Pediatric finger (lateral view)

Last revised by Andrew Murphy on 23 Mar 2023

The lateral finger view for pediatrics is part of a two view series examining the distal metacarpal, distal, middle and proximal phalanges of the finger of interest. The patient position can vary depending on which finger is being imaged. 

This projection is useful for diagnosing fractures and localizing foreign bodies in pediatric patients. It also presents as an orthogonal view of the posteroanterior finger view.

  • patient is either seated alongside the table or supine with arm outstretched
  • hand is pronated and medially rotated so the lateral aspect of the finger is in contact with the casette
  • fully extend finger(s) of interest in order to open the interphalangeal spaces
  • ensure other fingers are not superimposed over the finger of interest
  • if this position is too difficult for the child to remain still, the following method can be used for index and middle fingers; however the object to image distance will be slightly larger: 
  • patient is either seated alongside the table or supine with arm outstretched
  • medial aspect of extended little finger in contact with the cassette and ring finger is slightly flexed at metacarpophalangeal joint
  • other fingers fully flexed to avoid superimposition
  • lateral projection
  • centering point
    • approximately over the proximal interphalangeal joint
  • collimation
    • anteroposterior to skin margins
    • proximal to include the carpometacarpal joint
    • distal to the tips of the distal phalanges 
  • orientation  
    • portrait
  • detector size
    • 18 cm x 24 cm
  • exposure 1
    • 40-46 kVp
    • 0.8-2 mAs
  • SID
    • 100 cm
  • grid
    • no

Finger is visualized with open interphalangeal joint spaces and a concave appearance on the anterior side of phalanges demonstrating a true lateral position 2. The finger of interest must be correctly labeled and identified. 

Preparing the room beforehand (setting up the detector, exposure and preparing lead gowns) is important as pediatric patients may not remain still when their affected finger is moved onto the detector. 

For this lateral view, it is particularly important to avoid superimposition of the other fingers; hence the child's parent or radiographer may need to assist in keeping other fingers flexed. 

It is also 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

Placing radiolucent items such as a clear clipboard on top of the child's hand can be useful for keeping the child's finger still. However, placing items on top of the child's hand should be used only if it will not injure the child further. 

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Cases and figures

  • Normal pediatric finger series
    Drag here to reorder.
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