Pelvis radiograph (pediatric)
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:
- developmental dysplasia of the hip (DDH)
- transient synovitis
- perthes disease
- slipped upper femoral epiphysis (SUFE)
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.
Tips for pediatric pelvis radiography
The major difficulty in pediatric pelvis radiography relates to:
- motion artefact
- rotation of the pelvis due to patient motion
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.
Pelvic radiograph lines
When interpreting a pediatric pelvis x-ray, a number of lines will be inspected; where interruption of these lines will indicate pathology:
- 1. Maryann Hardy, Stephen Boynes. Paediatric Radiography. (2003) ISBN: 9780632056316
- 2. Markowitz RI, Altes TA, Jaramillo D. What causes the "wet diaper" artifact? computed tomography and magnetic resonance observations. (2009) Clinical imaging. 33 (3): 226-30. doi:10.1016/j.clinimag.2008.09.013 - Pubmed
- 3. Karami V, Zabihzadeh M, Shams N, Saki Malehi A. Gonad Shielding during Pelvic Radiography: A Systematic Review and Meta-analysis. (2017) Archives of Iranian medicine. 20 (2): 113-123. doi:0172002/AIM.0011 - Pubmed
- 4. Lee MC, Lloyd J, Solomito MJ. Poor Utility of Gonadal Shielding for Pediatric Pelvic Radiographs. (2017) Orthopedics. 40 (4): e623-e627. doi:10.3928/01477447-20170418-03 - Pubmed
- 5. Noonan S, Spuur K, Nielsen S. Immobilisation in Australian paediatric medical imaging: A pilot study. (2017) Radiography (London, England : 1995). 23 (2): e34-e40. doi:10.1016/j.radi.2016.12.005 - Pubmed
- 6. Ng Jessica Hui Shi and Edel Doyle. "Keeping Children Still in Medical Imaging Examinations- Immobilisation or Restraint: A Literature Review". Journal of Medical Imaging and Radiation Sciences (2018). . doi:10.1016/j.jmir.2018.09.008.
Related Radiopaedia articles
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