FEMUR DANELIUS MILLER

Question 1

What is the clinical indication for the axiolateral inferosuperior projection (Danelius-Miller method)?

Answer 1

Lateral view for fracture or dislocation assessment in trauma hip situations when the affected leg cannot be moved.

Question 2

What is the minimum SID for the axiolateral inferosuperior projection?

Answer 2

40 inches (102 cm).

Question 3

How should the patient be positioned if they cannot be moved?

Answer 3

• The patient may be on a stretcher or bedside, supine with a pillow provided for the head.
• Elevate the pelvis 1 to 2 inches (3 to 5 cm) if possible by placing supports under the pelvis (especially important for thin patients or those on a soft pad or bed).

Question 3

How should the unaffected leg be positioned?

Answer 3

• Flex and elevate the unaffected leg so that the thigh is near a vertical position and outside the collimation field.
• Support in this position (do NOT place the leg on the collimator or X-ray tube due to risk of burns or electrical shock).

Question 4

How should the pelvis be checked for rotation?

Answer 4

Ensure no rotation of the pelvis by checking for equal ASIS-table distance.

Question 5

How should the image receptor (IR) be positioned?

Answer 5

• Place the IR in the crease above the iliac crest and adjust so that it is parallel to the femoral neck and perpendicular to the CR.
• Use a cassette holder or sandbags to hold the cassette in place.

Question 6

How should the affected leg be positioned if possible?

Answer 6

Internally rotate the affected leg 15° to 20° unless contraindicated by a possible fracture or other pathologic process

Question 7

How should respiration be managed during this projection?

Answer 7

Suspend respiration during exposure.

Question 7

Where is the CR directed for this projection?

Answer 7

Perpendicular to the femoral neck and to the IR.

Question 8

How should collimation be adjusted for this projection?

Answer 8

Collimate on four sides to the anatomy of interest.

Question 9

What anatomy should be demonstrated in the image?

Answer 9

Entire femoral head and neck, trochanter, and acetabulum.

Question 10

How should the lesser trochanter appear with inversion of the affected leg?

Answer 10

Only a small part, if any, of the lesser trochanter should be visualized.

Question 11

What should not be superimposed over the affected hip if the unaffected leg is raised sufficiently?

Answer 11

Soft tissue from the raised unaffected leg should not be superimposed.

Question 12

How should the grid lines appear?

Answer 12

No grid lines should be visible, indicating correct tube/IR alignment.