Pediatric clavicle (AP cephalic view)

The cephalad angulation clavicle view for pediatrics is part of a two view series examining the entirety of the clavicle and the sternoclavicular and acromioclavicular joints. This view is ideally performed erect, but supine may be necessary depending on the patient's level of distress and severity of injury. 

Indications

This projection is useful in determining the angulation of any clavicular fractures and dislocations in pediatric patients. The clavicle will appear straighter and projected above the scapula in comparison to the AP clavicle view. 

Patient position

• patient is ideally erect with their back against the image receptor
• affected clavicle is in the center of the image receptor
• affected arm is in a neutral position

Technical factors

• anteroposterior projection
• centering point
  • just below the mid clavicle
  • cephalic angle of 15-30° 
• collimation
  • superior to the skin margins
  • inferior to include mid scapula 
  • lateral to include the skin margin
  • medial to include the sternoclavicular joint
• orientation  
  • landscape
• detector size
  • 18 cm x 24 cm
• exposure ¹
  • 63-66 kVp
  • 2-4 mAs
• SID
  • 100 cm
• grid
  • no (this can vary departmentally or based on the patient's age or size)

Image technical evaluation

The clavicle is demonstrated superior to the clavicle with only the medial border superimposing the 1st and 2nd ribs ². Appropriate metal markers are visualized as this is ideal for pediatric imaging. 

Practical points

Preparing the room beforehand (setting up the detector, exposure and preparing lead gowns) is important as pediatric patients may not remain still for the duration of the x-ray. It is also important to ensure the detector is moved superiorly to account for cephalic angulation. 

Immobilization techniques

It is important for the radiograph to be free from motion artifact and rotation to avoid repeated x-rays.

• it may be necessary for the parent or radiographer to hold the patient in position
• ideally the parent should be in the child's direct line of sight
• techniques will vary based on the department
• distraction techniques can be utilized to avoid scattered radiation to parents and staff ³