Paeds Vivas · investigations-procedures-and-technology
Chest radiograph interpretation in children — branching viva
Branching viva on paediatric chest radiograph interpretation: the technical-quality check before the fields, the ABCDEFGH systematic approach, the normal paediatric thymus and the sail sign, the inhaled foreign body and air-trapping, and the radiation-aware principle of justification and ALARA.
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Target exams
RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Emergency department: a 4-year-old with fever, cough, and increased work of breathing has a chest radiograph performed. The examiner asks how you would assess the technical quality before reading the fields, then how you would apply a systematic approach, then branches to the infant whose film shows a right upper mediastinal opacity, to the toddler with a choking episode and a normal inspiratory film, and finally to the principle that governs whether the film should have been requested at all.
Opening question
This 4-year-old with fever, cough, and increased work of breathing has a chest radiograph. Walk me through the structured technical-quality check you would perform before you read the lung fields, and tell me what would make you distrust the film and request a repeat. [1] [2]
References4ShowHide
- [1]Bramson RT, Griscom NT, Cleveland RH Interpretation of chest radiographs in infants with cough and fever Radiology, 2005.PMID 15983074
- [2]Marais J, Venkatakrishna SSB, Calle-Toro JS, et al Patient rotation chest X-rays and the consequences of misinterpretation in paediatric radiology Paediatr Respir Rev, 2023.PMID 37244797
- [3]Wee T, Lee AF, Nadel H, et al The paediatric thymus: recognising normal and ectopic thymic tissue Clin Radiol, 2021.PMID 33762135
- [4]Sehgal A, Singh V, Chandra J, et al Foreign body aspiration Indian Pediatr, 2002.PMID 12466569