Pediatric abdomen (supine cross-table lateral view)
The supine cross-table lateral view is an additional projection to demonstrate the pediatric abdomen. As radiation dose is an important consideration for pediatric imaging, the horizontal beam lateral view is not often performed; although this will vary based on the department.
This view is ideal for neonates as free abdominal gas can be visualized without the neonate being erect. This view is also ideal for children who are unable to move from the supine position due to the possibility of bowel perforation 1.
- patient is supine
- ensure no rotation of hips and shoulders
- remove any radiopaque items (e.g. ECG dots, diaper, shiny decorative clothing)
- take the x-ray in full inspiration
- lateral projection
- suspended inspiration (on observation)
- the midcoronal plane at the level of the iliac crest
- superior to the diaphragm
- inferior to the inferior pubic rami
- anteroposterior to include soft tissue edge
- will vary depending on the child's body habitus
- 60-75 kVp
- 3-10 mAs
- 100 cm
- if patient thickness is above 10 cm, use of a grid is advisable 2
Image technical evaluation
- include the
- diaphragms superiorly
- inferior pubic rami inferiorly
- skin edge anteroposteriorly to ensure inclusion of bowel and potential free air
- the abdomen should be free from rotation
- ideally no blurring of the bowel gas due to respiratory motion
Contact lead shielding is no longer recommended for any pediatric examination. Statements have been released by several radiological societies supporting an end to this practice 3-6, with the most comprehensive guidance statement on this matter being in an 86-page joint report 7.
Please see your local department protocols for further clarification as they may differ from these recommendations.
- it may be useful to position the patient so that they can see their parents in order to reduce anxiety
- for neonates it is ideal to image them whilst they are calm or asleep
- pediatric patients may feel uncomfortable when bony landmarks are felt for, therefore an appropriate explanation to the patient beforehand is ideal for improving patient comfort
- to achieve sufficient inspiration, using child-appropriate language will be useful
- e.g. 'breathe in as if you are about to go diving underwater!', 'breathe in as if you are about to blow out a birthday candle!'
It is important for the image to be free from movement artefact and rotation to avoid repeated x-rays.
- it may be necessary for the parent or radiographer to stand with the patient or hold them in position
- sometimes it is only necessary to keep the child's arms away from the abdominal area; in these cases, asking the child to hold onto something to their side (e.g. toy, mother's hand, pole) may be useful.
- techniques will vary based on the department
- 1. Maryann Hardy, Stephen Boynes. Paediatric Radiography. (2003) ISBN: 9780632056316
- 2. A paediatric X‐ray exposure chart. (2014) Journal of Medical Radiation Sciences. 61 (3): 191. doi:10.1002/jmrs.56 - Pubmed
- 3. Statement No. 13 – NCRP Recommendations For Ending Routine Gonadal Shielding During Abdominal And Pelvic Radiography (2021)". Ncrponline.org, 2021. [Link].
- 4. ASMIRT Position Statement Gonad Shielding". Asmirt.org, 2021. [Link].
- 5. ASRT Statement on Fetal and Gonadal Shielding. Asrt.org, 2021. [Link].
- 6. Yogesh Thakur, Stephanie C. Schofield, Thorarin A. Bjarnason, Michael N. Patlas. Discontinuing Gonadal and Fetal Shielding in X-Ray:. (2021) Canadian Association of Radiologists Journal. doi:10.1177/0846537121993092 doi:10.1177/0846537121993092.
- 7. Guidance on using shielding on patients for diagnostic radiology applications Joint report. Bir.org.uk, 2021. [Link].
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