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Plain Films - Chest

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General

  • Routine chest exams are to be taken in the erect  PA position if possible.

  • INSPIRATION: CXR should be on Inspiration -5-7- ant ribs should be visible on the PA.
  • LATERAL: L Lat is taken routinely. Lat should include the posterior angles of both lungs.
  • If child is uncooperative and impossible for caregiver(s) to hold, you can resort to supine and decubitus or rolled lat.
  • Very small babies (approx under 3 mths) can also be done supine.
  • Use maximum FFD and label images appropriately.
  • If any doubt please check images with radiologist before doing repeats.
  • Holding Patients: Ensure caregiver is over 18, not pregnant and wearing Pb apron. If caregiver pregnant, or patient needs 2 restrainers, phone referring area eg CED or OP for nurse to help
  • The code of practice (NRL C5) recommends that 'non radiation personnel' be used to hold patients in preference to MRTs (NRLC5, P9, 3.23)
  • Extra restraint must be documented in Quadrat as product EXT
  • Use NP cassettes or DR plate

Immigration CXR 

  • Immigration chest x rays will only be taken on Patients with refugee status
  • No Immigration chests will be taken on other patients or staff member.
  • If you are the MRT or Radiologist undertaking CXR or report you must verify the identity of the patient and the request form against a suitable photo ID eg passport.
    MRT & Radiologist must fill in the portion of the immigration form set aside for this purpose
Clinical Indications Views Required Comments
All new patients
Cystic Fibrosis
Oncology Patients
PA & Lateral   
TB & Cardiology
New Patients
Follow up  

PA  & Lateral
PA only  
Must have had PA & Lat in last 6 mths
Post surgery or PDA closure PA & Lat 
Inhaled Foreign Body PA Insp & Exp
Lateral  
Label Films Insp & Exp
Show Radiologist
Central line position Supine AP to include neck  
Naso-gastric/jejunal tube position Supine AP to include upper Abdo  CFU protocol for all new NG insertion
Ribs: Upper
Ribs: Lower
PA & LAT + R & L obliques
PA & Lat Chest + AP upper Abdo 
 
Epiglottitis or Croup PA & LAT (erect)
Soft Tissue Lat neck 
Do not lie patient supine  - may obstruct airway 
It is possible to lie patient lateral if difficult to obtain x ray erect 
Pleural effusion PA/LAT erect
Initially
PA erect only as follow up  
Decubitus (fluid side down) may be requested by
Radiologist /Consultant
Pneumothorax PA erect on inspiration  Show radiologist initial films to see if more required
Sternum   Lateral Radiologist may require oblique
RAO 45deg erect
Or supine LPO
 Portable CXR  Supine  See separate protocol

Portable Chest Xray

PICU

  • Infants: Most babies in PICU are on heat tables or beds that provide a space under the table for x-ray film. The NP cassettes show artefact when using these so try to put cassette directly under the patient with a minimum of extra sheets and wrappings. Always use Pb letters.
  • Check to see what kind of extra mattress might be under baby eg spenco, water blanket
  • If water blanket, put film on top of this IF POSSIBLE
  • ALWAYS check with nurse before moving baby
  • Remove as many leads and lines as possible from the area of interest
  • Position tube (you may have to carefully move overhead booms and /or heaters)
  • Set exposure (refer to previous exp in book)
  • Give Pb apron to holder
  • Announce that you are about to take an x ray so  other people can leave the room
  • Position baby only when everything else is ready
  • Film taken supine unless otherwise specified, Lat not normally done
  • IF patient on ECMO do not move   - may need to do x ray prone 

Older Patients:

  • Post op spine patients need to be carefully moved - be led by nurses. If possible put film in cassette holder /slider and slide under patient or under one mattress eg spenco
  • Prepare everything else before positioning patient
  • Film taken supine unless otherwise specified.

Baseline CXR pre bone marrow transplant:

  • These must be done in the BMTU with the patient supine
  • Subsequent films have to be exactly comparable eg also supine
  • Xray machine must be cleaned before entering BMTU and MRT to wash hands and gown up as per ward protocol. No colds or germs allowed.

Sternum

The sternum can be difficult to visualise because of its position in relation to the thoracic spine and ribs, so it is necessary to do an oblique (RAO) and use a breathing technique with a long time exposure.

  • If patient can stand:
    RAO (Left side raised) about 20-30-deg depending on the depth of patient's chest sternum centred to cassette.
    EXP: Low KV  60-70
             Low mA  eg 40
             Long time eg 500ms
             In bucky with grid
    LATERAL: film beside chest, shoulders back, coned to include whole length of sternum
    EXP: as for lat chest, on deep insp.                                                                 
  • If patient unable to stand:
    You can do an LPO (instead of RAO) using same exposure technique and shoot through lateral

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Document Control

  • Date last published: 23 August 2017
  • Document type: Imaging Protocol
  • Services responsible: Paediatric Radiology

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