Pediatric forearm (PA view)
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This view is ideal for patients who are unable to move their arm as per the standard forearm positioning technique but require assessment of suspected radius and/or ulna dislocations or fractures. This shows a PA view of the radius and lateral view of the ulna.
- patient is seated alongside the table
- with 90° elbow flexion, the palmar aspect of the forearm from wrist to elbow is kept in contact with the receptor, ensuring the same horizontal plane (see Figure 1)
- posteroanterior projection
- mid-forearm region
- distal to the wrist joint
- proximal to elbow joint
- 24 cm x 30 cm
- 50-55 kVp
- 2-4 mAs
- 110 cm
Image technical evaluation
- the elbow joint is in a true lateral position
- the wrist joint is in PA position with little to no superimposition
Contact lead shielding is no longer recommended for any pediatric examination. Statements have been released by several radiological societies supporting an end to this practice 2-5, with the most comprehensive guidance statement on this matter being in an 86-page joint report 6.
Please see your local department protocols for further clarification as they may differ from these recommendations.
Preparing the room beforehand (setting up the detector, exposure and preparing lead gowns) is extremely beneficial for forearm imaging as young children may begin to cry the moment their affected arm is brought away from their body.
If immediately abducting the patient's arm on to an elevated tabletop is challenging, begin with the arm adducted and rested on a lowered tabletop. Reassure the patient that their forearm will not be touched or moved, then slowly begin to raise the tabletop. Encourage the patient to focus on abducting their unaffected shoulder joint until all aspects of their arm are in the same horizontal plane.
To prevent malrotation/motion artefact in the radiograph, parental holding at the proximal half of the child’s arm and distal part of the hand may be required. Other alternative methods such as distraction techniques may be ideal to avoid scattered radiation to parents and staff 7.
- 1. A paediatric X‐ray exposure chart. (2014) Journal of Medical Radiation Sciences. 61 (3): 191. doi:10.1002/jmrs.56 - Pubmed
- 2. Statement No. 13 – NCRP Recommendations For Ending Routine Gonadal Shielding During Abdominal And Pelvic Radiography (2021)". Ncrponline.org, 2021. [Link].
- 3. ASMIRT Position Statement Gonad Shielding". Asmirt.org, 2021. [Link].
- 4. ASRT Statement on Fetal and Gonadal Shielding. Asrt.org, 2021. [Link].
- 5. Yogesh Thakur, Stephanie C. Schofield, Thorarin A. Bjarnason, Michael N. Patlas. Discontinuing Gonadal and Fetal Shielding in X-Ray:. (2021) Canadian Association of Radiologists Journal. doi:10.1177/0846537121993092 doi:10.1177/0846537121993092.
- 6. Guidance on using shielding on patients for diagnostic radiology applications Joint report. Bir.org.uk, 2021. [Link].
- 7. 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