Chest X-Rays and Children

Look up a cardiac-related terms in the Heart Institute glossary.

The chest X-ray is the most common radiologic procedure. The X-ray is projected toward the chest to show the heart and lungs, bones and soft tissues. The actual time of the average X-ray exposure is extremely short -- often less than one-half second. Some of the radiation penetrates the part of the body being examined and thus creates the X-ray image.

To understand what happens when an X-ray is taken, a comparison can be made with the use of a camera in taking a photograph.

The X-ray exposes the film to form an image just as the light exposes the film inside a camera. The film in a camera is developed and used to make a photographic print or it is used directly as a slide. The X-ray film is also developed and viewed with transmitted light on a light box or computer screen.

The chest X-ray technique in young children involves two views. The initial view is from the front, and the second is a side view.

In young children, the patient lies on the table and the hands are held above the head.

In an older patient, the child stands in upright and then in a lateral view as the images are obtained. The technologist tries to "tightly cone" the radiation beam using a light on the patient's chest. This reduces the scatter radiation to other parts of the body.

After the film is obtained, it is interpreted by a radiologist. Comparison with prior films is important, particularly in evaluating heart size and blood flow to the lungs.

A report is made and becomes part of the patient's permanent record. Results are shared with both the cardiologist and the referring physician.

Fortunately, the chest X-ray requires little or no advance preparation. Sometimes children are frightened by the large and unfamiliar equipment in the X-ray room; however, a simple explanation is often helpful for reassurance depending on the child's level of understanding.

Parents are always allowed to be with the child to aid the study and for reassurance of the child. When the image is about to be taken, parents are encouraged to remind the child to hold still so that the picture will be sharp and clear.

Occasionally, restraining the child is necessary, as it is in the best interest of the patient to have an adequate film and to reduce radiation exposure (by not repeating the study).

The technologist works in tandem with parents to optimize techniques in working with the child.

The most frequently ordered X-ray is the chest X-ray, which helps the doctor decide if the heart is big, if there is pneumonia, or if there is fluid in the lungs.

X-rays are also used during cardiac catheterizations, which enable the cardiologist to better understand the physiology of the heart, assess pressure measurements, identify sites of obstruction, and determine function.

In addition, interventional cardiology procedures use radiation to aid placement of catheters, coils, or other devices. The radiation exposure allows the cardiologist to "treat" nonoperatively specific congenital heart abnormalities.

Radiation is not something just made in the hospital, and natural radiation far exceeds man-made sources of radiation.

Natural radiation exposure comes from cosmic radiation from the sun, terrestrial radiation from rocks and soil, and internal radiation within our own bodies from things we have eaten such as milk or water.

The radiation in food and drink comes from water, plants and animals, which receive radiation from the earth or cosmic radiation from the sun.

Annual background radiation at sea level is one-half the radiation in Denver, Colorado. Denver is at high altitude and the earth's atmosphere filters cosmic rays so that the higher one goes above sea level, the greater cosmic radiation level.

Despite the variation in background radiation, there is no increase in cancer or congenital abnormalities detected in these areas.

Medical X-rays account for only about 15 percent of the annual radiation exposure in the United States. This figure includes the radiation used in radiation therapy (high dose) and in nuclear medicine.

Depending upon the severity of a child's problem, the number and complexity of X-ray examinations needed to diagnose and determine the extent of an illness are variable.

Even with multiple and repeated chest X-ray exams or repeat cardiac catheterizations, the total dose is still small. The expected benefits of the X-rays must always outweigh any possible risk for the examination to be performed.

  • X-rays are taken only on the recommendation of a qualified cardiologist or physician. The physician is able to balance the benefits of having the X-ray exam against the risk of causing any possible side effect.
  • Personnel performing the test are accustomed to dealing with children.

    The radiology and cardiology departments of Cincinnati Children's take great strides in having up-to-date equipment. Routine surveillance of equipment and fulfilling all state regulations for registration and maintenance of equipment are mandated, not only by the state health department Bureau of Radiation Safety, but also by the hospital.

    Annual inspections of the equipment and review of departmental procedures are always in compliance.
  • All Cincinnati Children's personnel who use the equipment are trained and qualified for its use.

    All X-ray technologists are part of the National Registry for Radiologic Technologists.

    Also, physicians involved in performing X-ray procedures undergo specific training to reduce radiation exposure and use techniques that decrease exposure.

    Technologists who are familiar in dealing with children are particularly good at obtaining quality images on the first try. This reduces the need for repeated radiation exposure.

Last Updated 11/2012