +</li>
- +<li>
- +<strong>SID</strong><ul><li>100 cm</li></ul>
- +</li>
- +<li>
- +<strong>grid</strong><ul><li>if patient thickness is above 10 cm, use of a grid is advisable <sup>2</sup>
- +</li></ul>
- +</li>
- +</ul><h4>Image technical evaluation</h4><ul>
- +<li>include the<ul>
- +<li>lateral abdominal wall</li>
- +<li>inferior pubic rami inferiorly</li>
- +</ul>
- +</li>
- +<li>
- +<strong>must </strong>include the diaphragm superiorly</li>
- +<li>the abdomen should be free from rotation with symmetry of the:<ul>
- +<li>ribs (superior)</li>
- +<li>iliac crests (middle)</li>
- +<li>
- +<a href="/articles/obturator-foramen">obturator foramen</a> (inferior)</li>
- +</ul>
- +</li>
- +<li>no blurring of the bowel gas due to respiratory motion</li>
- +</ul><h4>Practical points</h4><ul>
- +<li>it may be useful to position the patient so that they can see their parents in order to reduce anxiety</li>
- +<li>paediatric patients may feel uncomfortable when bony landmarks are felt for, therefore an appropriate explanation to the patient beforehand is ideal for improving patient comfort</li>
- +<li>to achieve sufficient inspiration, using child-appropriate language will be useful<ul><li>e.g. 'breathe in as if you are about to go diving underwater!', 'breathe in as if you are about to blow out a birthday candle!'</li></ul>
- +</li>
- +</ul><h5>Immobilisation techniques</h5><p>It is important for the image to be free from movement artefact and rotation to avoid repeated x-rays.</p><ul>
- +<li>it may be necessary for the parent or radiographer to stand with the patient or hold them in position</li>
- +<li>sometimes it is only necessary to keep the child's arms away from the abdominal area; in these cases, asking the child to hold onto something to their side (e.g. toy, mother's hand, pole) may be useful. </li>
- +<li>techniques will vary based on the department</li>
Images Changes:
Image 1 X-ray (Lateral) ( create )
Image 1 X-ray (Lateral) ( create )
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