Forearm series (pediatrics)
The forearm series for pediatrics comprises an anteroposterior and lateral projection. These projections examine the entire radius and ulna including the distal and proximal articulations.
Indications
Forearm x-rays are indicated for a variety of settings including:
- trauma
- bony tenderness
- suspected fracture
- obvious deformity
- suspected foreign body
- infection
Projections
Standard projections
- anteroposterior view
- demonstrates radius and ulna in natural anatomical position
- lateral view
Modified trauma projections
Where patients are in considerable amount of pain, these two projections may replace the standard projections instead to obtain diagnostic images of the radius and ulna whilst requiring little to no patient movement.
- posteroanterior view
- demonstrates PA wrist distally and lateral elbow proximally
- horizontal beam lateral view
- demonstrates lateral wrist distally and AP elbow proximally
Patient preparation
Patients should remove any jewelry or clothing over the arm to avoid artifact.
Gonadal shielding
The use of gonadal and fetal shielding has been deemed as non-beneficial to patients' health in current evidences 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 forearm radiography
The major difficulty in pediatric 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
- have the child sit on the carer's lap to ensure they are comfortable
Immobilization techniques
Children will find it difficult to keep their arm still; particularly if the limb is injured. If an immobilization splint has not been provided to the patient, one option is to have a carer or radiographer hold the child's arm at their hand and proximal arm to prevent movement of the forearm.
