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- Be aware that the weight written on the card on the incubator might be out of date – babies put on weight fast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)
- 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”
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