Pediatric finger (oblique view)

The oblique finger view for pediatrics is an additional view examining the distal metacarpal, distal, middle and proximal phalanges of the finger of interest. 

Indications

To minimize radiation dose, only the PA and lateral finger views are typically performed for pediatrics. However, the oblique view may be performed upon request to view any subtle pathology that is not demonstrated well on the routine PA and lateral views. 

Patient position

• patient is either seated alongside the table or supine with arm outstretched
• from a pronated position for PA fingers, the hand is rotated approximate 45 degrees (thumb side up), resting on a sponge if required
• fully extend finger(s) of interest in order to open the interphalangeal spaces
• fingers are separated to avoid superimposition

Technical factors

• posteroanterior oblique projection
• centering point
  • approximately over the proximal interphalangeal joint
• collimation
  • laterally to the adjacent fingers 
  • 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

Image technical evaluation

Finger is visualized with open interphalangeal joints, there is a noted uneven concavity of the mid-shaft of the metacarpal ². No soft tissue overlap between fingers and the finger of interest is correctly labeled and identified. 

Practical points

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. 

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