Pediatric/Geriatric Radiography PPT

Preparing the room for pediatric patient

- Toys

- VCR/DVD's

- Proper lighting (not dark)

- Advance prep of technical factors

- selection of immobilization tools/IR

Communication skills with parents

- explain exam to parent

- explain exam to child with parent present

- use simple terms

- allow parent in room when possible

What are advantages of having a parent in the room for the exam?

- parent can watch the child

- tech can leave the room

- parent can assist with immobilization

- parent can confirm professional conduct

How to defuse an angry parent

- remain calm

- speak in even tone

- use understanding phrases

- escort the parent to another room if possible

How should an R.T. communicate with a pediatric patient?

- smile

- introduce yourself

- suggest rather than demand

- be firm, yet gentle

- allow choice if possible

- use sincere praise

What can be done during the exam to help keep the child calm?

- allow child to turn on collimator light

- tell child tube is a camera

- keep exam short

- create distractions for young patient

- direct communications to disabled children rather than parent

- keep toys in room

- use detailed instructions to teenagers

- be aware of teenage "body image" factors

myelomeningocele

- protrusion of the meninges/spinal cord

- causes partial/complete paralysis

- care for in the prone position

Omphalocele

herniated bowel through naval area covered by thin membrane

Gastroschisis

Herniated bowel through naval area without a membrane (sac)

T/F Herniated contents must be kept cool

False, they should be kept WARM

Epiglottitis peak incidence ages?

ages 3-6

Epiglottitis symptoms include?

- respiratory obstruction

- fever

- high temp.

- dysphagia

Things to consider with patient that suffers from Epiglotittis

- pt should be accompanied by physician to radiology

- keep pt in upright position

- soft tissue lateral of nasopharynx

- keep child calm

How should a pt with Osteogenesis imperfecta be cared for?

- spontaneous fx

- accompanied by radiology by caregiver

- handle with care

- provide positioning directions in simple terms

- subtractive condition, decrease exp. factors

Suspected child abuse

may include physical, nutritional, or mental abuse.

signs of child abuse

- multiple fx (especially ribs)

- multiple bruises

- burns

classic radiography signs of child abuse

- corner fx

- bucket handle fx

suspected cases must be reported

- 1st to the physician

- 2nd to proper hospital authority if continuing doubts exist

Corner fracture

Bucket handle fracture

T/F avoid imaging babygrams (images of whole baby)

True

Bone survey protocols may include:

- AP/LAT of skull, spine and chest

-AP of pelvis and extremities

Pediatric radiation precautions

- High kVp low mAs

- Good instructions

- following proper age-specific guidelines

- precise shielding

- excellent collimation

- Alternate PA instead of AP projections of skull and thorax

- pulsed fluoro

- proper immobilization

Pediatric vital signs

Rectal, axillary, or temporal temps should be taken for pt under 6yrs

What are normal pediatric body temps?

a. 99.6 degrees rectally

b. 98.6 degrees orally for children >6yrs

Infant vitals (6m old)

- Blood pressure: systolic 90/50-66

- Pulse: 80-120bpm

- Respirations: 40-60

Toddler vitals (2yrs)

- Blood pressure: 90/53-66

- Pulse: 80-120bpm

- Respirations: 24

School age vitals(7yrs)

- Blood pressure: 100/57-71

- Pulse: 60-110

- Respirations: 12-20

Adolescent vitals (15yrs)

- blood pressure: 115/66-80

- pulse: 60-100

- respirations: 12-20

Adults

- blood pressure: systolic <120

- Pulse: 60-100

- respirations: 12-20

Immobilization devices

- tape

- sandbags/lead apron

- stockinet/pillow case

Mummy wrap technique

immobilization method often used for keeping infants still during x-ray exams. similar to swaddling a baby.

Papoose board

Used to immobilize infants and children from ages 2-6yrs

Pigg-O-Stat

used to immobilize infants-3yrs

What are advantages of using a Pigg-O-Stat?

- film holder

- restraints patient

- gonadal shielding

- can be used for chests, upright abdomens, and spines

Pediatric chest radiography

- Keep pt arms up by ears for good inspiratory effort, and include the epiglottis for croup.

- collimate from mastoid tip to top of iliac crest.

When imaging a baby in the Nursery:

- do not allow babies head to be turned, this causes rotation of the chest.

- good technique is 56@1.6 and 52@2 tube to the top (hand technique)

- put arms over head

- use shielding

- do not touch the baby with anything contaminated

Bone age studies

- checks skeletal development

- determined by comparing ossification centers

- size

- shape

- appearance

Gruelich and Pyle method

- Comparison of AP radiograph of lt. wrist/hand with standard radiographs

- Evaluation of degree of fusion at epiphysis

If between ages 1 -2, AP of left knee

TW2

- Comparison of 20 epiphyses of hand and wrist to atlas

- Score summed and compared with standard

sontag, snell, and Anderson methods

Under age 3

Includes:

• AP projection humerus

• PA projection left hand/wrist

• AP/lateral projections of left knee

• AP/lateral projections of left ankle

Limb Radiography (Newborn-2yrs)

- wrap child in towel (bunny wrap)

- Plexiglas and bookends may be used

to immobilize hands

- Lower limbs may be immobilized by wrapping both arms in towel, w/ velcro across abdomen, sandbag unaffected leg

T/F growth plate fx are common

True

Salter-Harris fx classification

Type I: fx thru growth plate

Type II: Fx thru growth plate into metaphysis

Type III: Fx thru growth plate into epiphysis

Type IV: Fx thru metaphysis

Type V: Crushing of growth plate

pediatric abdomen radiography

include supine and image for air/fluid levels

Which position is preferred for looking at air/fluid levels in a peds patient?

left lateral decub preferred over upright for pt. comfort/immobilization

Should diapers be removed prior to an exam?

Yes, as there may be artifacts such as urine

Aspirated foreign bodies typically occur in ages?

6 month - 3 yrs

Trapped foreign bodies causes trapped air on the affected side via?

ball valve mechanism

T/F Coins are the most common swallowed objects

True

A coin in the coronal plane is generally lodged in the?

esophagus

Complete scoliosis exam includes 4 images:

- PA

- Lateral

- RT bending lateral image

- LT bending lateral images

Scoliosis Procedure

- Patient supine, ASIS's equidistance from table

- Patient reaches lft/rt. for knees in bending images

- Collimate and center to MSP

- Obtain images from cervical to include crest

MRI (Peds) is useful for:

- Salter-Harris fx

- neoplasms

- Demyelination diseases

- congenital anomalies

- Tethered spinal cord

Disadvantages of MRI in peds?

- longer exposure times

- claustrophobia (may require sedation)

CT (Peds) is useful for:

- Congenital Abnormalities

- Metastatic disease

- sinus exams

- bone sarcomas

- leg length (replacing spot scanography)

CT (Peds) Advantages

- short scan times (seconds)

- Less scatter and improved image contrast over digital

- sectional images in all planes

CT (Peds) Disadvantages

- Claustrophobia

- Radiation dose (reduced by decreasing FOV and using High kV and low mAs)

(Peds) interventional radiology

- angioplasty

- Embolization

- insertion of vascular access devices

Peds Vascular access devices

- Non-tunneled catheters (PICC lines)

- inserted into basilic or cephalic vein

- single or double lumen

- anchored to skin after insertion

- tip usually resides in SVC near RT atrium

- Allows administration of medications and peripheral nutrition

Direct Radionuclide Cystogram (DRC)

- shows function of bladder

- Sometimes replaces VCUG

- shows reflux

What is an advantage of DRC compared to VCUG?

Less radiation than VCUG

What does DRC permit in terms of reflux?

Visualizing reflux over a period of time

What can be quantified using DRC?

Post-void residual volume

What is a tunneled catheter?

A catheter inserted subcutaneously into the subclavian or internal jugular vein.

What is a characteristic feature of tunneled catheters?

They normally have multiple lumens.

Why are tunneled catheters tunneled under the skin?

For security.

What is the typical duration of placement for tunneled catheters?

They are used for long-term placement.

What is a common name for a tunneled catheter?

Hickman line.

Tunnel catheters allow the administration of:

- chemotherapy

- antibiotics

- fluids and hemodialysis

implanted (ports) devices

- whole device is planted subcutaneously

- distal tip resides in SVC near RT atrium

- Good for long-term placement in children and adults

by 2030, 70M people will be ages

65 and above

___ of every ____ deaths occur in those 65yrs<

7 of every 10

What is a common change in the geriatric integumentary system related to skin structure?

Thinning of skin and loss of subcutaneous fat

What can develop on the skin of elderly individuals in as little as 1-2 hours?

Decubitus ulcers

What are the three types of skin tumors that can occur in the elderly?

Basal cell carcinoma, malignant melanoma, squamous cell carcinoma

What viral infection is commonly associated with the geriatric integumentary system?

Herpes zoster

Nervous system disorders

CVA (stroke) embolic and hemorrhagic

Strokes are the _____ leading cause of death in the US

3rd

How many NEW strokes happen in a year?

750,000

signs and symptoms of a CVA

- vision impairment on one side

- speech impediment that develops suddenly

- LOC

- hemipariesis

In Geriatric patients, women have 4x chance of having what over men?

Osteoporosis

What are some risk factors of Osteoporosis?

Estrogen&calcium deficiency, inactivity, smoking, carbonated beverages

Osteoarthritis leads to?

arthroplasty

Geriatric Cardiovascular system disorders

- loss of arterial elasticity

- Hypertension

- atherosclerosis

- CHF

T/F CHF will cause the heart to appear enlarged on radiographs.

True

Geriatric GI disorders

Diverticulosis, Iron deficiency anemia, Cholelithiasis, polyps with possible malignancies.

Geriatric respiratory disorders

- COPD (common)

- pneumonia

- lung cancer

T/F lung cancer is 3rd most common cancer in men and women?

False it is 2nd most common

What are some effects of aging?

self-efficacy, depression, weight gain, loss of bone mass, joint stiffness, loneliness, sensory deficits.

When should the R.T. look up medical Hx during a Geriatric exam with contrast?

Before the contrast will be administered

What should be done when x-raying a femur on a geriatric patient?

Do AP like normal, however, for lateral femur, use x-table if the patient is under fall precautions and/or there is significant pathological disease.

Is Emphysema an additive or subtractive disease?

Subtractive, which requires decreased exposure factors.

Is pneumonia an additive or subtractive disease?

Additive, which requires increased exposure factors.