Pediatric humerus (AP view)
Citation, DOI and article data
The anteroposterior humerus view for pediatrics is part of the humerus series and is usually taken in a standing position. However, it can also be obtained in a supine position.
The projection demonstrates the humerus in its natural anatomical position allowing for adequate radiographic examination of the entire humerus and its respected articulations.
Humerus views are often done to exclude large humeral shaft fractures or suspected soft tissue infections. If an occult fracture is suspected at either the proximal or distal end, it is best to do a separate elbow or shoulder series.
- the patient is preferably erect
- the patient's back is against the image receptor
- the affected arm is abducted and centered to the upright detector, if possible, the arm is slightly externally rotated to mimic the true anatomical position
- anteroposterior projection
- mid humerus shaft
- superior to the skin margins above the glenohumeral joint
- inferior to include the distal humerus including the elbow joint
- lateral to include the skin margin
- medial to include skin margin
- 35 cm x 43 cm
- 60-65 kVp
- 2-10 mAs
- 100 cm
Image technical evaluation
The humerus is positioned AP, evidenced by the:
- medial and lateral epicondyles seen in profile
- greater tuberosity being seen on the lateral aspect of the humerus
- shaft being abducted away from the patient's body, minimizing 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 3-6, with the most comprehensive guidance statement on this matter being in an 86-page joint report 7.
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 humerus imaging as young children may begin to cry the moment their affected arm is brought away from their body.
To prevent malrotation/motion artifact in the radiograph, parental holding at the mid-chest region and distal half of the child’s arm. Other alternative methods such as distraction techniques may be ideal to avoid scattered radiation to parents and staff 8.
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- 2. A paediatric X‐ray exposure chart. (2014) Journal of Medical Radiation Sciences. 61 (3): 191. doi:10.1002/jmrs.56 - Pubmed
- 3. Statement No. 13 – NCRP Recommendations For Ending Routine Gonadal Shielding During Abdominal And Pelvic Radiography (2021)". Ncrponline.org, 2021. [Link].
- 4. ASMIRT Position Statement Gonad Shielding". Asmirt.org, 2021. [Link].
- 5. ASRT Statement on Fetal and Gonadal Shielding. Asrt.org, 2021. [Link].
- 6. 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.
- 7. Guidance on using shielding on patients for diagnostic radiology applications Joint report. Bir.org.uk, 2021. [Link].
- 8. 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