Before the patient and/or parent arrives in the room, you should have all equipment set up in advance. Make sure to have an extra lead apron for a parent if they wish to remain in the room with the child. I always like to encourage this except when the physical presence of the parent seems to make the child more combative.
You should always attempt the exam without immobilization first. This doesn't mean you need to make a bad exposure. Use your judgement about the quality of your radiograph before you commit to the attempt. Better to try unsuccessfully without a radiation dose than to settle on a sub-par quality film and end up repeating anyways. Be sure to communicate with the parent about immobilization techniques and requirements of the procedure. This may encourage better parent participation because they just want to get it over with to minimize any emotionally traumatic experience the child may have to endure (i.e. the pigg-o-stat). Don't forget to ask the mother if there's a possibility she could be pregnant before letting her assist.
The table-top attempt:
Place an 8x10 or 10x12 cassette in a grid holder at one end of the table. At the other end, align the x-ray tube horizontally to the cassette. Consider placing a sheet over the cassette so the patient will not be startled because of its ice-cold tempurature. Have mom or dad put the lead on and have a small lead apron for the patient (a thyriod shield will work on small patients). You should already have a preliminary technique set up for the AP chest. Place the patient's back against the cassette and the shield over their lap. Mom or dad can hold the arms to the side, grasping mid-humerus, and making sure to keep the child's back flat against the cassette.
For the lateral, simply rotate the patient's legs to their left 90 degrees. Have a parent stand in front of the patient and grasp the arms at the elbows bringing them together to touch in front of the face, also ensuring proper elevation above the thorax. I typically like to increase the kV by 10% and double my mAs from the AP to the lateral, but everyone has a different rule of thumb.
At three years old, the pediatric patient may be too large for the pig-o-stat. If they are somewhat cooperative, you may be able to provide a foot-stool and stand them at the upright bucky. Most will not be able to perform a PA projection because they are trying to see all of the equipment and may be a little frightened to turn their back. I worked at a facility where we put a rather large "Shrek" sticker on the bottom of the x-ray tube to give them something familiar to look at for the AP projection. Another sticker was placed on the wall directly in front of them when they were in the left lateral position. All we said was "look at Shrek" and they cooperated, but you better be on the rotor because it didn't last more than a few seconds.
The pigg-o-stat:
If you have an absolutely uncooperative patient that requires immobilization, the pigg-o-stat is the method of choice for radiographers. Most come with different sized adjustable flanks and you may want to sneak a peak at your patient before bringing them into the room to estimate the appropriate size.
If you've never used one or seen one, they look like some sort of dark-age torture device, which they could easily turn into if you let the patient sit in them too long. You simply place them into the seat with arms above their head and close the flanks. Make sure to lock them in place. If you have all of this set up in advance, the patient should be in and out in just a few seconds.
Thanks for your blog. Great tips. I am a new Technologist and this is a good site.
ReplyDeleteThank you for the encouragement. Feel free to give me some suggestions for topics any time.
ReplyDeleteAnother tip for pediatric chests...you can put the foot board on the end of the table with cassette behind the patient. You can use a large film (doesn't matter with digital what size you use) and collimate. Parent can stand behind the patient and hold onto the patient's arms. Sometimes you need to angle caudad slightly because of not being able to lower tube enough. Another tech showed me this, and it works well.
ReplyDeleteAnother tip for pediatric chests...you can put the foot board on the end of the table with cassette behind the patient. You can use a large film (doesn't matter with digital what size you use) and collimate. Parent can stand behind the patient and hold onto the patient's arms. Sometimes you need to angle caudad slightly because of not being able to lower tube enough. Another tech showed me this, and it works well.
ReplyDeleteThat's another great one to mention... I've actually seen this done before and it's worked very well.
ReplyDeleteThat's another great one to mention... I've actually seen this done before and it's worked very well.
ReplyDeletei like to use a high ma station in order to reduce the time it takes to expose the film...also i wouldnt shy away from the pig-o-stat because this way your sure your patient wont be rotated and they're shouldnt be motion.
ReplyDeletei like to use a high ma station in order to reduce the time it takes to expose the film...also i wouldnt shy away from the pig-o-stat because this way your sure your patient wont be rotated and they're shouldnt be motion.
ReplyDeleteHaving worked at a major children's hospital and having a son who is a cardiac patient - do not use a pig-o-stat. If your patient is that combative do them supine on the table top where they can be restrained more easily. They are an archiac way of making a chest xray a very unpleasant experience for child and parent - plus if you've ever had a child seize or code in one, you'll never use it again.
ReplyDeleteHaving worked at a major children's hospital and having a son who is a cardiac patient - do not use a pig-o-stat. If your patient is that combative do them supine on the table top where they can be restrained more easily. They are an archiac way of making a chest xray a very unpleasant experience for child and parent - plus if you've ever had a child seize or code in one, you'll never use it again.
ReplyDeleteI tend to use the pigg-o-stat as a last resort... I've only ever used it once or twice in my career due to an inability to find another way to hold the child still. Having children myself, I would not want to use it if it could be avoided, and special circumstances such as low blood pressure and/or disease processes should be taken into consideration before using one.
ReplyDeleteI have seen a few facilities where the Radiologists want it used on every patient under 3 years old, and then you have no choice, but for the majority I think it's a last resort method.
I tend to use the pigg-o-stat as a last resort... I've only ever used it once or twice in my career due to an inability to find another way to hold the child still. Having children myself, I would not want to use it if it could be avoided, and special circumstances such as low blood pressure and/or disease processes should be taken into consideration before using one.
ReplyDeleteI have seen a few facilities where the Radiologists want it used on every patient under 3 years old, and then you have no choice, but for the majority I think it's a last resort method.
In reviewing pediatric chest images done with and without the use of a piggostat, I find that when a tech knows how to properly use the piggostat the images are without question superior. The key is the techs ability to properly position the child in the device. Many techs avoid using what they consider the "barbaric" device and never develop the competency needed to obtain good images. Think about Principle 7 of our Code of Ethics - using immobilization devices reduces radiation to both parent and child - which is our ethical responsibility.
ReplyDeleteIn reviewing pediatric chest images done with and without the use of a piggostat, I find that when a tech knows how to properly use the piggostat the images are without question superior. The key is the techs ability to properly position the child in the device. Many techs avoid using what they consider the "barbaric" device and never develop the competency needed to obtain good images. Think about Principle 7 of our Code of Ethics - using immobilization devices reduces radiation to both parent and child - which is our ethical responsibility.
ReplyDeleteAbsolutely, there should be proper training using the pigg-o-stat because sooner or later, you will come across a patient that you will absolutely need it in order to acquire an optimal film.
ReplyDeleteOn the other hand, we should also consider that each patient is different... I've taken x-rays on my own children, and one of them will follow instructions, hold still and cooperate in every way, while the other has a radiology-department-phobia, and has to be put in the pigg-o-stat.
If you can acquire equally good images without a pigg-o-stat on a patient, it will be less traumatic at the present time, as well as in the future if the patient learns to expect the device and becomes fearful before entering the room. This fear can carry on past the age when a pigg-o-stat can be used, and when a 6 year old will not hold still for an exam, it becomes a whole different ballgame.
As stated in my original post, I strongly believe you should attempt an exposure without immobilization, attempt to always improve your rapport with pediatric patients, and continually strive to improve your radiographic skills in this area, which can take a lot of time and years of experience. Directive 5 of the Code of Ethics also states that a Radiologic Technologist should also "assess situations; exercise care, discretion and judgment; assume responsibility for professional decisions; and act in the best interest of the patient."
Absolutely, there should be proper training using the pigg-o-stat because sooner or later, you will come across a patient that you will absolutely need it in order to acquire an optimal film.
ReplyDeleteOn the other hand, we should also consider that each patient is different... I've taken x-rays on my own children, and one of them will follow instructions, hold still and cooperate in every way, while the other has a radiology-department-phobia, and has to be put in the pigg-o-stat.
If you can acquire equally good images without a pigg-o-stat on a patient, it will be less traumatic at the present time, as well as in the future if the patient learns to expect the device and becomes fearful before entering the room. This fear can carry on past the age when a pigg-o-stat can be used, and when a 6 year old will not hold still for an exam, it becomes a whole different ballgame.
As stated in my original post, I strongly believe you should attempt an exposure without immobilization, attempt to always improve your rapport with pediatric patients, and continually strive to improve your radiographic skills in this area, which can take a lot of time and years of experience. Directive 5 of the Code of Ethics also states that a Radiologic Technologist should also "assess situations; exercise care, discretion and judgment; assume responsibility for professional decisions; and act in the best interest of the patient."
I am writing this to all of you radiologists out there because I am a 33 year old woman with extreme PTSD symptoms which are directly linked to childhood radiology scenes, specifically something like the pigostat or an even earlier version. I was between two and 3 years old. It happened in about 1977, in two different hospitals. This is my only early childhood memory, and I clearly remember being strapped down by various methods. I was scared to death, and one hospital eventually even tied me up in something like a straightjacket, out of frustration and confusion.
ReplyDeleteTo this day, my PTSD symptoms include shaking my head from side to side (as if saying no) and trying to push the thing off of me. I can't hardly stand to be with medical professionals, or wear a seatbelt. Anything that constricts my chest causes panic.
I am writing to say please don't EVER use these restraining devices, even if a child is completely uncooperative. Wait, have patience, try again at another time. Or develop a better way.
Thanks for reading this.
I am writing this to all of you radiologists out there because I am a 33 year old woman with extreme PTSD symptoms which are directly linked to childhood radiology scenes, specifically something like the pigostat or an even earlier version. I was between two and 3 years old. It happened in about 1977, in two different hospitals. This is my only early childhood memory, and I clearly remember being strapped down by various methods. I was scared to death, and one hospital eventually even tied me up in something like a straightjacket, out of frustration and confusion.
ReplyDeleteTo this day, my PTSD symptoms include shaking my head from side to side (as if saying no) and trying to push the thing off of me. I can't hardly stand to be with medical professionals, or wear a seatbelt. Anything that constricts my chest causes panic.
I am writing to say please don't EVER use these restraining devices, even if a child is completely uncooperative. Wait, have patience, try again at another time. Or develop a better way.
Thanks for reading this.
I'm sorry to hear about such negative experiences... that must still be very difficult to deal with. It's very possible that the technologist who was using this device on you may not have been using it correctly. The only reason I say that is because it should not be constricting chest movement. If anything, we utilize this to prevent the arms from obstructing our view of the lungs, but we absolutely need the chest to be able to take a full inspiration for good radiographs. Still though, it is important in considering any device like this for the physician and the parents to discuss the risks vs. benefits to performing an exam like this. And as always, I like to promote proper utilization and training with equipment like this as well in case it does need to be used in hopes to prevent situations like your own.
ReplyDeleteI'm sorry to hear about such negative experiences... that must still be very difficult to deal with. It's very possible that the technologist who was using this device on you may not have been using it correctly. The only reason I say that is because it should not be constricting chest movement. If anything, we utilize this to prevent the arms from obstructing our view of the lungs, but we absolutely need the chest to be able to take a full inspiration for good radiographs. Still though, it is important in considering any device like this for the physician and the parents to discuss the risks vs. benefits to performing an exam like this. And as always, I like to promote proper utilization and training with equipment like this as well in case it does need to be used in hopes to prevent situations like your own.
ReplyDeleteI'm a 1st year Rad student. I recently went into the ER at the hospital where I'm doing my clinicals this semester, to do a chest x-ray on a baby. I had never seen an actual pig-o-stat, much less, seen a procedure performed using it. I watched the technician and she held the baby in the pig-o-stat while I took the exposure. What I didn't realize was that she expected me to run out after the first exposure and collimate down for the lateral. I thought she would be more intent on getting the second exposure shot and getting the crying baby out of the pig. I guess not. I know now (at least with this tech) what's expected of me. I think that's the hardest thing about clinicals... we're almost expected to read minds of what the techs want us to do.
ReplyDeleteAngela
I'm a 1st year Rad student. I recently went into the ER at the hospital where I'm doing my clinicals this semester, to do a chest x-ray on a baby. I had never seen an actual pig-o-stat, much less, seen a procedure performed using it. I watched the technician and she held the baby in the pig-o-stat while I took the exposure. What I didn't realize was that she expected me to run out after the first exposure and collimate down for the lateral. I thought she would be more intent on getting the second exposure shot and getting the crying baby out of the pig. I guess not. I know now (at least with this tech) what's expected of me. I think that's the hardest thing about clinicals... we're almost expected to read minds of what the techs want us to do.
ReplyDeleteAngela
Interesting device... I never knew something like this exhisted. Thanks for the post - you should be in sales ;-)
ReplyDeleteIt seems that the Pigg-o-Stat has been around for fourty nine years for some good reason.
ReplyDeleteI work at a leading children's hospital in Australia. We would never consider using torture devices such as the pig-o-stat. We do 6month to 3year AP chests in a specially designed high chair. The CR plate slots in behind the patient. Parent stands behind the chair (with lead coat), and hold the child's arms in the air. Seatbelt, and lead protection are applied. Approx 10 degree caudal angle. Highest mA possible used on fine focus, to minimise time.
ReplyDeleteThis method results in high quality x-rays, a very high success rate, and minimal trauma for the child. We even have some children who can climb into the chair themselves, and put their own seat belt!
I work at a leading children's hospital in Australia. We would never consider using torture devices such as the pig-o-stat. We do 6month to 3year AP chests in a specially designed high chair. The CR plate slots in behind the patient. Parent stands behind the chair (with lead coat), and hold the child's arms in the air. Seatbelt, and lead protection are applied. Approx 10 degree caudal angle. Highest mA possible used on fine focus, to minimise time.
ReplyDeleteThis method results in high quality x-rays, a very high success rate, and minimal trauma for the child. We even have some children who can climb into the chair themselves, and put their own seat belt!
That sounds great... does the device you use assist you in obtaining lateral views? Someone can probably make a lot of money if they can successfully find a way to image 100% of pediatric patients for AP and Lat views of the chest without causing emotional distress to any of them.
ReplyDeleteThis is one of the reasons I post topics like this, because there may be devices/techniques used that I and other technologists in the U.S. have heard of... please feel free to post links of locations to find these devices.
That sounds great... does the device you use assist you in obtaining lateral views? Someone can probably make a lot of money if they can successfully find a way to image 100% of pediatric patients for AP and Lat views of the chest without causing emotional distress to any of them.
ReplyDeleteThis is one of the reasons I post topics like this, because there may be devices/techniques used that I and other technologists in the U.S. have heard of... please feel free to post links of locations to find these devices.
Many major children's hospitals have abandoned the archaic pigg-o-stat for the Tame-em board. There are too many liabilities with the pigg. Also, the gentle manner, confidence and speed of the technologist go a long way in obtaining a diagnostic exam with the least amount of trauma to the child or parents.
ReplyDeleteToo right... I now work at a hospital that has a tame-em board and love it. I couldn't imagine ever going back to a pigg-o-stat again, but I use the tame-em board every time now.
ReplyDeleteMy 6 week old baby had a chest X-ray at a prominent children's hospital here in Miami this week and the experience was horrific. I was asked to assist with the radiology tech to get the chest X-ray, but was never formally told what my role would be. Another tech showed up and told me to hold my child by her right shoulder and her right thigh and he would hold her by the left shoulder and the left thigh, in order to take the X-ray. This would be the arrangment as the other radiology tech ran back to 'shoot' the X-ray. Well apparently my hands got into the shot and the baby's head dipped in to the frame in another, and then her legs needed to be straighter so the 'shooting' tech proceeded to push them down only to run back to 'shoot' again, nope legs in the frame! She told me I somehow had to hold the legs down, the head back (somehow holding her head against the flat surface with my free thumb and at the same time trying to keep my child's shoulder from popping out of its socket, with a person I had met a couple of minutes before-I SNAPPED. My child had already been spinal tapped and stuck with an IV and this was torture for her and with each ZAPP!!! more radiation and another inadequacy told to me in my role in holding her. I have no formal training in radiology and as a parent I was there "to help". All of this did not sit well with me and apparently this is an every day occurance in that department. They have no other way of shooting a baby's X-ray, which I find very hard to believe in the year 2011. I found this site in my search for answers now that she is discharged and medically cleared (thankyou God). I wonder what the liability is on the institution when you rely oh the help of a parent who is not formally trained in working in that room? What if the child is dropped? In the search for the perfect X-ray she could have been dropped as the X-ray tech was so forceful at times and abrupt. If I pull you up by your shoulders at what point do you feel uncomfortable? I know there has to be a better way and please find it soon as we seemingly have better regulation of exercise equipment than what goes on in a pediatric X-ray department.
ReplyDeleteSo how does one take pediatric cxr with a pt that is a toddler when using a shimatzu digital, machine? The table cassette is large,tethered and heavy to set on their little legs to hug it and get a good shot on the p/a. The cassette is also too big for the parents to work around to get a lateral
ReplyDelete