Chest radiograph interpretation in children — branching viva

Opening question

This 4-year-old with fever, cough, and increased work of breathing has a chest radiograph. Walk me through the structured technical-quality check you would perform before you read the lung fields, and tell me what would make you distrust the film and request a repeat. [1] [2]

Branch 1 — the ABCDEFGH systematic approach

You have accepted the technical quality. Now describe the systematic method you would use to read the film zone by zone, and tell me which two signs you would use to localise and characterise an alveolar opacity. [1]

Branch 2 — the right upper mediastinal opacity in the infant

Suppose instead this is a 6-month-old infant with a sharp, angular soft-tissue opacity in the right upper mediastinum with a straight inferior border. What is the most likely finding, what is it called, and how do you distinguish it from a pathological mass? [3] [1]

Branch 3 — the choking toddler with a normal inspiratory film

A 2-year-old has a sudden choking episode followed by a persistent right-sided wheeze, and the inspiratory chest film is normal. What is the likely diagnosis, why is the inspiratory film normal, and what imaging would confirm it? [4] [1]

Closing — justification and ALARA

Finally, tell me the principle that governs whether a chest film should be requested at all. Quote the approximate effective dose of a paediatric chest radiograph, explain why children are more radiosensitive than adults per unit dose, and tell me when a chest film is not indicated in a wheezy child. [1] [2]