Paediatric Imaging
Paediatric imaging tests age-appropriate technique, recognition of congenital and acquired emergencies, and radiation protection tailored to children.
Core principles
- Use the lowest dose that answers the question: weight-based kVp and mAs, ultrasound first where possible, and avoid adult CT protocols.
- Neonatal bowel obstruction: duodenal atresia gives a double bubble; malrotation risks volvulus; necrotizing enterocolitis shows pneumatosis.
- Intussusception: ultrasound target sign; air enema is both diagnostic and therapeutic when there is no peritonitis.
- Developmental dysplasia of the hip is screened by ultrasound using Graf classification in early infancy.
- Non-accidental injury: metaphyseal corner fractures, posterior rib fractures and injuries of different ages are red flags.
Worked example
A 6-month-old has intermittent screaming and redcurrant jelly stool. Ultrasound shows a target sign, confirming ileocolic intussusception. Air enema reduction is attempted if there is no perforation or peritonitis; surgery is reserved for failure or complications.
Traps
- Applying adult CT parameters to a small child.
- Missing a subtle buckle fracture or attributing a metaphyseal fracture to normal variation.
- Using fluoroscopy for a diagnosis that ultrasound can make.