1. Part 2.0 Standardised Interpretation of Paediatric CXR
Done in collaboration with:
Authors:
The Northern School of Radiology, UK
Dr. Alasdair Mackie MD
Dr. Nadia Mcallister MD
County Durham and Darlington NHS Foundation Trust
Dr. Abdelrahman Omer MD
Dr. Ramdas Senasi MD
Special Thanks:
Professor Bernard Laya

2. Aim
Demonstrate a systematic approach to paediatric Chest X-rays using an ABCDE method.

3. Systematic approach Technique A - Airways and lungs
B - Bones and soft tissues
C - Cardiac
D - Diaphragm
E - Extra body equipment
+ - ABC Double check: Important review areas to minimise missing abnormalities.

4. RIPE Technique Rotation Inspiration Picture Exposure Centred film.
Equal distance between medial ends of clavicles

5. RIPE Technique Rotation Inspiration Picture Exposure Rotated film.
Note the gap between medial end of right clavicle.

6. RIPE Technique Rotation Inspiration Picture Exposure
Normal CXR, should see 7 anterior ribs and 9 posterior. Do not need to count both.
RIPE
Rotation
Inspiration
Picture
Exposure 1 2 3 4 1 5 2 6 3 7 4 8 5 6 9 7
Posterior ribs
Anterior ribs

7. RIPE Technique Rotation Inspiration Picture Exposure Overinflated
Underinflated

8. RIPE Technique Rotation Inspiration Picture Exposure
Ensure important body parts included in image
RIPE
Rotation
Inspiration
Picture
Exposure
Adequate CXR
Suboptimal CXR

9. RIPE Technique Rotation Inspiration Picture Exposure
Vertebral bodies should be faintly visible throughout.
RIPE
Rotation
Inspiration
Picture
Exposure
Underexposed
‘too bright’
Overexposed
‘too dark’

10. Normal Structures seen on a CXR

11. Systematic approach Technique Airways and lungs: B C D
+ - ABC Double check.
Start at top and compare right with left.
Trachea should always be central.
Can deviate to right on expiration in younger patients.

12. Lobar anatomy – right lung – 3 lobes upper, middle and lower lobes
Note the overlap of the lobes on the frontal view. Minor (Horizontal) fissure separates the upper an middle lobes

13. Lobar anatomy – left lung, 2 lobes upper and lower lobes
Note the overlap of the lobes on the frontal view

14. Systematic approach Technique A Bone and soft tissues: C D E
+ - ABC Double check.
Bony or soft tissue lesions can be easily missed if not looked for.

15. Abnormal soft tissue mass at right apex.
Abnormal bony lesion on left rib.

16. Systematic approach Technique A B Cardiac and mediastinum: D E
+ - ABC Double check.
Important to review size, borders and for mediastinal masses.

17. Mediastinum; thymus regularly seen in children.
Normal
Normal thymus
Normal thymus
Size; generally no more than 50% (exception is neonates, can be bigger)
Mediastinum; thymus regularly seen in children.
Not to be confused with mediastinal lymphadenopathy.
Abnormal mediastinal adenopathy seen in lymphoma
Enlarged

18. Systematic approach Technique A B C Diaphragms: E
+ - ABC Double check.
Should be clear and crisp, if blurred/obscured this should raise suspicion.

19. Right hemi diaphragm is normally higher than the left, approximately one rib space.
Clear costophrenic angles.
Normal
Right sided effusion.
Can not see entire hemi diaphragm and have lost costophrenic angle.

20. Systematic approach Technique A B C D Extras: + - ABC Double check.
Check for lines and tubing

21. Umbilical artery catheter
Endotracheal tube
Temperature probe
Nasogastric tube
Endotracheal tube
Central line
Umbilical artery catheter
Umbilical vein catheter
Nasogastric tube

22. Systematic approach Technique A B C D E
+ - ABC Double check Apex, Behind heart, costophrenic and cardio phrenic angles.

23. These lesions can be easily missed.
Review areas are important.

24. Summary
Demonstrated a systematic approach to paediatric CXR using ABCDE.
Reinforced importance of review areas to ensure subtle things not missed.

25. Thank you for your attention.
Any questions?

26. References Images obtained from following resources; Eurorad.org
Radiopaedia.org
Wikiradiography.net
Lifeinthefastlane.com
Slideshare.net