Part 3.0 Standardised Interpretation of Paediatric AXR Done in collaboration with: Authors: The Northern School of Radiology, UK Dr. Alasdair Mackie MD County Durham and Darlington NHS Foundation Trust Dr. Abdelrahman Omer MD Dr. Ramdas Senasi MD

Aim Demonstrate a systematic approach in the interpretation of paediatric Abdominal X-rays using ABCDE method. To state the aim and objectives of the presentation

Test you skills To stimulate their prior knowledge before embarking on our systematic approach Engage the learner

The answer is Splenomegaly and right femoral head sclerotic abnormality. How not to miss it Systematic approach

Systematic approach Technique A - Air B - Bones and Bowel C – Calcification and soft tissue. D - Diaphragm E - Extra body equipment

Child vs Adult Anatomy

Systematic approach Air: B C D Extra-luminal air – always pathological. Intra-luminal air – it depends on the distribution

Small bowel gas distribution centrally Large bowel gas peripheral Gastric bubble Small bowel gas distribution centrally Large bowel gas peripheral NO EXTRA)LUMINAL FREE GAS Gas in the rectum

Systematic approach A Bone and Bowel: C D E Bones: ribs, pelvis, femur, spine. Bowel: Thorough look at the bowel dilatation from stomach to rectum

Spine Ribs Thin bowel wall Femur Pelvic bones

Systematic approach A B Calcifications and soft tissue D E Easy to miss especially soft tissue because of poor contrast difference E.g: Hepatosplenomegaly

Abnormal calcifications Spleen Abnormal calcifications Liver Left Kidney Left psoas muscle line

Systematic approach A B C Diaphragm: E Should be clear and crisp. Not to miss lung bases or air under diaphragm

Lungs bases No air under diaphragm

Systematic approach A B C D Extras: Check for lines and tubing

Umbilical vein catheter Temperature probe Endotracheal tube Nasogastric tube Umbilical vein catheter Umbilical artery catheter

Test you skills now!

Summary Demonstrated a systematic approach to paediatric AXR using ABCDE.

Thank you for your attention. Any questions?

References Images obtained from following resources; https://www.pinterest.com/pin/241927811204734854/ http://www.pedrad.org/portals/5/events/2013/markowitz-abdradiograph.pdf Radiopaedia.org