NEONATAL IMAGING

Neonatal Imaging

Radiography in children,

“… the most highly skilled task required of a radiographer. In no other age group does correct diagnosis and treatment depend so much on high-quality films”

 

Hygeine

 Hands – Handwashing, before and after placing hands into the incubator

OBJECTS – Foam pads, image plate etc. Bag them or clean    them before and after placing in the incubator

PATIENT IDENTIFICATION

• AS PER IRME(R) & LOCAL POLICIES
• BE CAREFUL OF WEIGHTS ON INCUBATOR I.D. CARDS…

 

Scattered radiation

 Distance from tube                                    time to receive equiv backgrd dose

50 cm                                                                                                 42 minutes

1M                                                                                                       11 minutes

3m                                                                                                      1 minute

                                               

Exposure 64kV, 1mAs, 100cm, 1cGy cm²

 AGREE HOLDING TECHNIQUES

• BABY’S ARMS ABOVE HEAD ?
• BABY’S ARMS LYING AT SIDES AWAY FROM THE BODY?

WHATEVER IS PREFERRED

– AGREE BEFOREHAND

 

LOOK EXCELLENT CHEST RADIOGRAPHY RESULTS

LOOK                                     =    LORDOSIS

EXCELLENT                        =          EXPOSURE

CHEST                                  =          COLLIMATION

RADIOGRAPHY                 =           ROTATION

RESULTS                             =          RESPIRATION

 

Park Mobile at an Angle to Base of the Incubator

Position the Tube Now – Use a 10% Angle

Ensure Holding PERSON is Protected & Not Pregnant

L – Lordosis

E – Exposure

• Set exposure now before you start positioning – so you do not forget later
• Be aware that the weight written on the card on the incubator might be out of date – babies put on weight fast
• Dr ≥ 3kg 60kV 0.8mAs

1.5–3kg          60kV 0.7mAs

0-1.5kg           60kV 0.63mAs

C – Collimation

• Collimate as tightly as possible using the collimator blades
• Use the lead strips provided on top of incubator
• Ensure a side marker on the L-shaped strip is included

 R – Rotation (1)

• Nurse should hold baby’s head in AP position. Hips and shoulders parallel to image plate
• Baby’s arm lying by sides but angled away from body if possible
• Baby’s legs supported – e.g. by small towel
• Centre to mid-sternum

R – Rotation (2)

• Radiographer to stand at bottom of incubator when exposing– allows easier assessment of rotation
• Note again the caudal angle of the x-ray tube

R – Respiration

• Radiographer watches baby’s breathing closely
• Baby is a tummy breather – when tummy is pushed out, lungs are full
• Expose when tummy is pushed out
• Counting 1-2-3 might help
• If baby is wriggling, wait a  minute – baby might settle

NOT THAT DIFFICULT AFTER ALL

Rotated Images

Why are they bad?

• Alters heart shape and size
• Causes mediastinal distortion
• Shows differences in the degree of lung translucency
• To avoid:
• Ensure head is straight
• Ensure shoulders and hips are level

Lordotic Images

Why are they bad?

• Alters heart shape
• Causes lower lobes of   lungs to be masked by diaphragms
• To Avoid:
• Don’t centre too low -centre to mid-sternum
• Do not have central ray at 90° to the image plate, angle tube or tray
• Be aware that holding baby arms above head can cause back to arch

Be Careful Not To Overangle Caudally

Ventilator Tubing Must Be Clear of Chest

Lateral Decubitus Chest

• Position baby lying on a foam pad facing the x-ray tube
• Holding person holds head and arms with one hand and lower limbs with the other
• Suspicious side up but clinician will usually advise which they wish
• Beware of skin folds

Supine Decubitus Chest

• Again Horizontal Beam to be Used
• Baby to Lie Supine
• Baby Held as for Lateral Decubitus
• Reduce Exposure by Around 4kV!!!

Chest & Abdomen 1 Image

Note the ECG leads are all moved to the lateral chest and abdomen walls

• • Note also the “rugby- ball” shape of baby – be careful not to over collimate the diaphragm area laterally.Neonatal ImagingRadiography in children,“… the most highly skilled task required of a radiographer. In no other age group does correct diagnosis and treatment depend so much on high-quality films” 

    Hygeine

     Hands – Handwashing, before and after placing hands into the incubator

    OBJECTS – Foam pads, image plate etc. Bag them or clean    them before and after placing in the incubator

    PATIENT IDENTIFICATION

    • AS PER IRME(R) & LOCAL POLICIES
    • BE CAREFUL OF WEIGHTS ON INCUBATOR I.D. CARDS…

     

    Scattered radiation

     Distance from tube                                    time to receive equiv backgrd dose

    50 cm                                                                                                 42 minutes

    1M                                                                                                       11 minutes

    3m                                                                                                      1 minute

                                                   

    Exposure 64kV, 1mAs, 100cm, 1cGy cm²

     Lines

    Endotracheal tubes (ETT

    nasogastric line (NGT)

    Electrocardiography (ECG)

    umbilical venous catheter (UVC)

    Umbilical artery catheters (UAC)