Transcript Pediatric Radiography 2

Pediatric Radiography 2
Chest AP
Technical Factors
• IR size—determined by the size of the patient
• IR crosswise (if supine, place cassette under patient)
• Grid not required
• Small focal spot
• 70 to 80 kV, shortest exposure time possible
Shielding
Contact lead shielding should be placed over the pelvic
area with upper margin to level of iliac crests.
Patient Position—With Patient Supine
• Patient is supine, arms extended to remove scapula from the lung fields.
• Arms are secured to the table with sandbags or Velcro straps if Tam-em
board is used.
• Legs are extended to prevent rotation of pelvis. Hips and legs are
secured by placing sandbags at the level of the hip to the top of the knee.
If a Tam-em board is used, hip and legs are Velcro strapped to the board.
• With parental assistance (if parent is not pregnant), do the following:
1.Have parent remove child's chest clothing.
2.Provide parent with lead apron and gloves.
3.Place child on the IR.
4.Parent should extend child's arms over head with one hand while
keeping head tilted back to prevent superimposing upper lungs. With other
hand, hold child's legs at level of the knees, applying pressure as
necessary to prevent movement.
5.Place parent in a position that will not obstruct technologist's view of
patient while exposure is made.
6.Place lead gloves over the top of the parent's hands if parent is not
wearing the gloves. (It may be easier to hold on to the patient if not
wearing the gloves.)
Part Position
• Place the patient in the middle of the IR with the shoulders 2 inches (5 cm) below
the top of the IR.
• Ensure that the thorax is not rotated.
Central Ray
• CR perpendicular to the IR, centered to the midsagittal plane at the level of
midthorax, which is approximately at the mammillary (nipple) line
• SID of 50 to 60 inches (127 to 212 cm); tube raised as high as possible
Collimation
Closely collimate on four sides to outer chest margins.
Respiration
Make exposure upon second full inspiration. If child is crying, watch respiration and
make exposure immediately after the child fully inhales.
.
Patient Position—With Patient Erect
• Patient is placed on seat with legs down through center opening. Adjust
seat to correct height so top of IR is about 1 inch (2.5 cm) above
shoulders.
• Arms are raised and side body clamps are placed firmly against patient
and are secured by base adjustment and adjustable strap.
• Lead shield is raised to a level about 1 inch above iliac crest.
• Correct R and L markers and “insp” (inspiration) marker are set to be
exposed on lower image.
• Ensure no rotation
Central Ray
• CR perpendicular to IR at level of midlung fields (at mammary line)
• SID of 72 inches (180 cm)
Collimation
Collimate closely on four sides to outer chest margins.
Respiration
If child is crying, watch respiration and make exposure as child fully
inhales and holds breath. (Children can frequently hold their breath on
inspiration after a practice session.)
Radiographic Criteria
Structures Shown: • Entire lungs should be included from apices (C7T12 level) to costophrenic angles. • The air-filled trachea from T1 down is
demonstrated, as well as the hilum region markings, heart, and bony
thorax.
Position: Chin is sufficiently elevated to prevent superimposition of
apices. • No rotation, as evidenced by equal distance from lateral rib
margins on each side to the spine and distance from both SC joints to the
spine. • Full inspiration—visualizes 9 (occasionally 10) posterior ribs
above diaphragm on most patients.
Collimation and CR: • Collimation margins on all four sides with equal
margins on top and bottom, indicating a correct CR location to midlung
fields (T6 or T7).
Exposure Criteria: • Sufficient lung contrast to visualize fine lung
markings within lungs. • Faint outlines of ribs and vertebrae visible
through heart and mediastinal structures. • No motion, as evidenced by
sharp outlines of rib margins, diaphragm, and heart shadows
Lateral Chest
Technical Factors
• IR size—determined by the size of the patient
• IR lengthwise under patient (unless horizontal beam is taken on Tamem board)
• Grid not required
• Small focal spot
• 75 to 80 kV, shortest exposure time possible
Shielding
Contact lead shielding should be placed directly over pelvic area with
upper margin at the top of the iliac crest.
Patient Position—With Patient Recumbent
• Patient is lying on side in true lateral (generally left lateral) position with
arms extended above head to remove arms from lung field. Bend arms at
the elbows for patient comfort and stability with head placed between
arms.
• Place one sandbag across arm that is closest to the IR.
• Place a second sandbag over the top of the upside humerus.
• Place a third sandbag between the legs at the level of the knee while
bending the legs forward.
• A fourth sandbag is placed across the top of the hips to further immobilize
the patient.
• If a Tam-em board is used, patient position does not change from the AP
projection. Turn x-ray tube for horizontal beam projection, and place
vertical cassette against the lateral wall of the chest as shown .
• If parental assistance is required, perform the following steps:
Central Ray
• CR perpendicular to the IR centered to the midcoronal plane
at the level of the mammillary (nipple) line
• With use of Tam-em board, the x-ray tube centered in horizontal
beam lateral position to midcoronal plane of thorax at level of
mammillary line
• SID of 50 to 60 inches (127 to 212 cm)
Collimation
Closely collimate on four sides to outer chest margins.
Respiration
Make exposure upon second full inspiration. If child is crying,
watch respiration and make exposure when the child fully inhales.
Patient Position—With Patient Erect
• Patient is placed on seat and adjusted to correct height so top of film
holder is about 1 inch (2.5 cm) above shoulders.
• Arms are raised and side body clamps placed firmly against patient and
secured by base adjustment and by adjustable strap.
• Lead shield is raised to a level about 1 inch (2.5 cm) above iliac crest.
• Correct R and L markers and inspiration marker are set to be exposed on
image.
• Ensure that no rotation exists.
Procedure if lateral follows PA projection: If patient is already in position
from the PA projection, then patient and swivel base are turned 90° to lateral
position. Lead shield remains in position, and lead marker is changed to
indicate correct lateral. IR is placed in film holder mount.
Central Ray
• CR perpendicular to IR at level of midthorax (mammillary line)
• SID of 72 inches (180 cm)
Collimation
Collimate closely on four sides to outer chest margins.
Respiration
If child is crying, watch respiration and make exposure as child fully inhales
and holds breath
Radiographic Criteria
Structures Shown: • Entire lungs from apices to costophrenic
angles and from sternum anteriorly to posterior ribs.
Position: • Chin and arms should be elevated sufficiently to prevent
excessive soft tissues from superimposing apices. • No rotation
should exist; bilateral posterior ribs and costophrenic angles should
be superimposed.
Collimation and CR: • Collimation borders on four sides with near
equal margins on top and bottom with CR to midlung fields.
Exposure Criteria: • No motion is evidenced by sharp outline of
diaphragm, rib borders, and lung markings. • Sufficient exposure to
faintly visualize rib outlines and lung markings through the heart
shadow and upper lung region without overexposing other regions of
the lungs.
AP and Lateral Upper Limbs
Technical Factors
• IR size determined by the size of the patient
• Grid not used for any body part smaller than 10 centimeters
• Extremity/detail screens used if available
• Small focal spot
• 55 to 65 kV, shortest exposure time possible
Shielding
Secure or place lead shield over entire pelvic area.
Patient Position
• Place patient in the supine position.
• Immobilize patient body part not to be radiographed either on the Tamem board or with sandbags before the part to be radiographed is
positioned.
• When radiographing a long bone, place IR under the limb to be
radiographed, including both proximal and distal joints.
• When radiographing a joint, place IR under the joint to be radiographed,
including a minimum of 1 to 2 inches (2.5 to 5 cm) of proximal and distal
long bones.
Immobilization
Immobilize the hand, forearm, and humerus with tape or
compression band, or have parent immobilize while wearing lead
gloves.
Central Ray
• CR perpendicular to the IR directed to the midpoint of the part to
be radiographed
• Minimum SID of 40 inches (100 cm)
Collimation
Collimate closely on four sides to area of interest
Radiographic Criteria
Position: • Generally two views 90° from each other should be obtained.
(An exception is the hand requiring a PA and oblique.)
Collimation and CR: • Collimation borders should be evident on four
sides without cutting off essential anatomy.
Exposure Criteria: • No motion is evidenced by sharp trabecular
markings and bone margins. • Optimal exposure demonstrating soft
tissue and joint space regions without underexposing the more dense
shaft regions of long bones
AP and Lateral Lower Limbs
Technical Factors
• IR size determined by the size of the body part to be radiographed, IR crosswise
• Grid not necessary for infants and small children
• 60 to 70 kV, shortest exposure time possible
• Small focal spot
Shielding
Male or female gonadal shields correctly placed so as not to obscure hips and
proximal femora
Patient Position and Central Ray
AP and lateral
• Patient is supine with IR under patient centered to affected limb or placed
diagonally for bilateral limbs if needed to include entire limbs from hips to feet.
• Immobilize with tape and/or compression band, or have parent hold leg in position
with one hand on the pelvis above the hip region and one hand holding the foot
(wearing lead gloves and apron.)
• For lateral, rotate leg externally and immobilize with tape, or have parent hold as
for AP projection.
• For bilateral limbs, abduct both limbs into “frog-leg” position. Immobilize with tape
or compression band across knees and/or ankles.
• CR is perpendicular to mid area of limbs.
• Minimum SID is 40 inches (100 cm).
KUB abdomen,
AP erect
Lateral and dorsal decubitus
Technical Factors
• IR size—determined by the size of patient, IR lengthwise
• High-speed film-screen
• Moving or stationary grid, if 10 cm or larger
• 65 to 85 kV NB to 18 years, shortest exposure time possible
Shielding
• Gonadal shield on all males—size appropriate for age (tape shield in
place)
• No gonadal shielding on females
Patient and Part Position
• Patient is supine, aligned to midline of table and/or cassette.
• Immobilize with soft flexible sandbags and compression band.
Newborns and young infants
• Position the arms away from the body and mold a large flexible
sandbag over each arm. Because it is difficult to straighten the little,
short legs of infants, place one sandbag under their knees and another
over the top to immobilize their legs. Babies, if they feel snug and warm,
are usually calm unless they are in pain. If a baby is crying, a pacifier
may help and will not interfere with the exam.
Infants and toddlers
• Restrain the arms the same as for younger infants. Place a sandbag
under the knees and tighten a compression band over both femora and
knees. Be sure to place padding under the band so that it does not cut
into the child's legs. Compression bands on most x-ray tables are
designed for adults, so this restraint works best if the spaces between
the band and the patient are padded with foam sponges or towels.
If parents are providing assistance, do the following:
•Provide parent with lead apron and gloves.
•Position tube and cassette and set exposure factors before
positioning.
•Position patient so that technologist's view is not obstructed.
•Usually, it is necessary to have a parent hold only the child's arms.
The legs can be satisfactorily immobilized as described above.
Central Ray
• With infants and small children, CR and cassette centered 1 inch (2.5
cm) above the umbilicus
• With older children and adolescents, CR centered at the level of iliac
crest
• Minimum SID of 40 inches (102 cm)
Respiration
• With infants and children, watch the breathing pattern. When the
abdomen is still, make the exposure. If the patient is crying, make the
exposure as the baby takes a breath to let out a cry.
• Children over 5 years of age usually can hold their breath after a practice
session.
Radiographic Criteria
Structures Shown: • Soft tissue border outlines and gas-filled
structures such as the stomach and intestines, calcifications (if
present), and faint bony skeletal structures are shown.
Position: The vertebral column is aligned to the center of the
radiograph. • No rotation should exist: pelvis, hips, and lower rib cage
should be symmetric.
Collimation and CR: Collimation borders from symphysis pubis to
diaphragm and to bilateral borders of abdomen.
Exposure Criteria: No motion should be evident, and diaphragm and
gas patterns should appear sharp. • Optimal contrast and exposure will
visualize bony structure outlines such as ribs and vertebrae through
abdominal contents without overexposing gas-filled structures.
AP Erect
Respiration
• With infants and children, watch the breathing pattern. When the
abdomen is still, make the exposure. If the patient is crying, make the
exposure as the baby takes a breath in to let out a cry.
• Children older than 5 years of age usually can hold their breath after
a practice session
Radiographic Criteria
Structures Shown: • Entire contents of abdomen, including gas
patterns and air-fluid levels and soft tissue if not obscured by
excessive fluid in distended abdomen.
Position: • The vertebral column is aligned to the center of the
radiograph. • No rotation should exist: pelvis and hips should be
symmetric.
Collimation and CR: • Collimation to borders of abdomen from
symphysis pubis to diaphragm.
Exposure Criteria: • No motion should be evident, and diaphragm
and gas pattern borders should appear sharp. • Bony pelvis and
vertebral body outlines should be evident through abdominal
contents without overexposing air-filled structures.
Lateral Decubitus and Dorsal Decubitus
Lateral decubitus
• Patient on side on a radiolucent foam block with back against IR
• Horizontal CR directed to 1 inch (2.5 cm) superior to umbilicus
Dorsal decubitus
• Patient is supine on a rectangular radiolucent foam block.
• Legs are immobilized with sandbags as for a supine AP abdomen.
• Gently pull arms above head and ask parent to hold arms and
head with newborn or small infant.
• Place IR lengthwise, parallel to the midsagittal plane against side
of patient (support with cassette holder device or with sandbags).
Radiographic Criteria (Dorsal Decubitus)
Structures Shown: • Abdominal structures in the prevertebral
region as well as air-fluid levels within abdomen; diaphragm
included superiorly and pelvis and hips inferiorly.
Position: • No rotation should exist: posterior ribs should be
superimposed.
Collimation and CR: • At least minimal collimation borders should
be visible on four sides, with center of collimation field (CR) to
midcoronal plane, midway between diaphragm and symphysis
pubis.
Exposure Criteria: • No motion should be evident, and diaphragm
and gas patterns should appear sharp. • Abdominal soft tissue detail
should be visible without overexposing gas-filled structures. • Faint
rib outlines should be visible through abdominal contents