Neonate chest (supine view)

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The supine chest view of the neonatal patient is a common radiographic examination when examining preterm patients . 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 .

Patient position

  • 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
  • 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 . 

Technical factors

  • anteroposterior projection
  • suspended inspiration (observe patient's breathing)  
  • centering point
  • collimation
    • superior to the 3rd cervical vertebrae
    • inferior to the thoracolumbar junction
    • lateral to the skin margins
  • orientation  
    • portrait
  • detector size
    • often smaller 'mini' detectors are used for the neonate chest x-ray
  • exposure
    • 55-65 kVp
    • 1-2 mAs
  • SID
    • 110 cm
  • grid
    • no

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
Rotation
  • 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)

Practical points

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 . 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.

Consent

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 is an adequate introduction and explanation of the examination, ensuring the parents are comfortable with the procedure.