Plain Films - Neck and Nasopharynx

Date last published: 07 July 2023

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Radiology

Sit the patient beside the chest holder as for lat chest.
Position Cassette to include nasopharynx and trachea.
Two assistants are necessary - one to hold child's arms and pull down on shoulders and one to hold the child's head still in lateral position with neck slightly extended.
Expose in inspiration.
Alternatively you can lie patient on side and support the head on a pad.
Image supine/horizontal ray only if you are sure there is no risk to child's airway eg stridor.
NB: If there is any concern re child's airway being at risk ensure nurse or ED Dr accompanies patient to Radiology

(if request mentions 'snoring')

Patient positioned as above but exposure centred on and coned to nasopharynx and more penetrated than lat neck
Can be done supine/horizontal ray if child difficult to position erect. Do not overextend neck.
Cassette should be positioned at side of head but do not turn the neck to achieve this, elevate chin instead.
Expose on normal inspiration, if possible breathing through nose, with mouth closed NOT VALSALVA
NB a lateral chest exposure at 180cm FFD is appropriate for lat neck

Lie patient supine with head turned to side.
Include nose to anus on one film if possible. If not - make sure there is overlap.
If suspected FB is of low density (e.g. Aluminium can tab), proper lat neck and lat CXR may be needed to visualise FB if not seen on initial film.
If FB has been poked up nose: Lat nasopharynx 1st -if can't see FB, proceed to CXR/AXR

Rarely seen these days - should not need imaging, clinical management more appropriate. If CED insist

Do not lie patient supine. If patient does have epiglottitis the epiglottis can fall back and block the airway completely. If child unco-operative you can image in lateral position with horizontal ray.

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