LO4 RDGR 203 - Practice pediatric positioning

What is an important safety concern for infants and toddlers?

Ensure small items (like directional markers) that could be swallowed are out of reach

What is an important consideration when positioning and moving infants?

Always support infants head and neck

Can you leave children unattended in the radiology rooms?

NO

What are 3 key ways to reduce pediatric radiation exposure in regards to general and fluoroscopic xray?

• be precise with exposure factors, positioning, centering, and collimation

• opt for PA rather than Ap projections of the thorax and skull to reduce lens and breast exposure

• use a pulsed fluoroscopic beam and “last image hold” (to avoid taking spot films)

What is the age range to ask female patients for possible pregnancy?

10-55 years

What age range is considered neonatal?

0-28 days old

What is the greatest danger to premature infants?

Hypothermia

How are premature infants specially protected?

the use of an isolate prevents hypothermia, and the utilization of isolation protocols reduce risk of infections

how old is considered infant?

28-18 months

how old is considered toddler?

18 months to 3 years

how old is considered a preschooler?

3-5 years old

how old is considered school age?

6-12 years

What is valuable to toddlers?

The participation of their parents

What is the best way to keep a preschooler engaged?

Treat the situation like a game, praise the child, use analogies, and constantly reassure the child. Explain and talk to the child at eye level

How should adolescents be treated?

Treated like adults

How should special needs children over the age of eight be treated?

Just like their peers, talk to the child first.

What is important to remember about physically disabled children?

They know what works best for them, they know their abilities best

When approaching a parent of a child who will be having an x-ray examination, what two guidelines should be followed when explaining the exam?

• If the child is capable of understanding direct explanation to him or her

• If the child is too young to comprehend, direct the explanation to the parent

What factors will determine the amount of parent participation in their child’s x-ray examination?

• The general philosophy of the department

• The wishes of the parent

• The laws of the province or state regarding radiation protection

What functions can the parent assist within the radiographic room?

• Watch the child

• Assist with immobilization

• Can witness the procedure - i.e. for professional conduct

• Assist in explaining the procedure to the child

State how you would approach a three-year-old with an explanation of a procedure.

Smile, bend down to talk to the child at his/her level, praise the child and speak to child in a language they will understand

What are the basic needs of an infant? 

Warmth, security and nourishment

What should be avoided with infants? 

loud noises (and sudden movement)

What are the fears of a child six months to three years of age?

Separation from parent and limitation of movement

What age group would respond to making a game of the radiographic procedure? 

3 to 5 years

What age group is concerned with their modesty?

Adolescents (or like anyone beyond 6 years old bruh)

What the is shape of a new born baby body

round

How are techniques changed for newborn babies AP and lateral chest, and abdomen

they dont need to change (round baby)

At what age does the torso become wider than thick?

6 months

What is the best hack to determine technical factors for pediatric patients?

compare the body part to some portion of the average human adult

At the age of six how much on average does the technique need to be increased when moving from AP/PA to lateral?

3 to 4 times - usually adjusting kVp to limit dose

Why does an AP infant chest have a lordotic appearance?

infants have not developed the natural kyphotic curvature of the T-spine

What change in kV is required for every 1cm of increase in tissue thickness? 

Increase by kV by 2 for every 1 cm

At six months how much wider is the torso than thick ISH?

4cm (double the exposure) > add 8kVp (15%)

What is the best way to increase exposure factors on xrays to reduce dose?

increase kVp to the maximum acceptable for chest contrast AND then increase mAs

What are the keys methods to reduce repeats on pediatric xrays?

effective immobilization, great communication

What is parent or radiographer holding considered in pediatric positioning?

Last resort!! unneeded dose to staff/general public

How do we adjust technical factures to limit motion artifact?

Use high mA and short exposure time

How thick anatomy requires grid?

greater than 10-12cm

For every 4cm increase of tissue thickness how is technical facture adjusted?

double the mAs

Why are only 2 abdomen projections done for pediatric xrays?

reduce the dose

What are the 2 key pediatric abdomen projections?

AP upright OR PA decubitus, Supine

What must always be removed for pediatric abdomen xrays?

Diapers and clothes

What must be included for supine neonate and infant abdomens?

both diaphragms/superior to 8th posterior rib, and inferior to pubic symphisis

What should be at the center of child/neonate/infant supine abdomens?

L4

What should be included for supine child abdomen?

both diaphragms/superior to T11 and pubic symphysis (CENTERED AT L4)

What is the centering point for AP supine infant and small child abdomen ?

1” superior to umbilicus

As children become larger where does the centering point for AP supine abdomens move?

level of iliac crests

What should be included for neonate and infant AP upright abdomen?

both diaphragms/superior to 8th posterior rib, to inferior to pubic symphysis (Center: L4)

what should be included for a child AP Upright abdomen?

Include diaphragm and T9, iliac wings > PS does not need to be included

What is AP Upright abdomen done for in children?

To look for free air

Where is the CR located for upright abdomen?

1-2” above iliac crest (depending on pt. height)

What is the best method for upright abdomen and chest image position in older children?

sit them on a stool with legs apart, feet on the ground. However standing is usually safer

What position are decubitus abdomens done?

left lateral

What should be included for neonate and infant lateral decubitus abdomen images?

both diaphragms and superior to 8rib, L4 at center

What should be included for child lateral decubitus abdomen images?

right hemidiaphragm/superior to T9, iliac wings, and the right lateral body soft tissue (to ensure free air is included)

What situations is dorsal decubitus abdomen done?

trauma, line placement localization, air-fluid levels when patient cannot be rotated

What can be added to a lateral decubitus abdomen to prevent lateral arching of spine?

sponge under the waist

When is lateral abdomen with a vertical (lateral recumbent with beam down) done?

localization of lines or foreign bodies (NO AIRFLUID levels)

What is the difference of a lateral decubitus abdomen with a vertical vs horizontal CR?

vertical shows a lateral image, horizontal shows an AP/PA decubitus

What position is done for pneumoperitoneum?

left lateral decubitus to show air against liver

What is supine and left lateral decubitus abdomen done for?

air fluid levels

What are supine and lateral abdomen x-rays done to visualize?

catheter/line placements

Why are chest radiographs hard of pediatric patients?

Difficult to immobilize and position, Scared and strong

Why are caregivers not the best at helping when their child needs an xray?

they are also scared and may not confidently hold the child firmly

What level should the CR be for pediatric chest radiographs?

T6-7, AKA the nipple line

What is included in a pediatric chest xray?

mastoid tip to just above iliac crests

why is iliac crest included in a peade chest radiograph?

to ensure inferior costal margins are included

What position is preferred for a pediatric chest?

upright to allow gravity to lower diaphragm

Where should you watch to evaluate breathing on a calm baby? (3 key checks)

abdomen expands on inspiration

ribs become outlined on inspiration

the sternum rises

where are babies arms placed in pigg-o-stat

up by their head

After a large cry what occurs?

big breath in yo

How many people should help the pigg-o-stat?

2 people for safety yo

should you lock the wheel of a pigg-o-stat?

no, the thrashing and no leeway = fall over = ow = darn more images and 5million paperwork = bad tech OR just = device move and need to reposition/retake

what are the two options for cassette placement of a pigg-o-stat?

in the build in holder, roll up to the bucky

what can be done for small chests at the upright bucky?

remove the grid when less than 10-13cm

for children ages 3-10 how should PA upright chests be done?

sitting on box or stool

How can the arms be positioned for a lateral chest radiograph?

parent could hold up, or they hold bars

If the baby is small enough to hold arms up with one hand how should they be positioned?

Hold the arms with one hand and legs with the other

what should you be careful of for neonate chest radiographs?

not to dislodge chest tubes, gastrostomy tubes, drainage tubes, IV lines

What must be ensured to prevent rotation when positioning neonatal chests?

head in true ap to align SC joints

What is the AP/PA chest technique for peadiatric patients

80-90kVp

What is visualized to indicate adequate penetration of a chest radiograph?

Recorded detail of peripheral lung markings and intervertebral disc spaces

through the heart

How to asses a pediatric chest radiograph?

Evaluate the position of midline structures ​

• Same as adults, look at SC joints, pedicles etc.​

• Symmetry of clavicles to vertebral column​

• Include apices to costophrenic angles (may ask for mastoid tips to above iliac crests –case dependent)​

• 8-9 posterior ribs visible above diaphragm is adequate for a pediatric pt.​

• Note: adults 10 posterior ribs

What needs to be removed for pediatric hip and pelvis xrays?

diapers and underwear and clothes

What are the common hip projections for pediatric hips?

AP and AP Oblique (frog leg)

What is a good way to support children’s legs when doing frog leg AP Oblique?

sponge

What is an Adren-Von Rosen view

a modified AP pelvis to look for congenital hip dislocation (dysplasia) of pediatric patients

What does a Adren-von Rosen view look like?

bilateral hip projection where both legs are abducted at atleast 45 degrees to inwardly rotated femora

Legs apart abducted and inwardly rotated

what symptoms are present with congenital dislocation of the hip?

clicking and popping sound, with a waddle-like walk

what ways do hips mostly dislocate?

anterior or posteriorly

What is included in an AP pelvis xray? How is rotation assessed?

iliac crests to proximal ¼ of the femora

• Midline structures are in the middle

• Sacrum and coccyx point to symph​ysis

• Iliac wings symmetrical

• Ala to appear the same and obturator foramen the same​

• Symmetry of skin folds (not an accurate indicator) - skinfold visibility indicates adequate techniques

• Trochanters visualized​

What kind of imaging is done to asses fractures of pediatric patients?

contralateral for comparison between # and epiphyseal plates

What is sometimes the only radiographic sign of injury?

fat pad displacement and tissue swelling

What are the common types of fractures in children?

green stick/Salter Harris/Torus

What is a Torus fracture?

an incomplete type of fracture that causes bony buldgeing and compression

What is a Salter Harris Fracture?

a growth plate fracture

What are common methods of limb immobilization for children?

• Sheets, towels and blankets for swaddling younger patients​

• Plexiglass​

• Sponges​

• Sandbags and Velcro straps​

• Parent/caregiver commonly assists with immobilization

What are common methods of immobilization for children under the age of 2?

• Swaddling –

“bunny wrap”​

• Plexiglass ​

• Sponges​

• Sandbags ​

• Velcro straps

What is a good way to prevent repeats and comfort children for limb radiographs?

Do with child sitting on the parent's lap​

• Protect parent and child properly​