Forearm series (pediatrics)
Citation, DOI and article data
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.
Forearm x-rays are indicated for a variety of settings including:
- bony tenderness
- suspected fracture
- obvious deformity
- suspected foreign body
Modified trauma projections
Where patients are in a 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.
- demonstrates PA wrist distally and lateral elbow proximally
horizontal beam lateral view
- demonstrates lateral wrist distally and AP elbow proximally
Patients should remove any jewelry or clothing over the arm to avoid artefact.
The use of lead shielding has been deemed as non-beneficial to patients' health in current evidences 1-3 and is no longer recommended for any pediatric extremity imaging. Statements have been released by several radiological societies supporting an end to this practice 4-7, with the most comprehensive guidance statement on this matter being in an 86-page joint report 8.
Please see your local department protocols for further clarification as they may differ from these recommendations.
Tips for pediatric forearm radiography
The major difficulty in pediatric radiography relates to:
To overcome this, a variety of techniques can be used 9:
- 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
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.
- 1. Rebecca M. Marsh, Michael Silosky. Patient Shielding in Diagnostic Imaging: Discontinuing a Legacy Practice. (2019) American Journal of Roentgenology. 212 (4): 755-757. doi:10.2214/AJR.18.20508 - Pubmed
- 2. BIR. Guidance on using shielding on patients for diagnostic radiology applications. (2020) The British Institute of Radiology. https://www.bir.org.uk/media/414334/final_patient_shielding_guidance.pdf - PDF
- 3. AAPM. AAPM position statement on the use of patient gonadal and fetal shielding. (2019) American Association of Physicists in Medicine. https://www.aapm.org/org/policies/details.asp?id=468&type=PP - Policy text
- 4. Statement No. 13 – NCRP Recommendations For Ending Routine Gonadal Shielding During Abdominal And Pelvic Radiography (2021)". Ncrponline.org, 2021. [Link].
- 5. ASMIRT Position Statement Gonad Shielding". Asmirt.org, 2021. [Link].
- 6. ASRT Statement on Fetal and Gonadal Shielding. Asrt.org, 2021. [Link].
- 7. Yogesh Thakur, Stephanie C. Schofield, Thorarin A. Bjarnason, Michael N. Patlas. Discontinuing Gonadal and Fetal Shielding in X-Ray:. (2021) Canadian Association of Radiologists Journal. doi:10.1177/0846537121993092 doi:10.1177/0846537121993092.
- 8. Guidance on using shielding on patients for diagnostic radiology applications Joint report. Bir.org.uk, 2021. [Link].
- 9. Ng JHS, Doyle E. Keeping Children Still in Medical Imaging Examinations- Immobilisation or Restraint: A Literature Review. (2019) Journal of medical imaging and radiation sciences. 50 (1): 179-187. doi:10.1016/j.jmir.2018.09.008 - Pubmed