This advertorial is sponsored by Adept Medical.
Overhead arm positioning has been supported by published studies demonstrating measurable improvements in imaging quality and reductions in radiation exposure during complex interventional procedures.1,2 This small but significant refinement in patient positioning can improve access and reduce radiation exposure during complex procedures such as fenestrated and branched endovascular aneurysm repair (F/BEVAR). These benefits, well established in adult practice, represent an important development in procedural safety and should not be limited by patient size.
This is according to Anna Sladkey, doctor of physical therapy at MemorialCare Miller Children’s & Women’s Hospital Long Beach (Long Beach, USA) and board-certified paediatric clinical specialist, who shares her experience with overhead arm positioning in paediatric and small adult patients.
“In paediatric patients, consistent and stable positioning is foundational to both procedural safety and long-term development. Thoughtful positioning protects joint integrity while children’s bodies are still growing, reducing the risk of injury that could have lasting consequences. Safe and predictable positioning helps reduce medical trauma—especially for children who will require multiple procedures and interventions throughout their lives.”
She reiterates that the same consistency and control that support complex interventions in adults are equally important for paediatric and small adult patients and emphasises a clear need to extend proven adult techniques into this underserved patient group.
Radiation and imaging outcomes with overhead arm positioning
Using the example of F/BEVAR procedures, which often require extensive fluoroscopic imaging to visualise the thoracoabdominal aorta and visceral vessels, prolonged imaging can expose both patients and interventional teams to significant cumulative radiation doses. This can increase the risk of skin injury, stochastic effects, and occupational exposure. Reducing radiation without compromising image quality remains a core clinical priority.
Published research indicates that arm positioning can influence both exposure and imaging outcomes. In 2021, Giulianna B Marcondes (University of Texas Health Science Center at Houston, Houston, USA) et al evaluated the safety of the overhead upper extremity positioning during F/BEVAR and reported it to be safe, with overhead positioning allowing optimal lateral and rotational imaging with satisfactory visualisation of visceral vessels.1 Additionally, Amit Pujari (University of Hertfordshire, Hatfield, UK) and colleagues quantified the radiation benefit, reporting a 30% reduction in radiation exposure in adult F/ BEVAR procedures compared with arm-at-side positioning, while maintaining adequate imaging during complex endovascular repair.2 In the pre-proof summary of their findings, the authors concluded overhead arm positioning should be considered a standard of care for improving radiation safety during aortic and visceral endovascular procedures.2
Standardising overhead positioning across adult and paediatric practice
The Adept Medical Overhead Arm Support MR Safe was designed to facilitate an unobstructed view of the abdominal area during diagnosis or intervention by comfortably supporting both arms in the overhead position. Made from durable engineered plastics, it provides a radiolucent, ergonomic, and easily attachable framework that accommodates patients with limited arm flexibility while keeping clear of the imaging table camera.
By standardising the overhead position, dedicated support devices can help promote more consistent positioning during interventional procedures. According to Marcondes et al, “overhead upper extremity position allows optimal imaging on lateral projections and rotational cone beam computed tomography [CBCT] during F/BEVAR” supporting reliable visualisation during complex cases.1 Further, in Pujari and colleagues’ discussion of their findings, overhead arm positioning was associated with reduced radiation exposure, supporting its use as a practical approach for reducing dose while maintaining imaging requirements during complex endovascular procedures.2
Speaking to Interventional News, Sladkey underscores that reliable upper-extremity positioning is “essential for protecting biomechanics, patient comfort, and long-term function”, among other benefits.
“Proper support and alignment reduce the risk of brachial plexus injuries,” she continues, “which can be detrimental to a child’s fine and gross motor development. Consistent positioning also decreases post-procedural numbness or tingling and allows clinicians to position patients more efficiently with less trial-and-error. From an imaging standpoint, our interventional cardiologist reports that stable upper-extremity positioning keeps the arms safely out of the field, improving lateral projections and overall image quality.”
As published clinical studies demonstrate the imaging and radiation benefits of elevated arm positioning, achieving stable and repeatable positioning becomes important to realising these benefits during interventional procedures.1,2
Engineering and workflow considerations for size-appropriate positioning
Published by the University of Virginia, a research paper by Keelin Reilly (University of Virginia, Charlottesville, USA) and colleagues titled ‘The Development of a Pediatric Interventional Cardiology Arm Positioning Device; Children Are Not Small Adults’ explored the systemic challenges that contribute to the paediatric device gap, including limited market size and financial incentives, clinical and technical hurdles, regulatory barriers, and ethical considerations.3,4
Reilly et al highlight that, at the time, the only commercially available overhead arm support was designed for adults and did not accommodate paediatric anatomy. The authors state that “forcing the device to fit smaller patients increases the risk of brachial plexus injuries”.4
In their discussion, the research team underline that, although overhead positioning is clinically advantageous, most commercial equipment has been built around adult anatomy. For example, in paediatric cardiac catheterisation, clinicians often rely on towels, straps, or foam blocks to hold a child’s arms overhead during lateral X-rays, methods that may compromise stability, require repeated adjustment, and increase the risk of nerve strain.
In Sladkey’s view, the Adept Medical Overhead Arm Support MR Safe – Small addresses a “real clinical gap in purpose-built paediatric devices that improvised positioning methods simply can’t fill”. The use of towels, foam blocks and straps are “inherently inconsistent” she adds, often requiring repeated adjustments, impacting both positioning quality and workflow.
“A dedicated device provides more stable, reproducible positioning and makes repositioning faster and more reliable. From an interdisciplinary standpoint, this consistency matters. Our interventional cardiologist is reassured knowing the child’s risk of injury is reduced, particularly to vulnerable structures like the brachial plexus. Purpose-built, paediatric-specific design—including appropriate sizing—supports safer procedures, smoother workflows, and better alignment with how paediatric care is truly delivered,” says Sladkey.
Extending the benefits to smaller patients
Building on clinical evidence and insights from practice, Adept Medical developed the Overhead Arm Support MR Safe – Small, designed specifically for paediatric and small adult patients, weighing between 13kg and 47kg. The device retains the radiolucent materials, ergonomic design, and secure overhead positioning of the adult model, but in a configuration tailored for smaller anatomy.
The Overhead Arm Support MR Safe – Small addresses the practical engineering and anatomical challenges associated with positioning smaller patients. Its design reflects considerations highlighted in recent research, offering a reliable, repeatable method for achieving optimal imaging access and patient stability, without improvised setups. This represents an important step forward in supporting paediatric interventional care, allowing evidence-based positioning to be consistently applied across a wider range of patient sizes.
Reflecting on the significance of a purpose-built support for the treatment of paediatric patients, Sladkey comments: “Children are not simply small adults—their bodies are growing, adapting, and developing over time. As medical advances allow more children with chronic conditions to live longer, we have a responsibility to design paediatric-specific equipment that considers not just today’s procedure, but lifelong function and wellbeing. When devices are built for paediatric needs, they support safer care, more sustainable workflows for clinicians, and better outcomes for the children we serve—now and into the future.”
To learn more about the Overhead Arm Support range, visit adeptmedical.com.
Disclaimer: Comment/s provided with permission. The clinician received no compensation for this statement.
References
- Marcondes GB, Tenorio ER. Evaluation of safety of overhead upper extremity positioning during fenestrated–branched endovascular repair of thoracoabdominal aortic aneurysms. Cardiovasc Intervent Radiol. 2021;44(12):1895–1902.
- Pujari A, Ahmad M, Sweet MP, Zettervall SL. Overhead arm support reduces radiation exposure during complex endovascular aortic repair. J Vasc Surg. 2023;78(2):2261–2270.
- Harrison AG, Nicholson AJ, Reilly KS. The development of a pediatric interventional cardiology arm positioning device. Charlottesville (VA): Department of Biomedical Engineering, University of Virginia; 2025. Technical report. Available from: University of Virginia Libra repository
- Reilly K. Children are not small adults: prioritization of pediatrics in medical device innovation. Charlottesville (VA): University of Virginia; 2025. Research paper. Available from: https://libraetd.lib.virginia.edu/ public_view/db78td62j
