Pediatric chest (lateral view)

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The pediatric lateral chest view may be performed as an adjunct to a frontal chest radiograph in cases where there is diagnostic uncertainty. The lateral chest view examines the lungs, bony thoracic cavity, mediastinum, and great vessels. Lateral radiographs can be particularly useful in assessing the retrosternal and retrocardiac airspaces.

There is a body of research that suggest the lateral projection it is not required for the detection of pneumonia in the paediatic patient . The appropriateness of a lateral chest x-ray in the paediatic patient will differ from institution to institution.

The lateral view of the paediatic patients shares many of the same points regarding positioning, however, the aspect of immoblisation and exposure factors differ greatly.

For patients under the age of 6 months see: Pediatric chest (horizontal beam lateral view).

Patient position

  • the patient will often be placed on a chair or standing, depending on cooperation and age 
    • chair
      • arms above head, either held by a carer or held by velcro straps
    • standing 
      • patient is holding a vertical pole/handle to ensure stability. It is not advisable to ask the patient to keep his/her arms above their head, they will find this difficult to do while keeping still 
  • left side of the thorax adjacent to the image receptor
  • chin raised out of the image field
  • midsagittal plane must be perpendicular to the divergent beam, therefore:
    • right side rotated 5-10° anterior

Technical factors

  • lateral projection
  • suspended inspiration  
  • centering point
    • the midcoronal plane of the level of the 7th thoracic vertebra, approximately the inferior angle of the scapulae  
  • collimation
    • superiorly 5 cm above the shoulder joint to allow proper visualization of the upper airways 
    • inferior to the inferior border of the 12th rib 
    • anteroposterior to the level of the acromioclavicular joints
  • orientation  
    • portrait 
  • detector size
    • fit to childs chest 
  • exposure
    • 112 kVp
    • 1-3 mAs
  • SID
    • 180 cm
  • grid
    • grid is often not used

Image technical evaluation 

The entire lung fields should be visible superior from the apices inferior to the posterior costophrenic angle

  • the chin should not be superimposing any structures 
  • there is superimposition of the anterior ribs 
  • the sternum is seen in profile 
  • superimposition of the posterior costophrenic recess
  • a minimum of ten posterior ribs are visualized above the diaphragm
  • the ribs and thoracic cage are seen only faintly over the heart
  • clear vascular markings of the lungs should be visible

Practical Points

In order to streamline workflow, preparing the room beforehand (set up the detector and prepare lead gowns) will be extremely useful in pediatric chest imaging.

Ensuring appropriate inspiration and no motion may also require specialized communication techniques to gain cooperation from the child. Examples include:

  • “you have to breathe in like you are about to blow out a birthday candle!”
  • “take a big sniff now”
  • “lets play dead fish!”
  • “freeze!”
Immobilization

Some children will maintain their position for the examination, others will not. Research regarding the most effective method of immobilization is lacking. Immobilization methods will range from radiographers/parents holding the child to the utilization of multiple Velcro straps, some departments may consider the latter 'restraint' it is important to clarify with local guidelines .

Family members may assist in distracting or holding the child. It is important to give the parents a focused task; particularly when they are feeling anxious for their children.

Specialized equipment

Specialized pediatric departments will have 'chairs' appropriate to hold children during the examination , these chairs often contain multiple Velcro strap points, are counter weighted for stability and have a radiolucent backing such as perspex. It is important when using this equipment that the children is safely fastened with no risk of falling. In extreme cases the parent may stand in front of the patient ensuring they feel safe.