Pediatric restraint for X-ray photography

Restraint apparatus is provided for immobilizing a pediatric patient during exposure of X-ray film, particularly in connection with chest examinations. The invention permits considerable reduction in the extent of exposure area of the patient's body. Manual restraint is not required and hence non-patient exposure to radiation is avoided. Because movement is restrained, the need to re-expose the patient is virtually eliminated. Adjustment is provided for the comfortable accommodation of infants up to small children. The apparatus secures both arms of an infant or small child in a forward and upward extension to achieve proper anatomical positioning for anterior-posterior or lateral chest X-ray study. Adjustable holders for different size film cassettes form part of the apparatus.

BACKGROUND AND SUMMARY OF THE INVENTION 
Chest examinations by X-ray photography commonly require exposure of X-ray 
film while an infant or child is in an upright position. The chest X-ray 
examination typically involves anterior-posterior and lateral exposures. 
Because the cooperation of babies and small children in these X-ray 
procedures is often lacking, it is usually necessary that an adult 
manually restrain the child while the film is being exposed. 
Unfortunately, this subjects the adult to the risk of exposure to X-ray 
radiation. Even with this form of immobilization inadvertent movement can 
easily take place. If the patient is not motionless during exposure, 
clouding or double-imaging occurs necessitating retakes of the photograph 
to achieve a clear image. 
Previous restraining devices have been provided for immobilizing young 
children during X-ray studies. U.S. Pat. Nos. 3,358,141, to Hoffmann et 
al., 3,526,222, to Dreibelbis, 3,650,523, to Darby, Jr., and, 3,933,154, 
to Cabansag, have offered immobilizers in the form of planar supports 
having straps for restraining the patient. The Cabansag patent further 
includes a flexible backer member allowing the patient to be placed in 
various orientations for X-ray examination of different parts of the 
anatomy. 
U.S. Pat. No. 4,027,869, issued to this inventor, provides a planar member 
particularly suited for hip studies requiring the so-called frog-leg 
position. 
These foregoing apparatuses do not include film holders and require that 
the apparatus, with restrained patient, be moved adjacent a film holding 
means. Further, such immobilizers require that they be radiotransparent in 
order to avoid shadows on the photographic images. Additionally, they must 
have sufficient sturdiness to permit moving the device and patient into 
proper anatomical positioning for the X-ray photograph. 
U.S. Pat. Nos. 3,051,832, to Pigg, and 3,892,399, to Cabansag, disclose 
restraining apparatuses which include film holding means positioned 
adjacent the immobilization portions. The Pigg device restrains the child 
in a body-conforming structure which holds the child upright with arms 
extending vertically above the head. Straps or bands are not the primary 
restraining device but rather two opposing body-conforming portions are 
laterally expansible to accommodate various sized children therebetween. 
Held in such fashion, the patient may be rotated to the desired anatomical 
position in front of the X-ray film holder. The child's legs extend 
unrestrained below a mid-body planar section whereby undesired movement 
may take place. Also, with the arms held above the head, an uncomfortable 
position is imposed, which may lead to disquietude in the young patient. 
The Cabansag apparatus is a chair-like device which positions the patient 
in a seated fashion with his back next to a film holder. The device 
further provides a lateral film holder, which may be pivotable. Like the 
Pigg structure, the Cabansag restraint may be rotatable. The film holding 
means is radially dislocatable to permit rotation of the chair-like 
device. A radio-transparent backer for the chair is needed inasmuch as it 
is disposed between the patient and film. The Cabansag apparatus offers 
restraints for the head, torso, legs and ankles. The examinee's arms may 
be restrained upwardly, above the shoulders, with a pair of arm straps at 
either side of a head restraining strap. 
It is a primary goal of the invention to provide a simplified pediatric 
retraining device which affords comfortable positioning of the patient 
with minimal strapping to achieve the proper anatomical posture for 
anterior-posterior or lateral X-ray examination of the upper torso of the 
child. 
It is an important object of the invention to provide an adjustable 
restraining apparatus for use with children up to about four years of age 
which affords adjustment of only a single vertical adjustment means to 
accommodate young patients in this range of sizes. 
It is further an object of the invention to provide adjustable film holding 
means for X-ray film cassettes which can accommodate different sized film 
cassettes. 
It is also an important goal of the invention to restrain the arms of the 
patient upwardly and outwardly on wing-like extensions forming arm rest 
means which attains the correct and preferred anatomical positioning of 
the chest for X-ray study. 
It is an allied object of the invention to restrain the child with a 
minimum number of straps in a relatively comfortable position to gain 
patient cooperation and calmness. 
It is therefore a concomitant object of the invention to position the 
patient in a seated position with arms restrained and supported in a 
relaxing posture at resting surfaces having an upward and outward 
extension. 
It is also an object of the invention to provide a relatively inexpensive 
device which is portable, easily stored, and requires only minor 
adjustments for patient and film sizes. 
It is an aim of the invention to securely immobilize the patient with a 
back strap, leg strap and arm straps by which the immature patient may be 
constrained in a relatively natural position. 
It is a concomitant object of the invention to include means for holding 
grid filter panels which is formed integrally with the film cassette 
holding means. 
The invention may be summarized as having a generally rectangular planar 
padded seat whereupon the patient sits lengthwise. At one end, the seat 
has overlying straps for leg restraint. An upright is fixed along a side 
edge of the seat with a vertically sliding sleeve engaged therearound. A 
locking knob means serves to vertically adjust the sleeve to desired 
positions. A cross framework associates with a side framework, and both 
are vertically movable by adjusting the sliding sleeve. The cross 
framework extends across the seat generally above the patient's thighs. 
The side framework extends along the side of the seat laterally of the 
patient's chest. Each framework includes film holding means having a pair 
of upper and lower, opposingly faced, horizontal double-channel members. 
Independent channel adjustment means are cooperative with each pair of 
double-channel members. The channel adjustment means movably interconnect 
the double-channel members and provide for relative vertical movement of 
the opposing double-channel members for the accommodation of different 
sized X-ray film cassettes. 
The cross framework further includes wing-shaped arm rests extending 
patient-outwardly and upwardly generally from opposite ends of the upper 
double-channel. The arms and upper back of the patient are restrained by 
strap and strap holder means associated with the arm rests for securement 
from wrist-to-wrist with the strap extending around the upper back, or 
shoulders, of the patient. A strap and strap holder means associate with 
the lower double-channel for restraint around the lower back of the 
pediatric patient. The chest is immobilized closely adjacent the cross 
framework, and the side framework is positioned laterally of the patient. 
In the preferred form, the side framework connects to a supporting tubular 
cross-bar of the cross framework by means of a slide arm movably 
positioned within the tubular cross-bar. Thereby, the side framework is 
also laterally movable with respect to the seat and patient, as well as 
being vertically adjustable by means of the locking knob and sliding 
sleeve.

DESCRIPTION OF MODE BEST EMBODYING THE INVENTION 
It will be seen from the Figures, that the invention embodied by pediatric 
restraint device 10, or pediatric restraint means, is intended for use 
with a small child or infant. An infant 11 is placed chest-forwardly 
adjacent a film cassette for the anterior-posterior X-ray photography 
position. A second film cassette may reside to the side of the infant for 
a lateral X-ray exposure. 
The pediatric restraint means utilizes a limited number of restraining 
straps thus affording as much comfort as possible to the patient in 
reducing fear and nervousness which sometime attend examination of the 
immature patient. 
The child is seated with legs extending forwardly chest closely adjacent a 
film cassette. His arms extend upwardly and outwardly, comfortably 
supported in wing-shaped arm rests, as will be described. Correct 
anatomical positioning of the child is attained with the relatively 
relaxed, but restrained, positioning of the child as shown. 
In the illustrated embodiment, film holding adjustment is made possible for 
typical 8".times.10" to 10".times.12" size cassettes. Additionally, 
adjustment means is provided for the accommodation of smaller or larger 
children in the age group from infant up to about 31/2 to 4 years of age. 
With more specific reference to the Figures, it will be seen that child 11 
sits lengthwise on top of a rectangular planar seat 12 over which a padded 
cushion 13 is affixed. The child is seated in an upright fashion with the 
torso generally at right angles to the planar seat 12 and his legs 
extended forwardly. 
The patient's chest is positioned closely adjacent across framework 14 
which includes means for positioning the arms and chin, as well as 
including means for holding a film cassette and filtering grid. X-ray 
filtering grids are used to eliminate scattered radiation and produce 
better film quality. Sideward of the child 11, a side framework 15 extends 
generally at right angles from cross framework 14. Side framework 15 has 
means for holding a laterally disposed film cassette and filtering grid. 
Cross framework 14 includes a tubular cross-bar 16 which is fixed to a 
movable, or sliding, sleeve 17. The movable sleeve 17 has a generally 
block-C configuration with a central channel receiving an upright 18. 
Upright 18 is fixed to a side edge of seat 12. Therefore, vertical 
movement of cross framework 14 is afforded by an up or down sliding action 
by sleeve 17 extending around upright 18. Once the elevation of tubular 
cross-bar 16 is determined for positioning above the thighs of child 11, 
an adjustment lock knob 19 is tightened to maintain this height. The 
locking adjustment provision is afforded by a boss 20 integrally formed 
with sleeve 17 at a corner thereof and having a threaded slot 21 for 
thread engagement with threaded shaft 22 extending from knob 19. The 
upright 18 has a beveled corner 23 positionally aligned with the threaded 
slot 21 of the boss onto which the threaded shaft 22 is forced for locked 
positioning. 
Cross framework 14 includes opposingly faced double-channel members 24, 25. 
The opposing pairs of channels are aligned for vertical placement of film 
cassette F and grid G. The patient-adjacent channels g-g receive the grid 
G and the channels f-f receive film cassette F, as shown in FIG. 1. 
Relative vertical spacing of members 24, 25 is attained by channel 
adjustment means comprising adjustment knob 26 in cooperation with 
vertical support channel 27 and movable bar 28. Support channel 27 is 
centrally fixed to tubular cross-bar 16 and extends upwardly to be slide 
engaged by movable bar 28. Double-channel 25 is affixed to movable bar 28. 
Adjustment knob 26 is of conventional design wherein a threaded shaft 
extends through a slot (not shown) in support channel 27 to contact 
movable bar 28 upon tightening. Untightening renders movable bar 28 free 
to move along support 27 for positioning at the desired separation 
distance between members 24, 25. Thus, different height grids and film 
cassettes may be accommodated. 
Side framework 15 includes opposingly faced double-channel members 29, 30. 
The double-channel members are movably interconnected by a channel 
adjustment means, as will be explained. The opposing pairs of channels are 
aligned for vertical placement of a film cassette and grid. The 
patient-adjacent channels g-g receive a grid (not shown) and channels f-f 
receive a film cassette (not shown). 
Side framework 15 is associated with cross framework 14 by means of 
double-channel 29 being affixed to a horizontal support rod 31, which is 
slidably disposed within tubular cross-bar 16 and vertically carried 
thereby upon vertical movement of sleeve 17. Support rod 31 may be 
horizontally translated within tubular cross-bar 16 to afford lateral 
adjustability of side framework 15. 
Double-channel member 29 includes a vertical panel 32 extending upwardly 
from the remote outer wall of channel f. Double-channel member 30 includes 
a vertical panel 33 extending downwardly from the outer wall of its 
channel f in a slightly offset and overlapping orientation with panel 32. 
A well-known friction-type retainer forms channel adjustment means and 
connects panels 32, 33 in a vertically adjustable relationship. 
Double-channel 30 is thereby capable of being raised or lowered relative 
to double-channel 29 for accommodation of different height grids and film 
cassettes. 
Upon seating child 11 to face cross framework 14, leg restraint is attained 
by the provision of leg straps 35 extending around the thighs of the child 
and passing through strap slots 36 formed in seat 12. The lower back of 
the patient is restrained by back strap 37 passing around the child to be 
secured at strap holders 38 which are located at the ends of tubular 
cross-bar 16. 
Seated in this upright position, immobilization in the correct anatomical 
position is completed by securement of the shoulders and arms. In the 
embodiment shown, a single arm strap 39 secures the left arm, shoulders 
and right arm. 
Particularly characterizing the invention is the provision of arm rests 40, 
41 extending upwardly and outwardly from cross framework 14. In the 
embodiment shown, the arm rests 40, 41 are fixed to a gusset 42 which is 
attached to movable bar 28. Thus, the double-channel 25, arm rests 40, 41 
and gusset 42 are carried as a unit by movable bar 28. 
The wing-shaped arm rests 40, 41 are concave, and may be padded, to allow 
the arms of the patient to be comfortably nested. Restraint 10 secures the 
patient's arms in a forward and upward extension to attain a desirable 
anatomical position. For added comfort and positioning of the head, a soft 
chin rest 43 is centrally located atop channel 30. Thereby, the patient's 
thorax is positioned directly against grid G to reduce any chance 
magnification. 
Arm rests 40, 41 include strap holders 44 for attachment of restraining 
strap 39. The strap 39 may be encircled about the arm rests, as shown, for 
full restraint of the arm from the wrist back to the shoulder. The strap 
39 passes across the upper back, between the arm rests, to effect 
restraint from the left wrist, across the back, to the right wrist of the 
patient. Thus, clouding or double-imaging is virtually eliminated by this 
very effective upper body restraint. 
A cross-brace 45 extends between arm rests 40, 41 for rigidity and arm 
stability. 
In FIG. 2, the lowest vertical position of the frameworks 14, 15 and the 
smallest separation distance of each of their film holder means are shown 
in solid lines. The highest vertical position and the largest film holder 
means separation distance are shown in phantom lines having "prime" 
reference numerals. Frameworks 14, 15 move together relative to seat 12 by 
adjustment of knob 19 and sleeve 17. To accommodate different sized film 
cassettes, the film holding means of the frameworks are independently 
adjustable by adjustment of knob 26 for cross framework 14 and by 
adjustment of friction retainer 34 for side framework 15. Further, lateral 
movement of side framework 15 is attained by the slideaction of support 
rod 31 within tubular cross-bar 16. Therefore, four quick adjustments are 
made possible by pediatric restraint 10. 
Standard film cassettes, and corresponding filter grids, are typically 10" 
or 12" high. Accordingly, the adjustable film holding means provides for 
separation between the opposing double-channel members from 10" at the 
smallest position to 12" at the largest (FIG. 2). It has been determined 
that the adjustment range for sleeve 17 of from about 2" to 3" is 
satisfactory for positioning tubular cross-bar 16 over the thighs of child 
11 and placing the chest adjacent cross framework 14. The low setting 
places cross-bar 16 about 3" above cushion 13 and about 5" to 6" at the 
high setting. This variability allows X-ray study of infants and small 
children. 
For additional restraint of the patient's legs, a yoke-shaped leg 
restrainer 47, as shown in FIG. 4, may be used in cooperation with leg 
strap 35 for disposition over the thighs. 
While double-channel members are shown for the adjustable film holder 
means, it will be clear that single channels are within the scope of the 
invention when filter grids are not required. Of course, the 
double-channel members of restraint 10 are usable for film cassettes 
alone. The invention is not intended to be limited to the illustrated 
configurations of the elements embodying restraint 10, as will be clear to 
those skilled in X-ray examination technology. 
ACHIEVEMENTS 
Accordingly, the invention provides a comfortable, yet immobilizing, 
restraint for infants and small children. Wing-shaped arm rests have a 
concave formation for restful disposition of the patient's arms. A single 
strap preferably extends from one wrist across the patient's back to the 
other wrist for close positioning of the chest to a cross framework having 
film holder means. The lower back is secured by a strap extending from one 
side of the cross framework to restrain the patient in an upright seated 
position. Forward of the cross framework, the legs are secured to the seat 
for complete immobilization of the patient. A side framework, also 
including film holder means, associates with the cross framework and both 
frameworks are vertically adjustable by a single vertical adjustment 
means. The pediatric restraint is thereby adjustable for accommodation of 
infants up to small children. Anterior-posterior and lateral X-ray 
exposures may be made with certainty that clouding and double-imagery is 
virtually eliminated. Manual restraint is not needed and non-patient 
exposure to X-ray radiation is also eliminated. 
Simple film holder adjustments allows different sized film cassettes and 
grids to be used. 
The invention is lightweight and sturdy. With the child immobilized, the 
apparatus may be re-positioned relative to an X-ray machine in easy 
fashion. 
The patient is secured in correct anatomical positioning at all times for 
chest X-ray examination. X-ray studies may quickly proceed with minimal 
discomfort and nervousness often encountered with the youthful patient.