Thumb series (pediatric)

The thumb series for pediatrics often consist of a posteroanterior and lateral view only in order to minimize radiation dose to the patient. Depending on the department and clinical indication, an additional oblique view may also be done.

Indications

• trauma with suspected fracture
• suspected dislocation
• foreign body detection

Projections

Standard projections

• anteroposterior/posteroanterior view
• oblique view
• lateral view

Patient preparation

Patients should remove any jewelry on the thumb. 

Gonadal shielding

The use of gonadal and fetal shielding has been deemed as non-beneficial to patients' health in current evidence ^1-3 and may or may not be useful for pediatric extremity imaging. Placing gonadal shielding can increase the examination time and may cause the child more stress. However, shielding can also reduce the family's anxiety in relation to radiation dose. Therefore, the decision to use shielding will depend on departmental protocols and the radiographer's judgment.

Tips for pediatric thumb radiography

The major difficulty in pediatric hand radiography relates to:

• motion artifact

To overcome this, a variety of techniques can be used ⁴:

• distract the patient with toys, games and/or conversation
• using the swaddling technique; wrap the child in a blanket to promote comfort and sleep
• have the child sit on the parent's lap to ensure they are comfortable

Immobilization techniques

Children will find it difficult to keep their thumb still; particularly if the limb is injured. One option is to have a parent or radiographer hold the child's hand in place; however, the parent's hand may appear on the radiograph and obscure the child's anatomy. Placing radiolucent items such as a clear clipboard on top of the child's hand can be useful for keeping the child's hand flat and still for the posteroanterior view. However, placing items on top of the child's hand should be used only if it will not injure the child further.