Pediatric humerus (lateral view)

The lateral 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 orthogonal to the AP view, allowing for adequate radiographic examination of the entire humerus and its respected articulations.

Indications

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.

Patient position

• patient is preferably erect
• patient stands facing the detector with the injured side closest to the detector 
• patient is then rotated so that the arm on the affected side has the shoulder, arm and elbow in contact with the upright bucky
• the elbow is flexed 90° (or as close to 90° as possible) 
• place the patient's hand on their ASIS or stomach to maintain position 

Technical factors

• posteroanterior lateral projection
• centering point
  • mid humerus shaft
• collimation
  • 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 
• orientation  
  • portrait
• detector size
  • 35 cm x 43 cm
• exposure ²
  • 60-65 kVp
  • 2-10 mAs
• SID
  • 100 cm
• grid
  • no

Image technical evaluation

The humerus is positioned lateral, evidenced by the:

• medial and lateral epicondyles superimposed and scapula in lateral (Y-shaped) position
• humerus is abducted to minimize superimposition with the rest of the patient's body

Lead shielding

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.

Practical points

Preparing the room beforehand (setting up the detector, exposure and preparing lead gowns) is extremely beneficial for humerus imaging. As young children may already favor having their affected arm close to their body, gentle coaxing to place their hand on their stomach and slowly abducting their arm should assist in achieving the desired position.

Immobilization techniques

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.