Pelvis radiograph (pediatric)

Last revised by Andrew Murphy on 23 Mar 2023

The radiography of the pelvis in the pediatric patient varies greatly from the adult examination; particularly as specialized techniques are often required to immobilize the patient. To avoid future mobility and pain complications, it is essential to treat fractures and correct developmental pathologies whilst the child is still developing. Therefore, the diagnostic pelvic radiograph is an essential part of this process.

Performing pelvis radiography on pediatric patients can be for a number of indications 1:

Patients should remove any clothing from the waist down; especially baby rompers as these often have metal buttons. Wet diapers are also known to create artifact on the radiograph, therefore should be removed 2.

The use of gonadal shielding will vary from department to department. However, recent studies no longer recommend the use of gonadal shielding for pediatric pelvis examinations 3,4. When placed incorrectly, additional repeats will be required, thereby increasing the radiation dose to the patient.

The major difficulty in pediatric pelvis radiography relates to:

To overcome this, a variety of techniques can be used:

  • distract the patient with toys, games and/or conversation
  • using the swaddling technique; wrap the child in a blanket to promote comfort and sleep
  • ensure the child’s distraction lies directly above or in front of them so they are not rotating their body to look at it (e.g. turning around to look at their parent)

As children are lying supine for the examination, distraction techniques may prove difficult. Therefore, immobilization techniques will vary from department to department. A radiographer or parent being in the room with the patient holding them still has been cited as a commonly used technique 5 in the Australian context. Other departments will make use of restraint devices, there is debate around the use of 'restraint' and if it fits the category of 'immobilization' 6.

When interpreting a pediatric pelvis x-ray, a number of lines will be inspected; where interruption of these lines will indicate pathology:

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Cases and figures

  • Figure 1: AP pelvis (12-year-old male)
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  • Figure 2: frog-leg pelvis (4 year old)
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  • Figure 3: hip surveillance AP pelvis
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