Paeds imaging

Question 1

Magic SSH Exposure

Answer 1

60 kVp / 1.6 mAs

Question 2

Extremities Exposure

Answer 2

Typically lower kVp and mAs (specifics vary by extremity)

Question 3

Baby Supine Chest Exposure

Answer 3

60 kVp / 2 mAs

Question 4

Skinny Non-Grid AP Adult Exposure

Answer 4

90 kVp / 2 mAs

Question 5

Grid AP/PA Adult Exposure

Answer 5

115 kVp / 2 mAs (approximately)

Question 6

Average Abdominal Exposure

Answer 6

mAs = Patient’s Age

Question 7

What is Developmental Dysplasia of the Hip (DDH)?

Answer 7

A condition where the hip joint is unstable or misaligned, often involving a misshapen acetabulum.

Question 8

Signs of DDH on an AP pelvis X-ray

Answer 8

Look for signs like a shallow or misshapen acetabulum, which may indicate hip instability.

Question 9

Risk factors for DDH

Answer 9

Breech birth
Family history
Uneven skin creases on the thighs or buttocks

Question 10

Clinical signs of DDH

Answer 10

“Clicky” hips
Abnormal crawl or walk
Uneven creases on the thighs
Family history of DDH

Question 11

Why is DDH usually assessed after 4 months on X-ray?

Answer 11

The pelvis isn’t fully developed in infants under 4 months, making it difficult for radiologists to assess DDH on X-ray. Ultrasound is preferred for younger infants.

Question 12

Severity and treatment of DDH

Answer 12

DDH can vary in severity, from mild instability to complete dislocation. Treatment options include harnesses, casts, and in severe cases, surgery.

Question 13

What is SUFE?

Answer 13

Slipped Upper Femoral Epiphysis (SUFE) is a condition where the femoral head slips posteriorly and inferiorly at the growth plate.

Question 14

Typical patient profile for SUFE

Answer 14

Occurs in 10-15-year-old children, often in bigger, active kids or those with obesity.

Question 15

Common symptoms of SUFE

Answer 15

Limping

Groin pain

Referred knee pain

Question 16

Best radiographic views for SUFE

Answer 16

AP pelvis + frog-leg lateral to assess femoral head displacement.

Question 17

What is Shenton’s line, and how does it relate to SUFE and DDH?

Answer 17

Shenton’s line: A smooth, curved line along the inferior border of the superior pubic ramus and the medial femoral neck.

In SUFE: The line is disrupted due to femoral head displacement.

In DDH: The line is also disrupted due to acetabular dysplasia or dislocation.

Question 18

Chest X-ray positioning by age

Answer 18

<4 months → Supine

4 months - 5 years → Sitting

5+ years → Bucky (standing)

Always consider patient condition and ability when positioning!

Question 19

How do you angle for a supine baby chest X-ray?

Answer 19

Use a sponge under the shoulders or angle the tube slightly to avoid lordosis.

Question 20

How to restrain a baby for a supine chest X-ray?

Answer 20

Bottom half secured with equipment (e.g., immobilization board).

Top half held by a caregiver.

Question 21

Landmarks for a supine baby chest X-ray

Answer 21

Nipple line (for centering)

Top of shoulders (for collimation)

Belly button (for lower collimation reference)

Question 22

Why is a sitting chest X-ray preferred in young children?

Answer 22

Better visualization of fluid levels, as gravity helps separate air and fluid.

Question 23

Should lateral or PA be done first in young children?

Answer 23

Lateral first – helps settle the child and may reduce movement for the PA.

Question 24

How to restrain a child for a sitting chest X-ray?

Answer 24

Elbows to ears for younger children.

Holding hands for more cooperative kids.

Question 25

Landmarks for a sitting chest X-ray

Answer 25

Nipple line (for lateral positioning) Bases of scapulae (for PA positioning) Shoulders + belly button (for general collimation reference)

Question 26

Why is temperature regulation important in neonates?

Answer 26

Neonates have poor thermoregulation and lose heat easily. Warm the room/incubator before handling. Minimize time outside the incubator.

Question 27

Why do neonates have low immunity?

Answer 27

Underdeveloped immune system makes them vulnerable to infections. Strict hand hygiene and PPE use are essential.

Question 28

Special handling considerations for neonates

Answer 28

Gentle handling to avoid stress and injury. Keep movements slow and minimal. Work efficiently to limit time out of warmth.

Question 29

Radiography in incubators—what to consider?

Answer 29

Use incubator X-ray trays when possible. Avoid opening ports too long to prevent heat loss. Be mindful of lines and tubes when positioning.

Question 30

Why are both inspiration and expiration views needed for inhaled foreign objects?

Answer 30

Many foreign objects are radiolucent, making them hard to see directly. Inspiration and expiration views help detect air trapping, lung collapse, or asymmetry.

Question 31

What does the inspiration view show in an inhaled foreign object case?

Answer 31

May appear normal if air can pass the obstruction. Can show a partially blocked bronchus.

Question 32

What does the expiration view show in an inhaled foreign object case?

Answer 32

Air trapping → hyperinflation if the object acts as a ball-valve (air in, but not out). Collapse (atelectasis) if the obstruction is complete.

Question 33

Key signs of an inhaled foreign object on X-ray

Answer 33

Mediastinal shift (toward or away from affected lung). Asymmetry in lung expansion (one lung overinflated or collapsed).

Question 34

What is the most common reason for a soft tissue neck X-ray?

Answer 34

Usually done to assess for enlarged adenoids. Enlarged adenoids can cause airway obstruction, hence the need for imaging.

Question 35

What anatomical range should be included in a soft tissue neck X-ray?

Answer 35

Nasal cavity to C7. ## Footnote This range ensures a complete view of the airway and surrounding structures.

Question 36

How should young children be restrained for a soft tissue neck X-ray?

Answer 36

Ideally, two restrainers: * One for the head * One for shoulders/arms ## Footnote Proper restraint minimizes movement and ensures accurate imaging.

Question 37

What are the key positioning points for a baby pelvis X-ray?

Answer 37

Straighten the body * Legs straight, together, and internally rotated ## Footnote Correct positioning is crucial for obtaining clear images.

Question 38

What landmarks are used for a baby pelvis X-ray?

Answer 38

Belly button * Genitalia * Soft tissue boundaries ## Footnote Landmarks help in aligning the X-ray correctly.

Question 39

What are the key image criteria for a baby pelvis X-ray?

Answer 39

Is everything included? * Is the pelvis rotated? * Is the exposure appropriate? ## Footnote These criteria ensure diagnostic quality of the X-ray.

Question 40

Why are longer casts used for horizontal ray laterals?

Answer 40

Longer casts help improve immobilization and reduce movement required during imaging. ## Footnote This is important to achieve clear and accurate images.

Question 41

What orthopedic cases commonly require imaging in theatre?

Answer 41

Manipulation Under Anesthesia (MUA) * K-wire insertion and ORIF (Open Reduction Internal Fixation) for fractures * Congenital deformity corrections * Scoliosis surgeries * Osteotomies * SUFE fixation * Line placements ## Footnote These cases often involve complex procedures requiring accurate imaging.

Question 42

What does an MCU (Micturating Cystourethrogram) assess?

Answer 42

It checks for urinary reflux, where urine flows backward from the bladder to the kidneys. ## Footnote This condition can lead to serious renal complications if not diagnosed.

Question 43

How is an MCU performed?

Answer 43

Contrast is introduced into the bladder via a catheter, and X-rays are taken while the patient voids. ## Footnote This method provides dynamic imaging of the urinary tract.

Question 44

Why is a barium swallow performed?

Answer 44

To assess for a safe swallow, checking for aspiration or structural abnormalities. ## Footnote Identifying these issues is crucial for preventing aspiration pneumonia.

Question 45

Why must younger patients be kept nil by mouth before a barium swallow?

Answer 45

To prevent aspiration and ensure clear imaging. ## Footnote This precaution is vital for patient safety.

Question 46

What are common tube and line placements imaged in radiology?

Answer 46

NJ (Nasojejunal) tube placement/insertion * GJ (Gastrojejunostomy) tube insertion/change * Vascular line placement (e.g., PICC, central lines) ## Footnote Proper imaging of these placements ensures correct positioning and function.

Question 47

What is intussusception?

Answer 47

A medical emergency where the bowel telescopes into itself, leading to obstruction. ## Footnote This condition can cause severe complications if not treated promptly.

Question 48

How is intussusception treated?

Answer 48

Usually treated with an air enema, which helps unfold the telescoped bowel. ## Footnote This non-invasive method is often effective in resolving the condition.

Question 49

What imaging is done before treating intussusception?

Answer 49

Ultrasound (USS) is performed first to confirm the diagnosis before starting treatment. ## Footnote Ultrasound is preferred due to its safety and effectiveness in children.