Clavicle series (pediatrics)

The clavicle series for paediatrics is a two view-view series containing an anteroposterior and a cranially angled axial radiograph. Depending on the patient's level of distress and severity of the injury, adapting the radiographic technique to suit a child sitting in bed or lying supine may be necessary. 

Indications

In paediatrics, clavicle radiographs are mainly indicated for:

• trauma with a suspected fracture

• acromioclavicular or sternoclavicular dislocation

Projections

Standard projections

• anteroposterior view

• anteroposterior cephalad angulation view

Patient preparation

Patients should remove any clothing, arm sling or jewellery from the affected clavicle. 

Gonadal shielding

The use of gonadal and fetal shielding has been deemed as non-beneficial to patients' health per current evidence and may or may not be useful for paediatric extremity imaging ^1-3. The use of gonadal shielding can increase the examination time and may cause the child more distress. Shielding, however, 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 judgement.

Tips for paediatric clavicle radiography

The major difficulty in paediatric radiography of the clavicle relates to:

• motion artifact

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 perform the images supine

• setting up the room before moving the patient into the required position can reduce patient distress

Immobilisation techniques

Children will find it difficult to keep their arm still; particularly if the limb is injured. One option is to have a carer or radiographer stand on the child's non-affected side, placing one hand on their mid-chest and another holding the proximal forearm.