Sie sind auf Seite 1von 24

The Art of Infant X-Ray

Dr Norhafizah Ahmad
Pediatrician
Hospital Ampang
Objectives
1. Identify reasons an infant would needs
an x-ray

2. Lists critical components of a quality film

3. Identify strategies for ensuring a quality


film

4. Discuss how technique & interpretation


might influence nursing intervention
What is an x-ray?

A picture of a shadow casts by the denser


materials (bone)

Projected onto a film - developed similar to a


photograph
Why we should do an x-
ray?
To assess heart, lungs, abdomen and bones

Ordered as part of :

physical examination

assessment of patient with symptoms related to heart/lung/abdomen

to check position of internal devices such as lines, ETT

to correlate with physical findings


Assess
Symptoms
Check position of internal devices
Correlate with
physical findings
How do x-ray works?

X-rays are absorbed by tissue in


varying amounts

Denser tissues absorb more and


appear white

less dense tissues absorb less and


appear black on film

bones look white

soft tissue looks grey

air filled structures looks black


X- ray position : AP view

Anterior-posterior view

Most common view

Best for

identification of heart/lung

diagnosing abdominal condition

verification of internal devices


placement
X-ray position : Lateral
decubitus

Best view to diagnose

small pneumothorax

bowel perforation
A systematic approach

Evaluate the diaphragm


Compare with previous film

Examine soft tissue Check the pleura

Review bony framework Identify gastric bubble and liver

Tracheal air or/and deviation Evaluate the lung fields


Examine the hilum Note indwelling devices
Evaluate mediastinal structures
Another systematic
approach
Evaluate quality of film

Survey infant position

Evaluate for extraneous objects

Evaluate the film systematically

Heart size, position and shape

Mediastinum

Lung fields volume

Aeration of lungs

Assess pulmonary vascularity


Systematic
assessments
Quality of an x-ray
Quality is essential for accurate evaluation

position
rotation
artefacts
penetration/exposure
Position and rotation

Ribs should appear equal in


length

Clavicles are symmetrical

Rotation causes skewed lungs


fields and possible misdiagnoses

Difficult to evaluate ETT and long


lines position
Lordotic position

Neonate conical shape

Front of chest tipped up naturally

Posterior lungs disappear behind


the diaphragm

exaggerated by tipped chest

improve by increase HOB 5-


10%
Artifacts
Penetration/exposure

Overexposed

Burn out

No lungs marking

Less contrast with background


of film

Underexposed

light grey all over

Lacks contrast
Inspiratory film clues

Less than 1/3 of the heart is


below the dome of the
diaphragm

Diaphragm dome are flat or


rounded

5th or 6th anterior rib crosses


the diaphragm

Lungs are black


Expiratory film clues

More than 1/3 of the heart


below the dome of the
diaphragm

Diaphragm are very domed

3rd or 4th rib crosses the


diaphragm

Lungs are white


Role of the nurse

Being aware of and ensuring


proper
technique

Ensure proper positioning of


the infant

Assisting the radiographer in


every x-ray procedure
We believed that empowering the nursing staff
with adequate lead protective gear and radiation
safety awareness will translate into increased
adherence to the standard protocol in bedside
imaging process and thereby ensure utmost
patient safety.