Pediatric Radiology

What should you try to do with the child before entering the room?

Talk and try to make friends with the child

The success of pediatric radiology is dependent on what two things?

• techs attitude and approach to the child

• techs preparation in the room

What is the pre-exam preparation for pediatrics?

• immobilization and shielding devices

• cassettes and film markers

• specific positioning routine

• role of team radiographers

• patient preparation

True or false: children do not reach a sense of understanding at a specific predictable age

True

By what age can children generally be talked through a diagnostic study without aid from parent or immobilization?

2-3

What are the steps you should take after bringing the parent and child into the x-ray room?

• introduce yourself to both the pt and the parent as the tech who will be doing the exam

• find out what info has been shared with them by the physician

• explain what you will be doing and what you will require from the pt (including immobilization)

What are the three roles the parent can have?

• parent is in the room has an observer/comforter

• parent is a participant who assists in immobilization

• parent is asked to wait in the waiting room

If the parent is participating in immobilization, what all should you explain to them?

Explain exactly what you need them to do, a lot of the time the parent won’t hold the child tightly for fear of hurting them, so explain the probability of repeats if not done properly

How can you protect your child when imaging them?

• always have supervision of a young child

• don't leave the room unless caretaker or another tech are in the room with them

• use immobilization devices only when necessary

What is the term used to describe a child who might be a victim of abuse?

Battered child syndrome (older), non accidental trauma (used today)

What is the techs role when it comes to reporting child abuse?

• not their job to make a judgement as to whether or not NAT has occurred, just report the facts

• techs should know what their responsibilities are concerning this in the state they are working in

What should you look for when there is suspected abuse?

• child may tell a different story than caretaker

• numerous bruises, cigarette burns

• parent not willing to leave child (especially teenager)

• several fractures seen on radiographs

  • rib fx

  • corner fxs or bucket fx on limbs

  • fx’s that don’t align with the story

• child tries to hid injuries

• child fearful of adults or overly compliant

• child extremely violent or says inappropriate comments

Who should you report any suspected abuse to?

Radiologist or physician

What are the radiographs typically ordered if suspect abuse case?

• lateral and AP skull

• complete AP and lateral spine

• AP humerus, forearm, wrist, and hand

• AP pelvis

• AP femur and tib/fib, feet

• AP and lateral ribs

What could your facility want when imaging for suspected abuse?

Leave collimation open to catch incidental findings

How must you act towards your patients parents if there is a suspected abuse case?

• remain calm and give the parent the same courtesy as any other parent

• remain nonjudgmental (the abuser may not be the person who brought the child in)

What are the six types of abuse?

• neglect

• physical

• sexual

• psychological

• medical

• other

What ages are included in pediatric pts?

Infants through the age of 12-14

If you are imaging an older child, they are treated more like adults except when it comes to what?

Gonadal shielding and reduced exposure factors according to their size

What type of technique should you always use when imaging pediatrics?

Short exposure times and as high of mA as allowable for an optimal image

Why do you want short exposure times and as high of mA as allowable for peds?

To minimize motion

What are the two main types of immobilization devices?

• tan-em-board (papoose/brat board)

• pigg-o-stat

What are some other common immobilization devices used?

• tape

• sheets or towels (mummifying)

• sandbags

• sponges

• compression bands

• stockinettes

• ace bandages

When can you not use a pigg-o-stat?

When the child cannot hold their head up on their own

How can you reduce patient motion in peds?

• good communication

• immobilization

• short exposure time

What type of immobilization device is this?

Tam-em-board

What type of immobilization device is this?

Pigg-o-stat

What type of immobilization device is this?

Tape

What type of immobilization device is this?

Sandbags

What type of immobilization device is this?

Stockinette and ace bandage

What type of immobilization device is this?

Compression band and head clamps

What type of immobilization device is this?

Weighted angle blocks

What type of immobilization device is this?

Mummifying

What are the steps for mummifying?

• prepare sheet

• place patient and immobilize right arm

• immobilize left arm and wrap body

• pull sheet tightly

• tape sheets at arms

• immobilize legs, tape sheet at knees

Primary centers of bone formation involve what area?

Mid shaft area and appear before birth

What is the diaphysis of long bones?

Primary centers of bone formation that involve the mid shaft area

What are the ends of diaphysis called?

Metaphysis

What is the metaphysis?

Area where bone growth occurs

What is the epiphysis?

secondary center of bone formation that involves the ends of long bones

What is the epiphyseal plate?

Space between the diaphysis and epiphysis, made up of cartilage

The reduction of what is critical in young children whose developing cells are particularly sensitive to the effects of radiation

Repeat exposures

What will reduce your chances of repeats in pediatrics?

Proper immobilization and short exposure times

True or false: accurate technique charts with body weights should be used

True

True or false: most examinations for pediatrics will have reduced views for children under a certain age

True

What type of gonadal shielding should be used for children?

Contact type

What other safeguards should be used and explained to the parent?

Close collimation, low dosage techniques, and a minimal number of exposures

What should be given to the parent if they are staying in the room during a child’s exam?

Radiation protection such as aprons and lead gloves

True or false: you should make sure that the person staying with the child is not pregnant

True

What all should be removed off the child before the exam and why?

Any clothing, bandages, embroidery, buttons, and diapers because due to the low exposure factors, these will show as artifacts

Salter-Harris fractures

• involve the epiphyseal plates, classified based on the location of the fracture and the involvement of surrounding anatomy

What is type I of salter-harris fractures?

Transverse fracture along the epiphyseal plate; may involve slipping of the epiphyses such as seen with slipped capital femoral epiphyses

What is type II of salter-harris fractures?

Fracture though the metaphysis and epiphyseal plate

What is type III of salter-harris fractures?

Fracture through the epiphyseal plate and epiphysis

What is type IV of salter-harris fractures?

Fracture though the metaphysis, epiphyseal plate, and epiphysis

What is type V of salter-harris fractures?

Compression fracture of the epiphyseal plate

What does NICU stand for?

Neonatal Intensive Care Unit

NICU

• special care for infants that are considered high-risk

• usually premature birth

• inquire on isolation procedure before working on infant

• sanitize equipment

• nurse will sometimes assist

• watch lines and catheters

What is the greatest danger to premature infants?

Hypothermia

True or false: infants can tolerate minimal movement without their heart rate become irregular

True

Whenever possible, how should chest x-rays be done?

Erect (if they can hold their head up)

How can the lateral chest x-rays be done on infants?

• pt on side

• pt on back and shoot through (x-table)

If you’re using AEC on infants what should you be sure to do?

Decrease your kVp

Where is your CR for chest x-rays?

To mid thorax (mammary line)

How many ribs should you see on a peds chest x-ray?

Minimum of 8-9 ribs

What size IR should you use for peds chest x-rays?

10 × 12

What can you sometimes do for extremities on infants?

Can sometimes be done in one shot

What should you do if your patient has clubfeet?

Do not attempt to straighten abnormality, just shoot as is

What views should you do on a patient with clubfoot?

Two projections at 90 degrees from each other

What is another name for club foot?

Bilateral talipes varus

What will typically be ordered for the pelvis and hips?

Pelvis and bilateral frog leg

What should always be removed for pelvis and hip peds imaging?

Diaper, snaps, other artifacts

What can you use for the upright abdominal x-rays?

Pigg-o-stat

What can you use for the flat plate abdomen x-rays?

Brat board

Where is your CR for infants for KUB x-ray?

1 inch above umbilicus

Where is your CR for children for a KUB x-ray?

1 inch above iliac crest

When do you exposure for the AP erect abdomen on a child?

On expiration

How many techs should you have when doing headwork on a child?

Two

Where is your CR for a AP skull projection on a child?

Parallel to OML

What might you have to do to your barium for a child?

Diluted

Who puts the tip in when doing a BE on a child?

Radiologist

What should you do with the child before beginning a fluoro procedure?

Demonstrate how it works and explain it to them

How much barium should be used for an upper GI study on a NB- 1 year old?

2-4 oz

How much barium should be used for an upper GI study on a 1-3 year old?

4-6 oz

How much barium should be used for an upper GI study on a 3-10 year old?

6-12 oz

How much barium should be used for an upper GI on a child over 10 years?

12-16 oz

What views are typically done on a child for a barium enema?

• start with pt supine

• left lateral

• LPO

• RAO

• right lateral

• end on prone

Who should start the IV on a child for urography?

The best in the department (or call lab)

Contrast for IVUs for children depends on?

Body weight, usually 1 cc per pound

What does a bone age study determine?

Skeletal maturation in children

What views are typically done for a bone age study on a child?

• left PA hand/wrist

• sometimes AP of the knee