Neonate chest (supine view)
Citation, DOI and article data
The supine chest view of the neonatal patient is a common radiographic examination when examining preterm patients 1. Although not overall technically demanding, the radiographer should allocate time to ensure little to no repeats are required.
Research surrounding the technical evaluation and technical parameters of the neonate chest x-ray is limited, with a high variation between departments and textbooks 2.
Indications for a chest x-ray are far and wide from suspected infection to a pneumothorax. The specific reason why these radiographs are conducted supine is the fact neonates will often stay on the ward (performed mobile) and do not have reliable head control until around 3 months old 13.
- patient is supine
- an image receptor is placed under the patient's chest via a tray, sliding sheet, or detector holder
- head is straight
- arms are placed by the patients' side outside of the field of view or above the head either method is equally effective 2
- any leads or lines that can be moved should be transferred out of the image area to improve image quality
- when performing this examination mobile in a special care nursery or ward, the scattered radiation to nearby neonatal patients and their family must be considered. It is essential to ensure that nearby neonates and family members are invited to leave the room or moved as far away as possible from the x-ray source during exposure 3.
- anteroposterior projection
- suspended inspiration (observe patient's breathing)
- the level of the 7th thoracic vertebra
- superior to the 3rd cervical vertebrae
- inferior to the thoracolumbar junction
- lateral to the skin margins
- often smaller 'mini' detectors are used for the neonate chest x-ray
- 55-65 kVp
- 1-2 mAs
- 110 cm
Image technical evaluation
- entire lung fields should be visible; post-processing collimation is not advisable in pediatric imaging (if it is exposed it should be examined), if this is to be conducted, consider sending the non-digitally collimated image and resending it post collimated
- 6 anterior ribs must be visible to ensure full inspiration
- the clavicle is in the same horizontal plane use of the medial end of the clavicles to the spinous process is not advised due to ossification centers and superior positioning of the shoulder girdle 2
- measure the distances from the 4th ribs lateral border to the center of the spine (upper)
- measure the distances from the 8th ribs lateral border to the center of the spine (lower)
Contact lead shielding is no longer recommended for any pediatric examination, multiple radiological societies have released statements supporting the cessation of this practice 8-11 the most comprehensive guidance statement on this matter (86 pages) is a joint report found at this citation 12.
Please see your local department protocols for further clarification as they may differ from these recommendations.
The neonatal chest is technically demanding not due to the examination; the neonatal patient is often underweight, and unable to keep still.
One of the most common repeated images in pediatric imaging is movement 7. To prevent movement during the examination will often require a staff member, in lead protection, to stay in the room holding the patient (often at the arms and legs). If this is the case, careful instruction should be provided to that staff member regarding the goal of the examination. Research regarding the most effective method of neonatal immobilization is lacking; departmental protocols will vary.
It is imperative that the patient's family is acknowledged and respected. Often the parents of the newborn child will be in the room. One must ensure that there are an adequate introduction and explanation of the examination, ensuring the parents are comfortable with the procedure.
- 1. Don S, Macdougall R, Strauss K, Moore QT, Goske MJ, Cohen M, Herrmann T, John SD, Noble L, Morrison G, Lehman L, Whiting BR. Image gently campaign back to basics initiative: ten steps to help manage radiation dose in pediatric digital radiography. (2013) AJR. American journal of roentgenology. 200 (5): W431-6. doi:10.2214/AJR.12.9895 - Pubmed
- 2. Pedersen Christina Carøe Ejlskov, Maryann Hardy and Anne Dorte Blankholm. "An Evaluation of Image Acquisition Techniques, Radiographic Practice, and Technical Quality in Neonatal Chest Radiography". Journal of Medical Imaging and Radiation Sciences 49, no. 3 (2018): 257-264. . doi:10.1016/j.jmir.2018.05.006.
- 3. Olgar T, Onal E, Bor D, Okumus N, Atalay Y, Turkyilmaz C, Ergenekon E, Koc E. Radiation exposure to premature infants in a neonatal intensive care unit in Turkey. (2008) Korean journal of radiology. 9 (5): 416-9. doi:10.3348/kjr.2008.9.5.416 - Pubmed
- 4. Kohn M. M. European guidelines on quality criteria for diagnostic radiographic images in paediatrics, 1996.
- 5. Knight SP. A paediatric X-ray exposure chart. (2014) Journal of medical radiation sciences. 61 (3): 191-201. doi:10.1002/jmrs.56 - Pubmed
- 6. Hardy Maryann and Beverly Snaith,. "Improving neonatal chest radiography: an evaluation of image acquisition techniques, dose and technical quality". In UK Radiological Congress. Manchester, 2014.
- 7. Ng Jessica Hui Shi and Edel Doyle. "Keeping Children Still in Medical Imaging Examinations- Immobilisation or Restraint: A Literature Review". Journal of Medical Imaging and Radiation Sciences (2018). . doi:10.1016/j.jmir.2018.09.008.
- 8. Statement No. 13 – NCRP Recommendations For Ending Routine Gonadal Shielding During Abdominal And Pelvic Radiography (2021)". Ncrponline.org, 2021. [Link].
- 9. ASMIRT Position Statement Gonad Shielding". Asmirt.org, 2021. [Link].
- 10. ASRT Statement on Fetal and Gonadal Shielding. Asrt.org, 2021. [Link].
- 11. Yogesh Thakur, Stephanie C. Schofield, Thorarin A. Bjarnason, Michael N. Patlas. Discontinuing Gonadal and Fetal Shielding in X-Ray:. (2021) Canadian Association of Radiologists Journal. doi:10.1177/0846537121993092 doi:10.1177/0846537121993092.
- 12. Guidance on using shielding on patients for diagnostic radiology applications Joint report. Bir.org.uk, 2021. [Link].
- 13. Lima-Alvarez CD, Tudella E, van der Kamp J, Savelsbergh GJ. Early development of head movements between birth and 4 months of age: a longitudinal study. (2014) Journal of motor behavior. 46 (6): 415-22. doi:10.1080/00222895.2014.929562 - Pubmed