Paediatric shoulder (lateral view)

The lateral shoulder view in paediatrics is part of a two view series examining the shoulder joint, clavicle, scapula and proximal humerus. 

Indications

This projection is an orthogonal view of the AP shoulder and is useful in paediatric imaging for identifying potential fractures or dislocation. 

Patient position

• patient is sitting or standing erect facing the upright detector
• patient's affected arm is placed on their stomach, with the elbow away from the body
• patient is rotated until the anterior portion of shoulder is touching the detector
• an imaginary line between the medial border of the scapula and acromioclavicular joint should be perpendicular to the upright detector

Technical factors

• posteroanterior lateral projection
• centring point
  • ​2.5 cm inferior to the coracoid process
• collimation​
  • superior to the skin margin
  • inferior to include the entire scapula
  • lateral to include the skin margin
  • medial to include the entire medial scapula border
• orientation
  • ​portrait
• detector size
  • ​18 cm x 24 cm for babies, toddlers, small children
  • 24 cm x 30 cm for larger children or adolescents
• exposure ¹
  • ​63-66 kVp
  • 2-8 mAs
• SID
  • 100 cm
• grid
  • no

Image technical evaluation

The entire scapula must be fully visualised, with the medial and lateral borders aligning to create a 'Y' appearance. When not dislocated, the humeral head should superimpose the base of the 'Y'. Clear and sharp bony markings to ensure no patient motion ². A physical metal marker is ideal for paediatric imaging. 

Practical points

Preparing the room beforehand (setting up the detector, exposure and preparing lead gowns) is important as paediatric patients may not remain still.

Immobilisation 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 utilised to avoid scattered radiation to parents and staff