Pediatric humerus (AP view)

The anteroposterior humerus view for pediatrics is part of the humerus series and is usually taken in a standing position. However, it can also be obtained in a supine position.

The projection demonstrates the humerus in its natural anatomical position allowing for adequate radiographic examination of the entire humerus and its respected articulations.

Indications

Humerus views are often done to exclude large humeral shaft fractures or suspected soft tissue infections. If an occult fracture is suspected at either the proximal or distal end, it is best to do a separate elbow or shoulder series.

Patient position

• the patient is preferably erect

• the patient's back is against the image receptor

• the affected arm is abducted and centered to the upright detector, if possible, the arm is slightly externally rotated to mimic the true anatomical position

Technical factors

• anteroposterior projection

• centering point

  • mid humerus shaft

• collimation

  • superior to the skin margins above the glenohumeral joint

  • inferior to include the distal humerus including the elbow joint

  • lateral to include the skin margin 

  • medial to include skin margin 

• orientation  

  • portrait

• detector size

  • 35 cm x 43 cm

• exposure ²

  • 60-65 kVp

  • 2-10 mAs

• SID

  • 100 cm

• grid

  • no

Image technical evaluation

The humerus is positioned AP, evidenced by the:

• medial and lateral epicondyles seen in profile

• greater tuberosity being seen on the lateral aspect of the humerus

• shaft being abducted away from the patient's body, minimizing superimposition

Lead shielding

Contact lead shielding is no longer recommended for any pediatric examination. Statements have been released by several radiological societies supporting an end to this practice ^3-6, with the most comprehensive guidance statement on this matter being in an 86-page joint report ⁷.

Practical points

Preparing the room beforehand (setting up the detector, exposure and preparing lead gowns) is extremely beneficial for humerus imaging as young children may begin to cry the moment their affected arm is brought away from their body.

Immobilization techniques

To prevent malrotation/motion artifact in the radiograph, parental holding at the mid-chest region and distal half of the child’s arm. Other alternative methods such as distraction techniques may be ideal to avoid scattered radiation to parents and staff ⁸.