Clavicle series (pediatrics)
Citation, DOI & article data
The clavicle series for pediatrics is a two view series containing an anteroposterior and a cranially angled axial radiograph. Depending on the patient's level of distress and severity of the injury, adapting the radiographic technique to suit a child sitting in bed or lying supine may be necessary.
In pediatrics, clavicle radiographs are mainly indicated for:
- trauma with suspected fracture
- acromioclavicular or sternoclavicular dislocation
- anteroposterior view
- anteroposterior cephalad angulation view
Patients should remove any clothing, arm sling or jewelry over the affected clavicle.
The use of gonadal and fetal shielding has been deemed as non-beneficial to patients' health in current evidences 1-3 and may or may not be useful for pediatric extremity imaging. Placing gonadal shielding can increase the examination time and may cause the child more stress. However, shielding can also reduce the family's anxiety in relation to radiation dose. Therefore, the decision to use shielding will depend on departmental protocols and the radiographer's judgment.
Tips for pediatric clavicle radiography
The major difficulty in pediatric radiography of the clavicle relates to:
To overcome this, a variety of techniques can be used:
- distract the patient with toys, games and/or conversation
- using the swaddling technique; wrap the child in a blanket to promote comfort and perform the images supine
- setting up the room before moving the patient into the required position can reduce patient distress
Children will find it difficult to keep their arm still; particularly if the limb is injured. One option is to have a carer or radiographer stand on the child's non-affected side, placing one hand on their mid-chest and another holding the proximal forearm.
- 1. Marsh R & Silosky M. Patient Shielding in Diagnostic Imaging: Discontinuing a Legacy Practice. AJR Am J Roentgenol. 2019;212(4):755-7. doi:10.2214/ajr.18.20508 - Pubmed
- 2. BIR. Guidance on using shielding on patients for diagnostic radiology applications. (2020) The British Institute of Radiology. https://www.bir.org.uk/media/414334/final_patient_shielding_guidance.pdf - PDF
- 3. AAPM. AAPM position statement on the use of patient gonadal and fetal shielding. (2019) American Association of Physicists in Medicine. https://www.aapm.org/org/policies/details.asp?id=468&type=PP - Policy text
- 4. Ng J & Doyle E. Keeping Children Still in Medical Imaging Examinations- Immobilisation or Restraint: A Literature Review. Journal of Medical Imaging and Radiation Sciences. 2019;50(1):179-87. doi:10.1016/j.jmir.2018.09.008 - Pubmed