Pediatric chest (lateral view)
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The pediatric lateral chest view may be performed as an adjunct to a frontal chest radiograph in cases where there is diagnostic uncertainty.
The lateral chest view examines the lungs, bony thoracic cavity, mediastinum, and great vessels. Lateral radiographs can be particularly useful in assessing the retrosternal and retrocardiac airspaces.
There is a body of research that suggests the lateral projection it is not required for the detection of pneumonia in the pediatric patient 1,2. The appropriateness of a lateral chest x-ray in the pediatric patient will differ from institution to institution.
The lateral view of the pediatric patients shares many of the same points regarding positioning, however, the aspect of immobilization and exposure factors differ greatly.
For patients under the age of 6 months see: Pediatric chest (horizontal beam lateral view).
the patient will often be placed on a chair or standing, depending on cooperation and age
arms above head, either held by a carer or held by velcro straps
patient is holding a vertical pole/handle to ensure stability. It is not advisable to ask the patient to keep his/her arms above their head, they will find this difficult to do while keeping still
left side of the thorax adjacent to the image receptor
chin raised out of the image field
midsagittal plane must be perpendicular to the divergent beam, therefore:
right side rotated 5-10° anterior
the midcoronal plane of the level of the 7th thoracic vertebra, approximately the inferior angle of the scapulae
superiorly 5 cm above the shoulder joint to allow proper visualization of the upper airways
inferior to the inferior border of the 12th rib
anteroposterior to the level of the acromioclavicular joints
fit to childs chest
grid is often not used
Image technical evaluation
The entire lung fields should be visible superior from the apices inferior to the posterior costophrenic angle
the chin should not be superimposing any structures
there is superimposition of the anterior ribs
the sternum is seen in profile
superimposition of the posterior costophrenic recess
a minimum of ten posterior ribs are visualized above the diaphragm
the ribs and thoracic cage are seen only faintly over the heart
clear vascular markings of the lungs should be visible
Contact lead shielding is no longer recommended for any pediatric examination, multiple radiological societies have released statements supporting the cessation of this practice 4-7 the most comprehensive guidance statement on this matter (86 pages) is a joint report found at this citation 8.
Please see your local department protocols for further clarification as they may differ from these recommendations.
In order to streamline workflow, preparing the room beforehand (set up the detector and prepare lead gowns) will be extremely useful in pediatric chest imaging.
Ensuring appropriate inspiration and no motion may also require specialized communication techniques to gain cooperation from the child. Examples include:
“you have to breathe in like you are about to blow out a birthday candle!”
“take a big sniff now”
“lets play dead fish!”
Some children will maintain their position for the examination, others will not. Research regarding the most effective method of immobilization is lacking. Immobilization methods will range from radiographers/parents holding the child to the utilization of multiple Velcro straps, some departments may consider the latter 'restraint' it is important to clarify with local guidelines 3.
Family members may assist in distracting or holding the child. It is important to give the parents a focussed task; particularly when they are feeling anxious for their children.
Specialized pediatric departments will have 'chairs' appropriate to hold children during the examination 3, these chairs often contain multiple Velcro strap points, are counter weighted for stability and have a radiolucent backing such as perspex. It is important when using this equipment that the children is safely fastened with no risk of falling. In extreme cases the parent may stand in front of the patient ensuring they feel safe.
- 1. Lynch T, Gouin S, Larson C, Patenaude Y. Does the lateral chest radiograph help pediatric emergency physicians diagnose pneumonia? A randomized clinical trial. (2004) Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 11 (6): 625-9. Pubmed
- 2. Audette LD. BET 1: Lateral chest radiography and the diagnosis of pneumonia in children. (2017) Emergency medicine journal : EMJ. 34 (1): 57-58. doi:10.1136/emermed-2016-206487.1 - Pubmed
- 3. Ng JHS, Doyle E. Keeping Children Still in Medical Imaging Examinations- Immobilisation or Restraint: A Literature Review. (2019) Journal of medical imaging and radiation sciences. 50 (1): 179-187. doi:10.1016/j.jmir.2018.09.008 - Pubmed
- 4. Statement No. 13 – NCRP Recommendations For Ending Routine Gonadal Shielding During Abdominal And Pelvic Radiography (2021)". Ncrponline.org, 2021. [Link].
- 5. ASMIRT Position Statement Gonad Shielding". Asmirt.org, 2021. [Link].
- 6. ASRT Statement on Fetal and Gonadal Shielding. Asrt.org, 2021. [Link].
- 7. 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.
- 8. Guidance on using shielding on patients for diagnostic radiology applications Joint report. Bir.org.uk, 2021. [Link].