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Plain Films - Neck and Nasopharynx

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Lateral Neck

  • Sit the patient beside the chest holder as for lat chest. 
  • Position Cassette to include nasopharynx and trachea.
  • Two assistants are necessary - one to hold child's arms and pull down on shoulders and one to hold the child's head still in lateral position with neck slightly extended.
  • Expose in inspiration.
  • Alternatively you can lie patient on side 
  • NB: If there is any concern re child's airway being at risk ensure nurse or ED Dr accompanies patient to Radiology

Adenoids /Nasopharynx 

(if request mentions 'snoring')

  • Patient positioned as above but exposure centred on and coned to nasopharynx and more penetrated than lat neck 
  • Cassette should be positioned at side of head but do not turn the neck to achieve this, elevate chin instead.
  • Expose on normal inspiration, if possible breathing through nose, with mouth closed NOT VALSALVA 
  • NB a lateral chest exposure at 180cm FFD is appropriate for lat neck

Nasopharynx etc for ingested foreign body

  • Lie patient supine with head turned to side.
  • Include nose to anus on one film if possible. If not - make sure there is overlap. 
  • If suspected FB is of low density (e.g. Aluminium can tab), proper lat neck and lat CXR may be needed to visualise FB if not seen on initial film. 
  • If FB has been poked up nose: Lat nasopharynx 1st -if can't see FB, proceed to CXR/AXR

Epiglottis

Rarely seen these days - should not need imaging, clinical management more appropriate. If CED insist :

  • Do not lie patient supine.
  • If patient does have epiglottitis the epiglottis can fall back and block the airway completely. 

Croup

  • Should not need imaging 
  • As above -if possible have patient perform valsalva technique

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Document Control

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

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