EMed

Radiography Protocols Paediatrics (CUH)

Paediatric protocols

Chest

Anatomy Indication Projections
Chest
Marker time of exposure at all times

Respiratory:

  • LRTI/ Pneumonia
  • Chest trauma
  • Pneumothorax
  • Haemothorax

PA Erect CXR

  • AP Erect, if PA not possible
  • AP Supine, if above not possible

Remove all clothing.

Depending on age of child, always attempt an Erect x-ray first.

Lateral not to be performed routinely.
Chest
Marker time of exposure at all times

Cardiac

  • Clinical cardiomegaly
  • Heart failure
  • Heart murmur
  • Hypertension

PA Erect CXR

  • AP erect or AP supine if more appropriate / above not possible
Chest
Marker time of exposure at all times

Other

  • Inhaled FB

Lateral Soft Tissue Neck

PA erect CXR

  • AP erect or AP supine if more appropriate
  • Expiratory CXR may be requested if FB confirmed in chest

Abdomen

Abdomen

Gastrointestinal

  • Suspected bowel obstruction
  • Bowel perforation*
  • Intussusception
  • Suspected abdominal mass

PFA

To include from diaphragm to symphysis pubis.
  • * Erect CXR also indicated in suspected bowel perforation
Abdomen
  • Blunt trauma – needs surgical assessment to decide most suitable Imaging modality
 PFA generally not indicated
Abdomen

Others

  • Vague abdominal pain
  • Gastroenteritis
  • Haematemesis
  • Pyloric stenosis
  • Appendicitis
  • Chronic constipation
  • Encopresis or enuresis
  • UTI
 PFA not indicated
Abdomen

Ingested Foreign Body

 Lateral Soft tissue Neck
CXR – PA erect (or AP erect or AP supine if more appropriate)
PFA
  • Single view of Chest & abdomen may be possible if size of child permits

Head & neck

Anatomy Indication Projections
Skull Child abuse SXR – AP & Lateral
Only as part of Skeletal Survey
Skull Head trauma (NAI not suspected Skull X-ray not indicated – CT to be performed if imaging required
Facial bones Facial trauma OM 45° – Water’s view only
Nasal bones Suspected Fracture Fracture - a clinical diagnosis
Xray not indicated unless FB suspected

Limb upper

Anatomy Indication Projections
Upper limb Shoulder Trauma - (possible # or dislocation)
Or
Infection 		AP* & Axial
Half Axial & Y-view (both views always) if axial not possible
Upper limb Clavicle Trauma - (possible # or dislocation)
Or
Infection 		AP* & 15-30 deg cranial tilt
*If appropriate, AP view can include proximal humerus and full clavicle
Upper limb Scapula Trauma
Possible # 		AP & lateral scapula (y-view)
Upper limb Humerus
Radius & Ulna
Elbow 		Trauma - (possible # or dislocation)
Or
Infection 		AP and Lateral of affected body part
True AP and true lateral positions are very important
Elbow imaging always separate from humerus or forearm if both asked for – i.e. 2 separate studies
Upper limb Pulled elbow
Clinical exam & mechanism of injury suggest subluxed radial head. 		Radiographs not indicated
Upper limb Wrist Trauma (possible # or dislocation)
Or
Infection 		PA & Lateral
Upper limb Hand Trauma (possible # or dislocation) / Foreign Body
Or
Infection		 PA & Oblique
Lateral view if suspected FB
Upper limb Finger Trauma (possible # or dislocation) / FB
Or
Infection		 PA & Lateral
Lateral view if suspected FB

Lower limb

Anatomy Indication Projections
Lower limb Pelvis Trauma
Limp with suspected
  • Perthes
  • SCFE
  • Unexplained
 < 1 yr of age : AP Pelvis
(legs internally rotated)
> 1 yr of age : AP & Frog Lateral views of Pelvis
  • Gonad shield for 1 view
Lower limb Pelvis Suspected Developmental Dysplasia of the hip (DDH, CDH) < 4/12 old – Ultrasound
> 4/12 old - AP Pelvis
(legs internally rotated)
Lower limb Femur
Knee*
Tibia & Fibula 		Trauma (possible # or dislocation)
Or
Infection 		AP and Lateral of affected body part
True AP and true lateral positions are very important
* Knee Lateral must be HBL where there is a history of  recent injury at any stage in the recent past
Lower limb Ankle Trauma (possible # or dislocation)
Or
Infection 		AP & lateral views
  • Additional mortise view if possible
Lower limb Foot Truama (possible # or dislocation)
Or
Infection		 DP & Oblique View
Lateral view if suspected FB
Whole Upper & Lower limb Refusing to move whole limb (lower or upper)
Refusing to weight-bear 		First image most suspected site of injury, including nearest joint.
Whole limb imaging may be justified - i.e.
Humerus, Forearm & hand
Pelvis, Femur, Tib/Fib & foot

Ossification centres

Spine

Anatomy Indication Projections
Cerbical spine Trauma 1. Lateral HBL priority.
One attempt at swimmers if C7/T1 junction not clear.
2. AP
3. Odontoid peg view
If > 5 yr olds. Must be co-operative.
Note:
>12 yrs C4-C7 injuries more common.
<12 yrs C1-C3 injuries more common.
Thoracic or lumbar Trauma
Pain		 AP & Lateral
Chronic pain, in the absence of trauma, requires discussion with paediatric radiologist

Content Drafted by Anne O' Loughlin, Dr Íomhar O' Sullivan 06/05/2005. Reviewed 15/03/2007. Last review Ms Anne O' Loughlin, Dr ÍOS15/06/21.