Describe how the patients lower limbs should be positioned for the AP projection of the pelvis and proximal femora
Extend and rotate the lower limbs medially 15-20 degrees
What is the rationale for positioning of the lower limbs? (AP projection pelvis and proximal femora)
To place the femoral necks parallel with the plane of the IR
How is rotation of the pelvis detected in an AP projection image? (Pelvis and proximal femora)
The alae of the ilia are asymmetrical if the pelvis is rotated
Which plane of the body should be positioned on the midline of the table and grid? (AP projection pelvis and proximal femora)
With reference to the patient where should the IR be centered? (AP projection pelvis and proximal femora)
Midway between the asis and the pubic symphysis (approximately 2 inches above the pubic symphysis)
Which structures in these two images appear different?
The proximal femora (greater and lesser trochanters and femoral Neck)
Which image demonstrates correct positioning of the proximal femora?
Describe how the lower limbs were positioned in fig 7-5
Fully extended and rotated medially 15-20 degrees
Describe how the lower limbs were positioned in fig 7-6
Fully extended with feet rotated laterally into a naturally relaxed position
Identify each lettered structure: A
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Anterior inferior iliac spine
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What other name commonly refers to the AP oblique projection, modified cleaves method?
How much should the hips and knees be flexed?
As much as possible to get the femora to a near vertical position
After the patients knees and hips are flexed how many degrees from vertical should the thighs be abducted? (AP oblique projection modified cleaves method)
What is the purpose of abducting the thighs as required? (AP oblique projection modified cleaves method)
To place the long axis of the femoral Necks parallel with the plane of the IR
What breathing instructions should be given to the patient? (AP oblique projection modified cleaves method)
Stop breathing during the exposure
Describe how and where the central ray should be directed (AP oblique projection modified cleaves method)
Perpendicular to a point on the midline of the patient about 1 inch above the pubic symphysis
Where should each lesser trochanter appear in the image? (AP oblique projection modified cleaves method)
On the medial side of the femur
T/F the patient may be positioned either supine or upright (AP oblique projection modified cleaves method)
False the patient must be supine
T/F the gonads should not be shielded for the AP oblique projection
False the gonads should be carefully shielded to ensure that the shields does not superimpose the hip
T/F the AP oblique projection should not be performed on a patient who is suspected to have a fractured femoral Neck
T/F the greater trochanter should be seen in profile on the lateral side of the proximal femur (AP oblique projection modified cleaves method)
False the greater trochanter can be minimally seen on the medial edge of the femur
T/F this projection can be modified to demonstrate only one hip area (AP oblique projection modified cleaves method)
Why should a radiographer ensure that the distance from the asis to the tabletop on each side of the pelvis is the same?
To ensure that the pelvis is not rotated
Which positioning maneuver should be performed to place the femoral Neck parallel with the plane of the IR?
Rotate the foot and lower limb medially 15-20 degrees
What procedure should help the patient keep the affected lower leg in the required position?
Place a support under the knee and a sandbag across the ankle
Describe how to find the centering point where the central ray should enter the patient
Locate a point about 2 1/2 inches distal on a line drawn perpendicular to the midpoint of a line between the asis and the pubic symphysis
Which trochanter (greater or lesser) is not usually demonstrated beyond the border of the femur?
T/F the entire pubis of the affected side should be demonstrated
T/F the exposure should be performed with the patient breathing shallowly
False the patient should suspend breathing
T/F an initial radiographic study of a fractured hip may include an AP projection of the pelvic girdle and proximal femora to demonstrate bilateral hip joints
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A lateral projection image obtained by the Lauenstein method or the hickey method is used to demonstrate the hip joint and the relationship of the head of the femur with the:
Describe how the unaffected lower limb should be positioned
The unaffected leg should be extended and supported at the level of the hip
How should the central ray be directed for the lauenstein method of a lateral hip projection?
How should the central ray be directed for the hickey method of a lateral hip projection?
Cephalically 20-25 degrees
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List two common names used to denote the axiolateral projection (danelius miller) of the hip
Cross table lateral
Surgical lateral
Why should a firm pillow or folded blanket be placed under the pelvis?
To elevate the pelvis and provide better centering of the hip to the IR
Describe how the unaffected lower limb should be positioned
Flex the knee and hip of the unaffected side to elevate the thigh in a vertical position then it can be rested on some support
Describe how and where the central ray should be directed
Perpendicular to the long axis of the femoral Neck entering the patient on the medial aspect of the affected thigh near the groin and centered to the IR
With reference to the femoral Neck how should the lead strips of the grid be placed?
Horizontally parallel with the long axis of the femoral Neck
What breathing instructions should be given to the patient?
What is the general rule concerning demonstration of any orthopedic appliance with this projection?
Any orthopedic appliance should be completely demonstrated
T/F the pelvis should be rotated approximately 15-20 degrees
False
The pelvis should be adjusted so no rotation exists
T/F the foot and lower limb should be rotated laterally 15-20 degrees
False
The foot should be rotated medially if the patients condition permits the maneuver
T/F the entire lesser trochanter should be demonstrated on the lateral surface of the femur
False
Only a small amount of the lesser trochanter should be seen on the
posterior surface of the femur
T/F a small area of soft tissue overlap from the thigh of the unaffected lower limb is permitted
False
No part of the unaffected thigh should superimpose the affected femur
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Projection for demonstrating the acetabulum: the internal oblique position places the affected side ___
Projection for demonstrating the acetabulum: the external oblique position places the affected side ____
Projection for demonstrating the acetabulum: what specific portion of the acetabulum and pelvis is demonstrated by the internal oblique position of the judet method?
The internal oblique position of the judet method demonstrates the iliopubic column (anterior) of the pelvis and the posterior rim of the acetabulum
Projection for demonstrating the acetabulum: what specific portion of the acetabulum and pelvis is demonstrated by the external oblique position of the judet method?
The external oblique position of the judet method demonstrates the ilioishial column (posterior) of the pelvis and the anterior rim of the acetabulum
Which figure (a or b) depicts the proper patient position to demonstrate a suspected fracture of the right iliopubic column and posterior rim of the acetabulum?
Figure a is the LPO position and places the affected side up in an internal oblique position demonstrating the right iliopubic pelvic column and the posterior rim of the right acetabulum
Which figure a or b depicts the proper patient position to demonstrate a suspected fracture of the ilioischial column and anterior rim of the acetabulum?
Figure b is the RPO position and places the affected side down in an external oblique position demonstrating the right ilioishial pelvic column and the posterior rim of the right acetabulum
Where should the central ray enter the patient as positioned in fig 7-15 a?
Perpendicular to the IR at a point 2 inches inferior to the Asis of the affected side
Where should the central ray enter the patient as positioned in fig 7-15 b?
The central ray should enter perpendicular to the IR at the pubic symphysis
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Which projection demonstrates the superior and inferior rami of the pubic bones superimposed medially?
The superoinferior axial “inlet” projection (bridge man method)
To demonstrate the pubic and ischial rami without foreshortening the ___ method should be used
Explain how the central ray orientation for the AP axial “outlet” projection (Taylor method) differs between male and female patients
Male patients:
central ray angled 20-35 degrees cephalad
Female patients: central ray angled 30-45 degrees cephalad
The superoinferior axial “inlet” projection (Bridgeman method) requires the central ray be directed ___
Where does the central ray enter the patient for the superoinferior axial “inlet” projection (bridgeman method)?
Where does the central ray enter the patient for the AP axial “outlet” projection (Taylor method)?
2 inches distal to the superior border of the pubic symphysis
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Pubic rami (superimposed)
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The orthopedic appliance is not included in its entirety this image must be repeated using a larger IR or collimated field to demonstrate he entire appliance
the ischia are clipped or not included in the image
What positioning error likely produced this image?
The central ray was entered too low on the patient and the IR was centered too low on the patient
The central ray and IR were centered too high on the patient
What likely caused the error demonstrated in fig 7-23
Central ray and IR centered too low
Which structure of the pelvis articulates with the femur?
Which bones of the pelvis compose the acetabulum?
On which bone is the ala located?
Which of the following pelvic structures is not used as a positioning palpation point?
- iliac crest
- ischial spine
- pubic symphysis
- asis
Which portions of the hip bone join to form the obturator foramen?
What is the name of the border that extends on the hip bone from the posterior superior iliac spine to the asis?
What is the name of the process that separates the greater sciatic notch from the lesser sciatic notch on the hip bone?
Which parts of the hip bones support the weight of the body when a person is in sitting position?
Where in the pelvis is the body of the pubis located?
It forms part of the acetabulum
In average sized patients where should the IR be centered for the AP projection of the pelvis?
About 2 inches inferior to asis and 2 inches superior to pubic symphysis
Where on the midline of the patient should the central ray enter for the AP projection of the pelvis?
2 inches above the pubic symphysis
Which positioning maneuver should be performed to place the femoral necks parallel with the IR for an AP projection of the pelvis?
Rotate the lower limbs medially 15-20 degrees
How should the central ray be directed for the AP oblique projection (modified cleaves method) to demonstrate bilateral hips?
For which projection of the lower limbs or pelvis should the hips be flexed and the femora be abducted from the midline of the patient?
AP oblique projection (modified cleaves method) for femoral necks
Where on the midline of the patient should the central ray be directed for the AP oblique projection (modified cleaves method)?
1 inch above the pubic symphysis
All of the following projections can be used to image a patient with a suspected intertrochanteric fracture except for the:
- AP projection of the hip
- AP projection of the pelvis
- lateral projection (lauenstein method) of the hip
- axiolateral projection (danelius Miller method) of the hip
Lateral projection (lauenstein method) of the hip
For the AP oblique projection (modified cleaves method) what is the purpose of abducting the femora the required number of degrees?
To position the femoral necks parallel with the IR
Which structure should be centered to the midline of the table when the AP oblique projection (modified cleaves method) is adapted to demonstrate only one hip?
For which projection of an individual hip should the unaffected hip be flexed and the thigh be raised out of the way of the central ray?
Axiolateral projection (danelius Miller method)
For which projection of the hip should the central ray be directed horizontally into the medial aspect of the affected thigh?
Axiolateral projection (danelius Miller method)
Which of the following best demonstrates suspected fractures of the acetabulum?
AP oblique projection (judet method)
Which of the following positions would be used to demonstrate the posterior rim of the left acetabulum?
What specific portion of the acetabulum is demonstrated by the AP oblique projection external oblique position (judet method)?
Which of the following would best demonstrate the pubic and ischial rami without foreshortening?
AP axial “outlet” projection (Taylor method)
What is the proper central ray orientation for the AP axial projection (Taylor method) for female patients?