Radiographic Procedures · ARRT 2025
Pediatric Radiography
Pediatric technique for the ARRT exam: the 10 cm grid rule, Pigg-O-Stat chest at 72 inches SID, the 13-entry skeletal survey for suspected abuse, and infant centering rules.
Overview
Pediatric radiography sits inside Radiographic Procedures, the largest domain on the ARRT exam at 72 of 200 scored questions. The chapter covers patients from infancy through ages 12 to 14, and one technique rule repeats on nearly every page: the shortest exposure time and the highest mA the generator allows, because motion is the repeat you cannot argue with. The grid comes out below 10 cm of part thickness, and the room is set up before the child arrives.
Immobilization gets specific. You learn four named devices (Pigg-O-Stat, Tam-em board, Posi-Tot, Papoose Board) plus the four-step mummy wrap for children up to 2 to 3 years old. Anyone in the room wears a lead apron, with lead gloves added when hands go in or near the primary beam, and a pregnant parent stays in the waiting area, asked before she stays. Centering changes too: an infant abdomen is centered 1 inch (2.5 cm) above the umbilicus, because the iliac crest is not a usable landmark yet.
Dose is the other half. The Image Gently campaign, begun in 2007, asks you to drop the grid under 10 cm, collimate on four sides, and raise kV so you can lower mAs. The erect chest on a Pigg-O-Stat runs at a 72 inch (183 cm) minimum SID, and the pediatric skull uses three central ray angles: 0 degrees, 15 degrees cephalad, and 30 degrees caudad for the Towne.
The chapter closes with survey studies. Bone age reads a child's hand and wrist. The metastatic series is full-body radiographs in an adult, with multiple myeloma as the bone scan exception. The non-accidental trauma skeletal survey runs thirteen entries from AP skull to AP feet, each separately collimated, because the babygram is not an acceptable method.
What you’ll learn in this chapter
The 35 lessons in this chapter break down as follows. The full lesson content is unlocked when you start a free account.
Pediatric Radiography
- Pediatric Radiography & Survey Studies
Anatomy
- Bone Development and Ossification
- A Child Is Not a Small Adult
- Quiz
Communication
- Talking to the Child and the Parent
Holding
- Who Holds, and What They Wear
Immobilization
- Devices and the Mummy Wrap
Dose
- Image Gently and Dose Reduction
Shielding
- Shielding the Child
- Quiz
Chest
- The Pediatric Chest
- Quiz
Abdomen
- The Pediatric Abdomen
- Quiz
Limbs
- Pediatric Limbs and the Kite Method
Pelvis & skull
- Pelvis, Hips and Skull
Contrast prep
- Preparing a Child for a Contrast Study
- Quiz
Upper GI
- Barium Swallow, Upper GI and Small Bowel
Urinary
- The Voiding Cystourethrogram
- Quiz
Survey studies
- Bone Age and the Met Series
- Quiz
- The Non-Accidental Trauma Skeletal Survey
- Quiz
Non-accidental trauma
- Suspected Abuse and Your Obligation
Clinical indications
- Pediatric Clinical Indications
- Quiz
Image critique
- Critiquing a Pediatric Film
Recap
- What to Carry Out of This Chapter
- Quiz
- Quiz
- Quiz
- Quiz
- Quiz
Key terms in this chapter
These are the 8 terms most likely to appear on the ARRT registry from this chapter. Use them as a flashcard pre-quiz.
- Pigg-O-Stat
- The commonly used immobilization apparatus for erect chest and abdomen imaging of infants and small children up to about age 5. Its mechanism swivels so the PA and lateral are taken without repositioning the child.
- Epiphyseal plate
- The cartilage between the metaphysis and the epiphysis, seen as a lucent band on radiographs. Growth plates remain until skeletal maturity, normally at about 25 years.
- Mummy wrap
- A four-step sheet-wrapping technique that immobilizes infants and some children up to 2 to 3 years old, the age band that cannot yet be talked through a study.
- Image Gently
- A campaign begun in 2007 to reduce pediatric dose. Its console-side requests include no grid below 10 cm, four-sided collimation, and higher kV with lower mAs.
- Skeletal survey
- The accepted method of imaging a child for suspected abuse: thirteen listed entries from AP skull to AP feet, each separately positioned, centered, and collimated.
- Bone age study
- A radiograph of a child's hand and wrist that measures skeletal age against chronological age, read from which ossification centers have appeared and how far the growth plates have closed.
- Kite method
- The approach for imaging talipes (clubfoot): two projections 90 degrees apart with the foot left in its deformed position, because straightening it destroys the examination.
- Classic metaphyseal lesion
- A tearing or avulsion fracture along the metaphysis, also called a corner or bucket-handle fracture. Caused by pulling on a limb or violent shaking, it is a key finding in non-accidental trauma.
Sample practice question: Extremity
One free sample from the 105-question Extremity bank. See the format, the rationale style, and the difficulty before you sign up.
A patient presents with wrist pain after falling on an outstretched hand. The PA, lateral, and oblique wrist projections appear normal but clinical suspicion for scaphoid fracture remains. What additional projection should be performed?
Show answer and rationale
A, Incorrect: The carpal tunnel projection demonstrates the carpal tunnel itself, not the scaphoid in particular.
B, Correct: Correct. The Stecher method (PA wrist with ulnar deviation, central ray angled 20° proximally toward the elbow) elongates the scaphoid and reveals fractures missed on routine PA. It is the standard supplementary view for suspected scaphoid fracture.
C, Incorrect: AP oblique medial rotation is for the elbow, not the wrist. Wrist obliques are routinely lateral rotation.
D, Incorrect: Radial deviation does not elongate the scaphoid. Ulnar deviation is required for the Stecher.
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Frequently asked questions
What does the ARRT Radiography Radiographic Procedures category cover?
Pediatric radiography sits inside Radiographic Procedures, the largest domain on the ARRT exam at 72 of 200 scored questions. The chapter covers patients from infancy through ages 12 to 14, and one technique rule repeats on nearly every page: the shortest exposure time and the highest mA the generator allows, because motion is the repeat you cannot argue with. The grid comes out below 10 cm of part thickness, and the room is set up before the child arrives.
How many lessons are in the Pediatric Radiography chapter?
This chapter contains 35 lessons across 19 sections, plus a knowledge-check quiz at the end. The full lesson content is unlocked with a Premium subscription. The free tier includes 3 complete chapters.
Is this chapter aligned with the ARRT 2025 Content Specifications?
Yes. Every chapter on this site maps directly to the ARRT Radiography Content Specifications effective 2025. This chapter falls under the Radiographic Procedures domain of the official ARRT exam blueprint.