Femur and Hip Girdle

Question 1

Femur - AP Distal Projection

Answer 1

Supine with leg internally rotated about 5 degrees - AP Knee
2” below knee joint and up
suspend respiration
remainder of femur on smaller image

Question 2

How do you ensure there is overlap of the 2 AP femur images?

Answer 2

do not move marker for the 2nd image

Question 3

Femur - AP Proximal Projection

Answer 3

supine with leg rotated 15-20 internally - AP hip and toes touching
ASIS down
Suspend respiration
Remainder on smaller image

Question 4

Femur - AP Evaluation criteria

Answer 4

proper collimation and marker showing overlap
most of the femur near the pathology and a smaller second projection of the other joint
femoral neck not foreshortened
no knee rotation
any orthopedic appliance in its entirety

Question 5

Femur - Lateral Distal Projection

Answer 5

knee flexed 45 degrees - patient in true lateral
2” below knee joint and up
suspend respiration
proximal on smaller image
CR - perpendicular

Question 6

Femur - Lateral Proximal Projection

Answer 6

roll externally until affected leg is lateral
keep unaffected leg posterior
ASIS down
suspend respiration
Shielding
Distal femur on smaller image

Question 7

Pelvis - AP Projection

Answer 7

IR: crosswise in Bucky
Body supine in true AP - internally rotate legs 15-20 unless there is a fracture
CP: approximately 2” below ASIS at MSP - light above iliac crests and below pelvis
suspend respiration

Question 8

Pelvis - AP Evaluation Criteria

Answer 8

all of pelvis and proximal femur
no rotation
- symmetric ilia
- symmetric obturator foramen
- ischial spines equally seen
- sacrum and coccyx aligned with pubic symphysis
femoral necks not foreshortened
greater trochanters in profile
lesser trochanters mostly superimposed with femur

Question 9

pelvis - AP Oblique projection - Frog leg or modified cleaves method

Answer 9

contraindicated if fracture or hip replacement
supine, legs flexed, feet together, thighs abducted 45 degrees - long axes of femoral necks parallel with IR
CP: 1” superior to symphysis pubis - 3” below ASIS at MSP
Suspend respiration

Question 10

Pelvis - AP oblique evaluation criteria

Answer 10

no rotation of pelvis
lesser trochanter on medial aspect of femur
femoral neck without superimposition by the greater trochanter

Question 11

Hip - unilateral frog leg

Answer 11

should be truly supine
affected leg abducted 45 degrees - sole of foot up to unaffected knee
CP: 3-4” below ASIS - over hip joint
ASIS down
suspend respiration
Not for fracture or dislocation

Question 12

Hip - Unilateral Frog Leg Evaluation Criteria

Answer 12

lateral proximal femur
oblique of femoral neck

Question 13

Hip - AP projection

Answer 13

internally rotate leg unless fractured
ASIS to proximal third of femur - include medially to symphysis
suspend respiration
include all of prosthetic

Question 14

Hip - AP Evaluation Criteria

Answer 14

proximal 1/3 of femur and symphysis
greater trochanter in profile
no foreshortening of femoral neck
head of femur in acetabulum
hip joint visualized
lesser trochanter should be superimposed

Question 15

Hip - Lateral Lauenstein Method Projection

Answer 15

Rotate onto affected side until affected femur is flat - flex knee and abduct leg 90 degrees to hip bone
CP: hip joint
Align collimator to anatomy
suspend respiration and use shielding
Hickey method if using 20 cephalad angle

Question 16

Hip - Lateral Lauenstein method evaluation criteria

Answer 16

hip joint, acetabulum and femoral head
femoral neck overlapped by greater trochanter

Question 17

Hip - axiolateral projection

Answer 17

IR: crosswise with grid, may have to elevate pelvis
CR: 45 degrees
cross-table
top of IR above crest and angled along femoral neck
unaffected leg raised and supported
affected leg internally rotated unless fractured
CP: exit through greater trochanter
May see filter in use

Question 18

Hip - axiolateral evaluation criteria

Answer 18

hip joint and acetabulum
femoral neck without overlap from greater trochanter
some of lesser trochanter on posterior femur
ischial tuberosity below femoral head and neck
all of prosthetic

Question 19

Hip - axiolateral on stretcher

Answer 19

IR crosswise in bucky
Align femoral neck to be parallel with bucky - bring foot of bed away from the bucky
internally rotate foot unless fractured
raise unaffected leg
suspend respiration
SID: 180cm

Question 20

Hip - Modifed Axiolateral

Answer 20

possible post-op, trauma
patient on edge of table
CR: 15-20 degrees from horizontal amid perpendicular to femoral neck
Grid cassette with 15-20 degree tilt