Pediatric thoracic spine (AP view)

The anteroposterior thoracic spine view for pediatrics is one of two views in order to examine the thoracic vertebrae.

Indications

This projection demonstrates the thoracic spine in its natural anatomical position. It is useful in diagnosing fractures in pediatric patients. This view will also demonstrate scoliosis, however in this case specifically, the scoliosis series should be performed.

Patient position

• the patient is erect with both shoulders and upper back in contact with the detector to avoid rotation

• hands are placed by the patient's side

Technical factors

• anterior-posterior projection

• suspended inspiration

• centering point

  • at the level of the 7th thoracic verterbra

• collimation

  • laterally to include the costotransverse joints and left and right paraspinal lines

  • superiorly to include the C7/T1 junction

  • inferiorly to include the T12/L1 junction

• orientation

  • portrait 

• detector size

  • 24 cm x 30 cm or 35cm x 43 cm depending on the patient's size

• exposure ¹

  • 65-80 kVp

  • 2-10 mAs

• SID

  • 100 cm

• grid

  • no

Image technical evaluation

All thoracic vertebrae from T1 to T12 should be clearly visible. Equidistant sternoclavicular joints to demonstrate no patient rotation. Intervertebral joints are also seen in profile ². A physical metal marker is ideal for pediatric imaging. 

Practical points

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

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