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Better still, you should be asking for a lateral chest, as this will tell you for sure where the object is and wherever it is it won't be overlain by the mediastinum. > -----Original Message----- > From: Accident and Emergency Academic List > [mailto:[log in to unmask]]On Behalf Of Adrian Fogarty > Sent: 13 April 2002 00:58 > To: [log in to unmask] > Subject: Re: 5th metacarpal base fractures > > > ----- Original Message ----- > From: Craig Ellis > > My personal favourite is the "Paediatric Foreign body" protocol which > requires a lat neck / chest / abdo films. For many it dosnt > matter if the FB > is found on the first film - we still religiously get all 3 films > - because > the protocol says so !!! I dispair. > > Slightly off your point I realise Craig, but most radiographers > tend to get > the neck and chest covered in one film in kiddies. I believe the > RCR believe > that this neck/chest film is all that is necessary, as you only need to > exclude an impacted FB in the upper aerodigestive tract (if it has reached > the stomach, then it is likely to be innocuous). However like yourself I > feel more comfortable seeing the offending object, so I often ask for an > abdo film first. If the FB shows in the stomach, I can then avoid a chest > film, unless the story is suggestive of multiple FBs or is unclear. > > Another reason I dislike the chest film, is that many radiographers use a > normal chest penetration, perhaps under the mistaken impression > that a soft > tissue view with low penetration is required (help me out here > Vikki). This > results in a typically white mediastinum, so you can't really be > sure there > isn't an FB lurking behind the heart. What is actually needed is an > overpenetrated film, rather like an AP thoracic spine view, which > makes the > mediastinum disappear, and your metallic FB shows up beautifully! > > Adrian Fogarty >