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Plain Films - Radiography in the NICU

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Technical advice

  • Use the highest resolution imaging cassettes available (DXG Needle Phosphor at SSH)
  • Tubes, catheters and wires on and under the chest and abdomen should be displaced, as much as possible, from the area of interest. 
  • Collimation is important but make sure you include clavicles and apices for a Chest film. See below for advice on collimation for specific indications.
  • Take the x-ray with the baby in the incubator - ensure Perspex is clean and avoid bends and holes in Perspex. Place cassette under baby with a minimum of cloth (wraps, nappies) to cover cassette. Do not use tray in incubator. There is too much artifact from mattresses and other bedding and significant magnification. 
  • Imaging must be accurate and straight - have NICU nurse hold baby.

Chest/Abdominal films

  • Chest films:  The first films include an AP chest and a rolled lateral, unless there are mitigating circumstances (such as baby too unstable to be handled excessively). If required the naso- or oro- gastric tube should be present for the first images. If the tube has not already been inserted, please ask the nursing staff to insert before taking the x-rays. 
  • Lateral chest  radiographs are not routinely required for subsequent x-rays unless for a specific indication such as checking on the position of chest drains. These lateral films can be done as a shoot through lat so baby is not lying on the tubing.
  • Umbilical lines (UAC/UVC) assessment.
    AP film that includes the abdomen and chest.
    Lateral Chest film, from umbilicus to apices. Unless there is a compelling reason to include the lumbar spine, such as suspected spinal anomalies, please don't re-irradiate the lower abdomen. Rolled lateral unless baby too unstable to move. 
    If a UVC is manipulated a repeat film should be taken to ensure the UVC is not malpositioned. Sometimes only a single view (AP or Lateral) may be requested.
  • Abdominal films: in cases of suspected obstruction or NEC
    AP view
    Left side down decubitus that must include the Right hemi diaphragm /and Right lower chest. Lateral shoot through abdomen only if baby too fragile to be turned on to side.
  • Additional films for abdomen:
    In low bowel obstruction a prone abdominal film can be helpful.
    If a prone shoot through lateral rectum film is requested (for imperforate anus), wait a few hours (ideally 12 or more) after birth so air has time to filter as far as it can. The baby should be prone for 15minutes prior to imaging to allow for maximal distention.
    In suspected meconium peritonitis a lateral abdominal film to assess for peritoneal calcification is helpful.
  • Long lines: 
    • For long lines inserted below the groin, a babygram (AP chest and abdominal) film and lateral abdomen to lower chest. The long line should reach the IVC. If the line has a wavy contour or deviates medially at the lumbar spine it may be malpositioned and a lateral film may be of help.
    • For long lines inserted from arms or head, an AP chest with head turned away from site of insertion. Make sure ECG lead is not near the medial clavicle on that side. It is not necessary to image the limb into which the line is inserted. Do not raise arm.
    • Contrast is not routinely used.
      If the line tip is difficult to see a lateral film may help
      Failing that contrast may be required (the registrar or NS-ANP will inject 0.5 -1.0 ml of non ionic contrast using sterile technique) Take care with positioning as line /syringe etc should remain sterile.
    • If a long line tip is in the heart (especially if curled) and needs to be withdrawn, repeat films including a lateral should be taken to ensure the line is not malpositioned.
      If a long line is repositioned for any reason, repeat films including a lateral may be required to ensure the line is not malpositioned.

Skeletal Survey

Infection

  • Babygram to include chest, abdo, shoulders, hips 
  • Both arms AP 
  • Both legs AP 
  • Hands, feet, spine, skull only if there is local swelling or erythema

Syndromic /dysmorphic 

  • AP and Lateral skull 
  • Chest AP & Lateral (includes thoracic spine)
  • Lateral lumbar, sacral and cervical spine 
  • Abdomen/pelvis 
  • Left leg, foot, arm, hand (Right only if there is definite asymmetry)

Post Mortem

Preterm

  • Babygram/AP whole body (tape to position)
  • Lateral whole body
  • Ensure good hand and feet images

Term

  • Whole body skeletal survey 

Processing (SSH)

  • Select neonatal study group 
  • Should default to 200 speed class

Contact Details

Radiographer
Starship MRT. Dept 25130 or 021 893 997

Radiologist
0800-1700 weekdays SSH Radiology Reception 25134
1700-0800 weekdays/ and all day Sat/Sun/Public Holidays

On call Radiology Registrar 021 412 581
On call Paediatric Radiologist via operator.

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Document Control

  • Date last published: 12 September 2018
  • Document type: Imaging Protocol
  • Services responsible: Paediatric Radiology
  • Review frequency: 2 years

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