The document outlines a systematic ABCDE approach for interpreting pediatric chest x-rays (CXR). It describes evaluating the airways and lungs, bones and soft tissues, cardiac and mediastinum, diaphragms, and any extra equipment. Proper technique is emphasized, including ensuring inspiration, centering, and adequate exposure. Normal anatomical structures are shown along with examples of common abnormalities. The importance of reviewing specific areas to avoid missing subtle findings is stressed.

1. Part 2.0
Standardised Interpretation of Paediatric
CXR
Done in collaboration with:
The Northern School of Radiology,
UK
County Durham and Darlington NHS
Foundation Trust
Authors:
Dr. Alasdair Mackie MD
Dr. Nadia Mcallister MD
Dr. Abdelrahman Omer MD
Dr. Ramdas Senasi MD
Special Thanks:
Professor Bernard Laya

2. Aim
 Demonstrate a systematic approach to
paediatric Chest X-rays using an ABCDE
method.

3. Systematic approach
Technique
• A - Airways and lungs
• B - Bones and soft tissues
• C - Cardiac
• D - Diaphragm
• E - Extra body equipment
+ - ABC Double check: Important review areas
to minimise missing abnormalities.

4. Technique
RIPE
Rotation
Inspiration
Picture
Exposure
Centred film.
Equal distance between medial
ends of clavicles

5. Technique
RIPE
Rotation
Inspiration
Picture
Exposure
Rotated film.
Note the gap between medial
end of right clavicle.

6. Technique
RIPE
Rotation
Inspiration
Picture
Exposure
1
2
3
4
5
6
7
8
9
1
2
3
4
5
6
7
Posterior
ribs Anterior
ribs
Normal CXR, should see 7 anterior ribs and
9 posterior. Do not need to count both.

7. Technique
RIPE
Rotation
Inspiration
Picture
Exposure
Overinflated Underinflated

8. Technique
RIPE
Rotation
Inspiration
Picture
Exposure
Ensure important body parts included
in image
Adequate CXR Suboptimal CXR

9. Technique
RIPE
Rotation
Inspiration
Picture
Exposure
Underexposed
‘too bright’
Overexposed
‘too dark’
Vertebral bodies should be faintly
visible throughout.

10. Normal Structures seen on a CXR

11. Systematic approach
Technique
Airways and lungs:
B
C
D
E
+ - ABC Double check.
Start at top and compare right
with left.
Trachea should always be central.
Can deviate to right on expiration
in younger patients.

12. Lobar anatomy – right lung – 3 lobes
upper, middle and lower lobes

13. Lobar anatomy – left lung, 2 lobes
upper and lower lobes

14. Systematic approach
Technique
A
Bone and soft tissues:
C
D
E
+ - ABC Double check.
Bony or soft tissue lesions
can be easily missed if not
looked for.

15. Abnormal soft tissue
mass at right apex.
Abnormal bony lesion
on left rib.

16. Systematic approach
Technique
A
B
Cardiac and mediastinum:
D
E
+ - ABC Double check.
Important to review size, borders
and for mediastinal masses.

17. Size; generally no more
than 50% (exception is
neonates, can be bigger)
Normal
Enlarged
Mediastinum; thymus regularly seen in children.
Not to be confused with mediastinal lymphadenopathy.
Normal thymus Normal thymus
Abnormal mediastinal adenopathy
seen in lymphoma

18. Systematic approach
Technique
A
B
C
Diaphragms:
E
+ - ABC Double check.
Should be clear and crisp,
if blurred/obscured this
should raise suspicion.

19. Normal
Right hemi diaphragm is
normally higher than the
left, approximately one rib
space.
Clear costophrenic angles.
Right sided effusion.
Can not see entire hemi
diaphragm and have lost
costophrenic angle.

20. Systematic approach
Technique
A
B
C
D
Extras:
+ - ABC Double check.
Check for lines and tubing

21. Endotracheal tube
Umbilical vein catheter
Umbilical artery catheter
Nasogastric tube
Nasogastric tube
Endotracheal tube
Central line

22. Systematic approach
Technique
A
B
C
D
E
+ - ABC Double check Apex, Behind heart,
costophrenic and cardio phrenic angles.

23. These lesions can be easily
missed.
Review areas are important.

24. Summary
Demonstrated a systematic approach to paediatric
CXR using ABCDE.
Reinforced importance of review areas to ensure
subtle things not missed.

25. • Thank you for your attention.
• Any questions?

26. References
Images obtained from following resources;
Eurorad.org
Radiopaedia.org
Wikiradiography.net
Lifeinthefastlane.com
Slideshare.net