Pediatrics radiology Child development - PowerPoint Presentation

Slide1

Pediatrics radiology

Child development

In the context of diagnostic imaging, childhood can be divided

into six main age groups, each of which has different needs and capabilities:

birth to six months;

infancy (six months to three years);

early childhood (three to six years);

middle childhood (six to 12 years);

early adolescence (12–15 years);

late adolescence (15–19 years)

Slide2

Anatomical differences betweenchildren and adults

Young babies have thin skull vaults and vascular markings are

not present before the age of one year.

The nasal bones are not ossified before three years of age.

Paranasal

sinuses are not normally

pneumatized

until six

years of age.

The

scaphoid

bone is not ossified before six years of age.

Children have faster heart and respiratory rates than adults.

More radiosensitive red bone marrow is more widespread in

children and is present in almost all bones of a neonate.

Slide3

Referral criteria

respiratory difficulty;

infection;

meconium aspiration;chronic lung disease;pleural effusion/pneumothorax;position of catheters/tubes;heart murmur/cyanosisProjections :-Basic ; AP supine Alternative ;PA proneSupplementary ;Lateral

Chest – neonatal

Slide4

Slide5

Chest – post-neonatal

Recommended projections

Examination is performed by means of the following projections:

Basic

Postero-anterior – erectAlternative Antero-posterior – erectAntero-posterior – supineSupplementary Lateral

Slide6

Position of child for

postero

-anterior erect chest radiograph

Position of child for

antero

-posterior chest radiograph

Position of child for

antero

-posterior chest radiograph seen from the side.

Slide7

Lateral

Chest – post-neonatal

Antero-posterior – supine

Slide8

Abdomen

Referral criteria will include suspected

intussusception

, chronic

constipation (suspected Hirschprung’s disease), possible swallowedforeign body.Examination is performed by means of the following:Basic Antero-superior – supineAlternative Postero-anterior – proneSupplementary Lateral

Postero

-anterior – left lateral

decubitus

Antero-posterior – erect

Slide9

Baby positioned in an incubator for

antero

-posterior abdomen

Older child positioned on imaging table for

antero

-posterior abdomen

Slide10

Skull

Recommended projections

Examination is performed by means of the following:

Basic •

Occipito-frontal Fronto-occipital – 30 degrees caudad LateralAlternative • Fronto-occipital

Slide11

Position of infant for

antero

-posterior skull with triangular sponges supporting the head on

either side

The child is positioned carefully in the supine position, withthe head resting on a pre-formed foam pad positioned on top of the cassette

The head is adjusted to bring the median

sagittal

plane at right-angles to and in the

midline of the cassette.

The external auditory

meati

should be

equidistant from the cassette

Slide12

The child is immobilized in this position with

The assistance of a

carer

, who is asked to hold foam pads on either side of the skull during

the exposure. The carer usually stands at thehead end of the imaging table to undertake this procedure

Slide13

Lateral – supine

Slide14

SinusesMaxillary

antra

are not well

pneumatized

before the age ofthree years and the frontal sinuses are not developed before the age of six years. Sinus X-rays are therefore rarely justified in children below this age. An occipito-mental projection ofthe sinuses Is performed erect in a similar way to that described for adults However, in children the patient’s nose and mouthAre first placed in contact with the midline of the vertical

Bucky and then the head is adjusted to bring the

orbito-meatal

line at 35degrees to the horizontal at the centre of the Bucky.

Slide15

Essential image characteristics

The X-ray beam should be well collimated and should

include the frontal sinuses (when developed in children

Over six years of age) and the bases of the maxillary sinuses and upper maxillary teeth

.

Slide16

PNS radiography is usually performed on children between

4 and 10 years of age, with the common problem of mouth

breathing due to nasal obstruction. A lateral projection (taken supine) of the PNS is performed to demonstrate

enlarged adenoids, hence

the PNS must be air-filled to be radiographically visible.

PNS radiography

Slide17

image of lateral projection of PNS in a 6-year-old child

Slide18

pelvis

Referral criteria

hip pain/limp (irritable hips,

Perthes

’ disease, slipped upperfemoral epiphysis, osteomyelitis);development dysplasia of the hip (DDH) congenital dislocated hip(CDH)traumapost-surgery

Slide19

Projections:-

DDH/CDH • Antero-posterior – supine

Antero-posterior – erect

Irritable hips • Antero-posterior

Lateral – frog view Post op for slipped epiphysis • Antero-posterior – supine lateral Trauma • Antero-posterior – supine Lateral – horizontal beam

Slide20

Four-month-old baby boy positioned for hips in an immobilization device with

shaped lead protection

Antero-posterior – erect

(weight-bearing

)

Slide21

SPINE

Referral criteria

The referral criteria for all types of pathology where a whole spine, rather than a segmental spine, examination is indicated are as follows:

idiopathic/congenital/paralytic and post-infective scoliosis;

spina bifida;severe injury;metastatic disease;

Slide22

Spine – scoliosis

Postero

-anterior – standing

Direction and

centring of the X-ray beamA horizontal central ray is employed, and the beam is collimated and centred to include the whole spinal column.The lower collimation border is positioned just below thelevel of the anterior superior iliac spines, thus ensuring

inclusion of the first sacral segment. The upper border should beat the level of the

spinous

process of C7

An increased FFD is used to ensure the correct cassette

coverage (180–200 cm).

Slide23

AP scoliosis LAT

Slide24

Baby positioned for lateral projection in prone position

erect for lateral projection

erect for (AP) projection

dorsi

-plantar projection of feet with feet support

lateral projection of foot with pressure applied by

A wood block support in order to try and correct any

equinus

deformityof

the ankle

Slide25

Bone age

The protocol requires a

dorsi-palmar

projection of the whole hand, including

all digits and the wrist joint.The fingers should be straight, with the metaphyses in profile.

Slide26

Skeletal survey for non-accidental injury

A skeletal survey is the main radiological investigation for NAI.

It comprises a series of images taken to assess the whole skeleton.

Evidence of NAI to children is an all too common

occurrence in any department dealing routinely with children. It can result in serious long-term physical injuries. The latter include serious neurological deficits, mental retardation and in, the worst cases, death of the child.

Slide27

The advised projections are as follows:

antero

-posterior chest (chest to show all ribs, clavicles

andshoulders

);abdomen (to include pelvis);antero-posterior right and left femur (to include hip and kneejoints and upper two-thirds of tibia and fibula);antero-posterior right and left ankle (to include distal third oftibia and fibula);

Slide28

antero-posterior right and left

humerus

;

antero

-posterior right and left forearm;lateral cervical, thoracic and lumbar spines;antero-posterior skull, lateral skull (and Towne’s if occipitalfracture suspected);oblique ribs (may be delayed by up to 10 days);anterior oblique of both hands;antero-posterior both feet;

Slide29

Imaging room

The room should already be prepared before the child enters. It

is preferable to keep waiting times for examinations to a minimum,

as this will significantly reduce anxiety. The room must be

immediately appealing, with colourful decor, attractive postersand stickers applied to any equipment that may be disconcerting. Soft toys undergoing mock examinations are also helpful.

Slide30

Modifications technique

Abdomen:-

Constipation

s :- A very fast film/screen system should be used in chronic cases.

Suspected swallowed foreign body:- The initial radiograph should be with a fast-speed screen/filmsystem to include the neck and upper abdomen. The radiograph should demonstrate the mandible to iliac crests. Lead protection should be used.The most likely sites of hold-up are the neck, mid oesophaguswhere the left main bronchus crosses theoesophagus

, and at the

gastro-

oesophageal

junction.

If a foreign body is demonstrated in the neck or chest, a

lateralradiograph

should be taken to confirm position.

Slide31

Suspected diaphragmatic hernia

A combined

antero

-posterior chest and abdomen radiograph

isrecommended.Imperforate anus (prone invertogram)A lateral (ventral decubitus) projection is selected using a horizontalbeam. This allows intraluminal air to rise and fill the most distalbowel

to assess the level of

atresia

. Radiography

shouldnot

be performed less than 24 hours after birth

.

Slide32

Position of patient and cassette

The infant should be placed in the prone position, with the pelvis and

Buttocks raised on a triangular covered foam

pador

rolled-up nappy.The infant should be kept in this position for approximately 10–15 minutesThe cassette is supported vertically against the lateral aspect ,of the pelvis and adjusted parallel to the

mediansagittal

plane.

Direction and

centring

of the X-ray beam

The horizontal central ray is directed to the centre of the cassette

Note

A lead marker is taped to the skin in the anatomical area where

the anus would normally be sited. The distance between this

and the most distal air-filled bowel can then be measured

.