Pediatric shoulder (AP view)

The anteroposterior shoulder view in pediatrics is part of a two view series examining the shoulder joint, clavicle, scapula and proximal humerus. 

Indications

This projection demonstrates the shoulder joint in natural anatomical position and is used as an orthogonal view to the lateral shoulder view for identifying potential fractures or dislocations. 

Patient position

• patient standing with affected shoulder against the upright bucky or supine with the detector underneath the affected shoulder
• humerus is kept in neutral rotation
• ensure that the affected shoulder is in contact with the detector

Technical factors

• anteroposterior projection
• centering point
  • ​2.5 cm inferior to the coracoid process
• collimation​
  • superior to the skin margins
  • inferior to include one-third of the proximal humerus
  • lateral to include the skin margin
  • medial to include the sternoclavicular joint
• orientation
  • ​landscape
• detector size
  • ​18 cm x 24 cm for babies, toddlers, small children
  • 24 cm x 30 cm for larger children or adolescents
• exposure ¹
  • ​63-66 kVp
  • 2-8 mAs
• SID
  • 100 cm
• grid
  • no

Image technical evaluation

The entire scapula and clavicle must be fully visualized in the anatomical position as identified by a slight overlap of the humeral head with the glenoid. Clear and sharp bony markings to ensure no patient motion ². A physical metal marker 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.

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