Humerus series (pediatric)
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The humerus series for pediatrics is a set of anteroposterior and lateral radiographs taken to investigate elbow joint pathology, often in the context of trauma.
As the elbow joint is also imaged in this series, being familiar with the order of elbow ossification is important in assessing the elbow joint in a pediatric patient. This will ensure that a normal ossification center is not mistaken for an epicondylar fracture. Additionally, if an elbow injury is suspected, dedicated elbow radiographs should be acquired.
Humerus x-rays are indicated for a variety of settings including:
bony tenderness at the glenohumeral joint/region
restriction of abduction
suspected bone tumors
demonstrates the humerus in its natural anatomical positioning
shows the entire shaft of the humerus
orthogonal view of the AP image
demonstrates the degree and direction of any suspected dislocations or fractures
Modified trauma projections
supine AP view
an alternative examination to the AP view performed supine
supine lateral view
an alternative examination to the lateral view performed supine
usually done with the use of tube angulation but can be done transthoracic
Patients should remove any jewelry or clothing over the arm and shoulder to avoid artifact.
The use of gonadal and fetal shielding has been deemed as non-beneficial to patients' health in current evidence 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.
Tips for pediatric humerus radiography
The major difficulty in pediatric radiography relates to:
To overcome this, a variety of techniques can be used 4:
distract the patient with toys, games and/or conversation
using the swaddling technique; wrap the child in a blanket to promote comfort and sleep
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' non-affected side, placing one hand on their mid-chest and another holding the proximal forearm.
- 1. Rebecca M. Marsh, Michael Silosky. Patient Shielding in Diagnostic Imaging: Discontinuing a Legacy Practice. (2019) American Journal of Roentgenology. 212 (4): 755-757. 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 JHS, Doyle E. Keeping Children Still in Medical Imaging Examinations- Immobilisation or Restraint: A Literature Review. (2019) Journal of medical imaging and radiation sciences. 50 (1): 179-187. doi:10.1016/j.jmir.2018.09.008 - Pubmed