Radiographic Assessment of Paediatric Chest

Area of interest to be included on the radiograph

The radiograph should include the whole of the chest including the first rib to the costophrenic angles inferiorly and the outer margins of the ribs laterally. When assessing the image the PACEMAN image evaluation technique should be used.

Rotation

The chest of a young child is more cylindrical than that of an adult and therefore a small amount of rotation will lead to the appearance of significant asymmetry. Due to difficulties visualising the medial ends of the clavicles in young children, rotation is better judged using the anterior ribs, which should be of equal length and symmetrically positioned with respect to the vertebral column. Minimising patient rotation is essential as many pathological conditions may be simulated as a result of rotation (enlarged cardiac outline) .

Lordosis

Lordosis is a common technical fault when performing AP chest radiographs and may be corrected by placing a 15° pad behind the patient’s shoulders and by ensuring that the arms are not hyperextended. Radiographically, lordosis can be identified when the anterior ribs appear horizontal or are angled cranially to lie above the posterior ribs. The altered position of the clavicles is not an accurate indication of lordosis in children as clavicular position changes with shoulder movement.

Artefacts

Care should be taken to avoid artefacts on children’s clothing (e.g. decals on T-shirts, or metal pressstuds on jumpsuits).


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