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INTRODUCTION:
Radiological examinations are fundamentally the same
whether the patient is child or adult. Protection from unnecessary radiation is very important , most of the radiological examinations are not painful. Yet small
children often vigorously resist such examination. It becomes necessary for technologists to take the child in confidence, which may take some time .
like children & not only happy with well children but also with the
sick children who often tired, cranky & frightened . One must understand the fears, needs & desires of children.
CONT..
Medical personnel who deals with children should develop a sensitivity against child reaction. By the help of parents, technologists & nurses prepare the child. Our hospital has posters & toys to prepare the children.
Cont.
Technologists need to learn to observe & quickly evaluate the children, their level of maturity & ability to communicate.
PRESCHOOLERS (3 5 YEARS):
Preschooler can understand instructions & explanations if they are offered with an understanding of child likely precaution . Preschooler are eager to please & a game like atmosphere can facilitate our work. Praise must be given when the child tries to cooperate.
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DIGITAL RADIOGRAPHY:
With the help of flat panel detector we can have direct acquisition of the radiograph.
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PORTABLE RADIOGRAPHY:
It is beneficial because of no need to bring the child to the radiographic room if the condition of child is critical. Usually infants are under treatment in ICU so we have to take some precautions : We should take care of different equipments attached to child. We should use gowns, masks, gloves & sterile sheets to the cassettes to avoid any infection. Use proper collimation. Set accurate exposure factors to avoid more radiation dose.
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The following should be clearly demonstrated: Anatomy from apices to pubic symphysis in thoracic & abdominal region. No rotation No blurring of lungs, diaphragm & abdominal structure.
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RADIOGRAPHIC TECHNIQUE:
It is important that the technologists have a different plan for procedure with children. The advantages include saving time, films & the energy of
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Cont
1. Read requisition form carefully. 2. Call the patients in the radiographic room. 3. Speak courteously & take him in higher confidence . 4. Explain the procedure if the patient is old enough to understand.
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5 Assemble necessary equipments . 6 Set machine for exposure. 7 Position the patient. 8 Shield the gonadal area if necessary. 9 Start the rotar and check till last moment
10 Make exposure.
1. 2.
AP -Projection
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Cont
A direct lateral view of wrist, FA, elbow & humerus with infants and uncooperative children are taken in supine position . CR: Pass through centre of cassette. Knees and lower extremities are easier to radiograph in prone position, because the knees can flex & contact remain uniform. Examination for possible fracture require special care, rough handling can increase the displacement of bone fragments, causing further damage to blood vessels & other soft tissues.
PA - Projection
Lateral - Projection
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CHEST RADIOGRAPHY:
It is the most common radiographic procedure performed. PREPARATION : Remove all lockets & chains. Have the patients be undressed completely from waist up. Apply a sheet on the cassette to prevent from hypothermia . Infants & children younger than 4 year are best examined in supine position.
1. 2.
3.
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AP (SUPINE POSITION):
The children are placed in supine position on the cassette, a compression band is placed over the pelvis & adhesive tapes are used to immobilize the legs. The head & arms are cradled b/w two sand bags. The head must not be turned, this will oblique the chest INDICATION : Pneumonia Cough & sneezing Empyema CHD (congenital heart disease) TB
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1. 2. 3. 4. 5.
AP VIEW
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LATERAL POSITION:
Supine child which are fixed in sponge immobilization device or with compression band as can be radiograph by horizontal expsure. To see free air or fluid in the pleural space, the baby is rotated in lateral decubitus position, affected side up for air & down for fluid. EXPOSURE: Make Exposure When child take deep breath (crying) Watching The Abdomen: Abdomen of child will extend on inspiration
1. 2.
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LATERAL PROJECTION
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Cont..
3. Watching Chest Wall: Ribs will be outlined on inspiration .
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ABDOMEN RADIOGRAPHY:
The standard AP (supine) position are recommended in all infants & children. An upright film should be included when condition such as obstruction, sub diaphragmatic hernia or abscesses. EXPOSURE: films are taken at expiration when the children are relaxed.
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A. B.
Abdominal distension
C.
Suspected perforation
a. b.
D.
Abdominal mass
a. b.
HIP RADIOGRAPHY:
1. 2. 3. 4. 1. The hip & pelvis are commonly examined radiograph in both pediatric & adult. INDICATION : Pathology Diseases Congenital dislocation Trauma PREPARATION : All images of abdomen & pelvic girdle should be performed with dipar completely removed.
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Cont
2. Because wet dipar produce significant artifacts on radiographs, often rendering them under diagnostic. 3. Before beginning arrange all necessary sponges, gonadal shielding, Velcro strips & Velcro restraining band on table . POSITIONING: The child lies supine on x-ray table on top of the cassette or a specially designed cassette holder, which is placed at the end of table with the median saggital plane of the trunk at right angles to the midline of cassette .
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Cont.
To maintain this position, a sand bag is placed on either side of trunk of baby with the arm of child left unrestrained . The legs of baby are held straight with the hands of holder positioned firmly around each leg, the fingers of holder under the calves of baby & the thumbs of holder on the knees. If using cassette holder at the end of table, the knees should be held together and flexed.
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SKULL RADIOGRAPHY:
It is very challenging job for technologists. But problems associated with cranial radiography in children can be improved by: IMMOBILIZATION: because small child once positioned, would not move but for preschooler, we can use clamp immobilization. Immobilization devices should be such that they did not stick to children. Avoidance of use of grid in children under the age of 1 year is an important dose saving measure.
1.
2.
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Cont..
3. Children of 7 years of age need almost as much exposure as an adult because their skull are almost fully grown. 4. A short exposure time required to avoid movement unsharpness. INDICATION: 1. Trauma 2. Neuroblastoma 3. Pituitary gland disorder 4. Hydrocephalus
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Cont.
Generally AP & LAT. views are done. AP View: Central ray pass through nasion.
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LATERAL: - Generally done in supine position . CR: - Passes midway b/w glabella & external occipital protuberance .
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IVP
Cont..
Indications: 1) Pain in abdomen. 2) UTI. 3) Hematuria.. 4) Renal Calculus. 5) Hydronephrosis. 6) Poor Kidney function.
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PATIENT PREPARATION:
No preparation below 4 years but ask for empty stomach by 4 hours and allowed very light dinner on previous night.
For child >= 4.5 years. I Dulcolax Tablet previous one night. For child> 8 years. I Dulcolax tablet previous 2 nights.
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CONTRAST:
IONIC: Urografin, Conray, Trazograf . NON IONIC: Iohexol, Iopamidol . Film sequence Plain film After giving CM 7 min. film 15 min. film 30 min. film Full bladder P.E film
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Cont.
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(2) MCU:
It is retrograde examination of bladder & urethra by filling it with CM through a catheter under sterile method INDICATIONS: 1) Reflux urinary tract infection. 2) Neurogenic bladder. 3) Vesico-uretric reflux.
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EQUIPMENT:
Fluoroscopy with spot film device and tilting table. PROCEDURE: I) First of all preliminary film of bladder are taken. 2) urethra is anaesthetized by xylocaine gel before introducing urethral catheter. 3) catheter is introduced. Any residual urine is drained & CM is slowly dripped into bladder up to full capacity & filling is observed by fluoroscopy.
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Cont
4) Catheter is removed if patient is ready to micturate. 5) Supine full bladder film is taken to see capacity & outline of bladder & also to see any filing defect or diverticulum. 6) Micturating views i.e. B/l oblique 7) Take PE film. NOTE: antibiotic is given for days after examination to prevent any infection.
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BARIUM STUDY:
It is to demonstrate GI tract by BaSO4 CM.
METHODS: I) Barium swallow: - It is investigation of esophagus up to GE junction by introducing barium orally.
INDICATION: I) Regurgitation 2) Esophageal varices. 3) Esophageal diverticulum. 4) Esophageal stricture.
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VIEWS OR FILMING:
1) Upper esophagus - AP & Lat. 2) Lower esophagus-RAO & Lat. 3) GE Junction -LPO & Lat
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VIEWS OR FILMING:
1) 1ST film- of lower esophagus including GE junction. 2) 2nd film-RAO-mucosal film of stomach. 3) 3rd film-R Lat position of filled stomach. 4) 4th film-4 spot of duodenal loop RAO and Rt. Lat.
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BMFT:
It is radiological investigation of bowel duodenum to IC junction. INDICATION: 1) Diarrhoea. 2) Partial obstruction. 3) Inflammation. 4) Abdominal mass. 5) Malrotation from
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BARIUM ENEMA:
Investigation of colon by retrograde introduction of cm. INDICATION: 1) Constipation. 2) Hirsch sprung disease.
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CHILD ABUSE:
Technologist should approach to an abused child in same way as that of other injured or ill child. TYPE of ABUSE: 1) Bone injuries. 2) Abdominal injury ( kicked, hit). 3) Inflicted burn. 4) Slap marks. 5) Sexual abuse.
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IMMOBILIZATION
Immobilization is required in pediatric because they do not understand the need to hold still in a fixed position
Children
Get down to child size
Kindness
Patience
Pediatric Immobilization
Communication Sheets Tape Velcro straps Octastop board Pigg-O-Stat
PRECAUTIONS
An immobilized child must never be left alone in room except for the moment the exposure is made. An infant or child must never be immobilized so tightly that small movements are impossible. Frequently the child will ask for the description of the procedure a number of times ,such repetation may indeed test one patience
RADIATION PROTECTION:
1) Keeping the number of radiograph examination to a minimum consistent with health and welfare. 2) Avoid repeat. 3) Use of high speed intensifying screen, I P plates & reduced exposure time. 4) Proper shielding of gonad, hip, pelvis & abdomen according to examination. 5) Proper collimation.
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Cont
6) Follow ALARA Principle( as low as reasonably achievable) - Distance - Time - Shielding 7) Use of lead gloves & apron by technologist & attendant if present. 8) Pregnant woman is not allowed to accompany the child. 9) During radiography of upper limbs protect the upper torso of all children.
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CONCLUSION:
Above points shows that children require special attention when they are to be radio graphed.
immobilization plays important role in pediatric radiography and radiation protection is must in pediatric radiography.
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