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Radiographic Positioning > Femur & Pelvis. > Flashcards

Femur & Pelvis. Flashcards

1
Q

AP Femur. Clinical Indications:

A

Evaluates fractures and/or bone lesions

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2
Q

AP Femur. Minimum SID:

A

40” (102cm)

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3
Q

AP Femur. IR size:

A

14x17” (35x43cm) lengthwise

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4
Q

AP Femur. Grid?

A

Yes

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5
Q

AP Femur. kV range:

A

Analog: 75 +/- 5 kV.
DIgital: 75 - 85 kV.

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6
Q

AP Femur. Pt position:

A

Patient is in supine postion, Femur centered to midline of table.

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7
Q

AP Femur. Part position:

A
  • Femur aligned to CR and midline of table or IR.
  • With knee included: Rotate leg internally about 5 degrees.
  • With hip included: Rotate leg, internally 15-20 degrees as for AP projection of the hip.
  • To ensure knee joint is included on IR - lower IR margin should be about 2” (5cm) below knee joint.
  • To ensure hip joint is included on the IR - Top of IR placed at the level of the ASIS.
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8
Q

AP Femur. Central Ray:

A

Perpendicular to femur and IR.

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9
Q

AP Femur. Recommended Collimation:

A

Closely on both side to femur.

End collimation to film borders.

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10
Q

AP Femur. Evaluation Criteria:

A

With knee included:
Distal 2/3rds of distal femur including knee joint.
Knee joint not fully open.
With hip included:
At least the proximal 1/3rd of femur along with the acetabulum and adjacent parts of pubis, ilium, and ischium.

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11
Q

AP Femur. Evaluation Criteria: Postion with knee included:

A

No rotation:
Femoral and tibial condyles appear symmetric.
Patella slightly toward medial femur.
Approximate half of fibular head superimposed by tibia.
Femur centered to collimated field and aligned with long axis of IR.
Knee joint space a minimum of 1” from distal IR margin.
Collimation to area of interest.

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12
Q

AP Femur. Evaluation Criteria: Position with hip included:

A

-Greater trochanter and femoral head and neck
in full profile without foreshortening.
-Lesser trochanter should not project beyond the medial border of the femur.
-Collimated field demonstrates entire hip joint and at least proximal third of femur.

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13
Q

Lateral projections of Femur. Mid and distal. Clinical Indications:

A

Mid and distal femur to include knee joint for detection and evaluation of fractures and /or bone lesions.

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14
Q

Lateral projections of Femur. Mid and distal. Minimum SID:

A

40” (102cm)

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15
Q

Lateral projections of Femur. Mid and distal. IR size:

A

14x17” (35x43cm) lengthwise.

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16
Q

Lateral projections of Femur. Mid and distal. Grid?

A

Yes

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17
Q

Lateral projections of Femur. Mid and distal. kV range:

A

Analog - 75 +/- 5 kV

Digital - 75-85 kV

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18
Q

Lateral projections of Femur. Mid and distal. Patient position:

A

Lateral recumbent.

Or supine for trauma.

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19
Q

Lateral projections of Femur. Mid and distal. Lateral recumbent:

A
  • Not for trauma
  • Knee is flexed about 45 degrees on affected side
  • Femur aligned to midline of table
  • Unaffected leg behind to prevent over rotation
  • Include knee joint
  • Second IR needed to include proximal femur and hip.
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20
Q

Lateral projections of Femur. Mid and distal. Trauma Lateromedial:

A
  • Support placed under leg and knee and leg placed in true AP position.
  • IR placed on edge against medial aspect of femur to include knee joint.
  • Horizontal xray beam directed from lateral side.
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21
Q

Lateral projections of Femur. Mid and distal. Central Ray:

A

Perpendicular to femur and IR.
To midpoint of IR
MInimum 40” SID.

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22
Q

Lateral projections of Femur. Mid and distal. Collimation:

A

On both sides to femur with end collimation to IR borders.

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23
Q

Lateral projections of Femur. Mid and distal. Evaluation Criteria:

A

Distal 2/3rds of distal femur including knee joint.
Because of divergent X-ray beam knee joint will not appear open and distal margins of femoral condyles are not superimposed.

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24
Q

Lateral projections of Femur. Mid and distal. Evaluation Criteria: Position:

A

True lateral:

  • Anterior and posterior margins of condyles superimposed.
  • Femur centered to collimated field.
  • Open patellofemoral joint space.
  • Knee joint space on distal IR margin and a minimum of 1” from distal IR margin
  • Collimation to area of interest.
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25
Q

Lateral projections of Femur. Mid and distal. Exposure:

A
  • Correct use of anode heel effect results in near uniform density of femur.
  • Use of compensating filter results in near uniform density (brightness)
  • No motion: Clear sharp bony trabecular markings.
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26
Q

Mediolateral projection of Femur. Mid and PROXIMAL.

A

Do not attempt this position for patients with possible fracture of the hip or proximal femur.
Trauma projection: Trauma lateral hip.

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27
Q

Mediolateral projection of Femur. Mid and PROXIMAL. Clinical Indications:

A

Mid and proximal femur for evaluation of fractures and bone lesions.

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28
Q

Mediolateral projection of Femur. Mid and PROXIMAL. Minimum SID:

A

40” (102cm)

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29
Q

Mediolateral projection of Femur. Mid and PROXIMAL.

IR size:

A

14x17” (35x43cm) lengthwise.

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30
Q

Mediolateral projection of Femur. Mid and PROXIMAL.

Grid?

A

Yes

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31
Q

Mediolateral projection of Femur. Mid and PROXIMAL.

kV range:

A

Analog: 75 +/- kV
Digital: 80 - 85 kV

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32
Q

Mediolateral projection of Femur. Mid and PROXIMAL. Patient position:

A

Lateral recumbent affected side down.

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33
Q

Mediolateral projection of Femur. Mid and PROXIMAL.

Part position:

A
  • Knee flexed about 45 degrees and femur aligned to midline of table.
  • Unaffected leg is extended and supported behind affected knee.
  • Patient rolls back posteriorly 15 degrees to prevent superimposition of proximal femur.
  • Upper margin of IR placed at level of ASIS.
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34
Q

Mediolateral projection of Femur. Mid and PROXIMAL.

Central Ray:

A

Perpendicular to femur and IR, directed to midpoint of IR.

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35
Q

Mediolateral projection of Femur. Mid and PROXIMAL. Recommended collimation:

A

Closely on all four sides.

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36
Q

Mediolateral projection of Femur. Mid and PROXIMAL. Evaluation Criteria:

A

Proximal one-half to two-thirds of proximal femur including hip joint.
Proximal femur is not superimposed by opposite limb.

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37
Q

Mediolateral projection of Femur. Mid and PROXIMAL. Position:

A

True lateral:
Superimposition of greater and lesser trochanters.
Small part of lesser trochanter seen on medial side.
Most of greater trochanter superimposed by femoral neck.
Femur centered to collimated field.
Hip joint included and a minimum of 1” from proximal margin of IR
Collimated to area of interest.

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38
Q

AP Pelvis. Clinical Indications:

A

Fractures, joint dislocation, degenerative disease and bone lesions.

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39
Q

AP Pelvis. Minimum SID:

A

40” (102cm)

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40
Q

AP Pelvis. IR size:

A

14x17” (35x43cm) crosswise.

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41
Q

AP Pelvis. Grid?

A

Yes

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42
Q

AP Pelvis. kV range:

A

Analog: 80 +/- 5 kV
Digital:

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43
Q

AP Pelvis. Pt position:

A

Supine with arms at sides or across superior chest.

May be performed erect.

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44
Q

AP Pelvis. Part position:

A
  • MSP of pt aligned to centerline of IR and CR.
  • Pelvis not rotated - ASIS equidistant.
  • Separate legs and internally rotate long axis of feet and lower limbs 15-20 degrees (if no fracture is suspected.)
  • Sandbags/tape.
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45
Q

AP Pelvis. Central Ray:

A
  • Perpendicular to IR.
  • Enters midway between level of ASIS and pubic symphysis.
  • IR centered to CR
  • NOTE* IF performed as part of hip routine, centering is about 2 inches lower to level of mid femoral heads or necks to include more of the proximal femora.
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46
Q

AP Pelvis. REcommended Collimation:

A

On all four sides to the anatomy of interest.

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47
Q

AP Pelvis. Respiration:

A

Suspended during exposure.

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48
Q

AP Pelvis. Evaluation Criteria:

A

Pelvic girdle.
L5, sacrum & coccyx
Femoral heads, necks and greater trochanter.

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49
Q

AP Pelvis. Position:

A

Lesser trochanters not visible or just tips visible.

Greater trochanters equal in size and shape.

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50
Q

AP Pelvis. Signs of no rotation include:

A
  • Symmetric wings, ischial spines and obturator foramen.
  • Foreshortened or closed obturator foramen indicates rotation in that direction.
  • Entire pelvis and superior femora without foreshortening and in collimated field.
  • Collimation to area of interest.
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51
Q

AP Pelvis. Exposure:

A

Optimal exposure visualizes L5, sacrum, femoral heads, acetabula without overexposing ischium and pubic bones.

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52
Q

AP Bilateral “Frog-leg” (Modified Cleaves method).

A

This position is not attempted on patients with destructive hip disease, or with potential hip fracture.

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53
Q

AP Bilateral “Frog-leg” (Modified Cleaves method). Clinical Indications:

A

Non trauma hip or development dysplasia of hip (DDH) also known as congenital hip dislocation (CHD).

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54
Q

AP Bilateral “Frog-leg” (Modified Cleaves method). Minimum SID:

A

40” (102cm)

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55
Q

AP Bilateral “Frog-leg” (Modified Cleaves method). IR size:

A

14x17” (35x43cm) crosswise

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56
Q

AP Bilateral “Frog-leg” (Modified Cleaves method). Grid?

A

yes

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57
Q

AP Bilateral “Frog-leg” (Modified Cleaves method). kV range:

A

Analog: 80 ± 5 kV

Grid systems 80-85 kV range

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58
Q

AP Bilateral “Frog-leg” (Modified Cleaves method). Pt position:

A

Supine with arms across chest.

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59
Q

AP Bilateral “Frog-leg” (Modified Cleaves method). Part position:

A
  • Patient aligned to midline of table and/or IR and CR.
  • Equal distance of ASIS - no rotation
  • IR centered to CR at level of femoral necks.
  • Top of IR approximately at level of crests
  • Knees flexed about 90º.
  • Both femora abducted 40º to 45º from vertical.
  • Ensure both femora are abducted equal amount with no rotation of pelvis
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60
Q

AP Bilateral “Frog-leg” (Modified Cleaves method). Note concerning less abduction of femora:

A

20º to 30º from vertical provides for least foreshortening of femoral necks, however, this foreshortens the entire proximal femora.

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61
Q

AP Bilateral “Frog-leg” (Modified Cleaves method). Central Ray:

A

Perpendicular to IR to a point 3 inches below level of ASIS (1” superior to pubic symphysis.)

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62
Q

AP Bilateral “Frog-leg” (Modified Cleaves method). Recommended collimation:

A

To IR borders on 4 sides.

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63
Q

AP Bilateral “Frog-leg” (Modified Cleaves method). Respiration:

A

Suspend during exposure.

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64
Q

AP Bilateral “Frog-leg” (Modified Cleaves method). Evaluation Criteria:

A

Femoral heads, necks, acetabulum and trochanteric area.

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65
Q

AP Bilateral “Frog-leg” (Modified Cleaves method). Position:

A

No rotation:

 - Symmetric pelvic bones, wings, obrurator foramina and ischial spines if present.
 - Heads, neck and greater and lesser trochanters symmetric.
 - Lesser trochanters projected beyond medial margin of femora.
 - Greater trochanters superimposed over femoral necks which appear foreshortened.
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66
Q

AP Bilateral “Frog-leg” (Modified Cleaves method). Exposure:

A

Margin of femoral head and acetabulum through pelvis structures. Proximal femora not overexposed.

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67
Q

AP Axial “Outlet” projection or Taylor Method. Pathology demonstrated:

A

Bilateral pubes and ischia.

Assess pelvic trauma for fractures and displacement.

68
Q

AP Axial “Outlet” projection or Taylor Method.

Minimum SID:

A

40” (102cm)

69
Q

AP Axial “Outlet” projection or Taylor Method.

IR size:

A

14x17” (35x43cm) crosswise

70
Q

AP Axial “Outlet” projection or Taylor Method.

Grid?

A

yes

71
Q

AP Axial “Outlet” projection or Taylor Method.

kV range:

A

Analog: 80 ± 5 kV

Grid systems 80-85 kV

72
Q

AP Axial “Outlet” projection or Taylor Method. Shielding:

A

Place gonadal shielding with great care so as not to obscure essential anatomy.

73
Q

AP Axial “Outlet” projection or Taylor Method. Pt Position:

A

Supine with legs extended.

74
Q

AP Axial “Outlet” projection or Taylor Method. Part postion:

A

MSP aligned to CR and midline of table/IR
Ensure no rotation (ASIS equidistance from table top)
Center IR to projected CR.

75
Q

AP Axial “Outlet” projection or Taylor Method. Central Ray:

A

Cephalad 20º to 35º for males and 30º to 45º for females.

Directed to a midline point 1 to 2 inches to superior border of pubic symphysis for greater trochanters.

76
Q

AP Axial “Outlet” projection or Taylor Method. Recommended collimation:

A

on 4 sides to anatomy of interest

77
Q

AP Axial “Outlet” projection or Taylor Method. Respiration:

A

Suspended during exposure.

78
Q

AP Axial “Outlet” projection or Taylor Method. Evaluation criteria:

A

Superior and inferior rami of pubes.
Body and ramus of ischium.
Minimal foreshortening or superimposition.

79
Q

AP Axial “Outlet” projection or Taylor Method. Signs of no rotation and Correct CR angle:

A
  • Obturator foramina and ischia are equal in size and shape.
  • Anterior/inferior pelvic bones with minimal foreshortening.
  • Midpoint of symphysis joint in center of collimated field.
  • Collimate to area of interest.
80
Q

AP Axial “Outlet” projection or Taylor Method. Exposure:

A

Body and superior rami of pubis well demonstrated without overexposure of ischial rami.

81
Q

AP Axial “Inlet” projection. Pelvis. Clinical Indications:

A

Assessment of pelvic trauma for evaluation of pelvic ring for posterior displacement or inward or outward rotation of the anterior pelvis.

82
Q

AP Axial “Inlet” projection. Pelvis. Minimum SID:

A

40” (102cm)

83
Q

AP Axial “Inlet” projection. Pelvis. IR size:

A

14x17” (35x43cm) crosswise

84
Q

AP Axial “Inlet” projection. Pelvis. Grid?

A

yes

85
Q

AP Axial “Inlet” projection. Pelvis. kV range:

A

Analog: 80 ± 5 kV

Grid systems: 80-85 kV

86
Q

AP Axial “Inlet” projection. Pelvis. Pt position:

A

Supine with legs extended.

87
Q

AP Axial “Inlet” projection. Pelvis. Part position:

A

MSP aligned to CR and table and/or IR.
No rotation: ASIS equidistant
Center cassette to projected CR

88
Q

AP Axial “Inlet” projection. Pelvis. Central Ray:

A

40º caudad (near perpendicular to plane of inlet) directed to a midline point at level of ASIS.

89
Q

AP Axial “Inlet” projection. Pelvis. Recommended collimation:

A

All four sides

90
Q

AP Axial “Inlet” projection. Pelvis. Respiration:

A

Suspended during exposure.

91
Q

AP Axial “Inlet” projection. Pelvis. Evaluation Criteria:

A

Pelvic inlet (superior aperture) in its entirety.

92
Q

AP Axial “Inlet” projection. Pelvis. Signs of no rotation:

A
  • Ischial spines demonstrated and equal in size and shape.
  • Superimposed anterior and posterior portions of pelvic ring indicates proper centering and angulation.
  • Collimation should include femoral heads and acetabula; superior to inferior: ala to pubic symphysis.
  • Center of inlet at center of collimated field.
93
Q

AP Axial “Inlet” projection. Pelvis. Exposure:

A
  • Optimal exposure demonstrates superimposed anterior and posterior portions of the pelvic ring.
  • Lateral aspects of ala generally are overexposed.
94
Q

Posterior Oblique Position - Acetabulum: Judet Method. Clinical Indications:

A
  • Acetabular fracture or hip dislocation.
  • Routine usually calls for both sides to be taken for comparison. May be performed on a 14x17” IR to include both sides.
95
Q

Posterior Oblique Position - Acetabulum: Judet Method. Minimum SID:

A

40” (102cm)

96
Q

Posterior Oblique Position - Acetabulum: Judet Method.

IR size:

A

10x12” (24x30cm) lengthwise for unilateral hip.

14x17” (35x43cm) crosswise if both hips must be seen on each projection.

97
Q

Posterior Oblique Position - Acetabulum: Judet Method. Grid?

A

yes

98
Q

Posterior Oblique Position - Acetabulum: Judet Method.

kV range:

A

Analog: 80 ± 5 kV

Grid systems 80- 85 kV

99
Q

Posterior Oblique Position - Acetabulum: Judet Method.

Pt position:

A

Depending on anatomy to be demonstrated, pt will be positioned for affected side up or affected side down.

100
Q

Posterior Oblique Position - Acetabulum: Judet Method. What anatomy is demonstrated when pt is positioned affected side down?

A

Ilioischial column.

101
Q

Posterior Oblique Position - Acetabulum: Judet Method. What anatomy is demonstrated when pt is positioned affected side up?

A

Iliopubic column (anterior)

102
Q

Posterior Oblique Position - Acetabulum: Judet Method. Part position:

A

Pt placed in posterior oblique position - thorax and pelvis oblique 45º
Femoral head and acetabulum of interest aligned to midline of IR.
Center IR to femoral head.

103
Q

Posterior Oblique Position - Acetabulum: Judet Method. Central Ray:

A

Downside: Perpendicular and centered to 2 inches distal and 2 inches medial to downside ASIS.

104
Q

Posterior Oblique Position - Acetabulum: Judet Method.

Recommended Collimation:

A

Four sides to anatomy of interest.

105
Q

Posterior Oblique Position - Acetabulum: Judet Method.

Respiration:

A

Suspended during exposure.

106
Q

Posterior Oblique Position - Acetabulum: Judet Method.

Evaluation Criteria:

A
  • Downside:* Anterior rim of acetabulum and posterior (ilioischial) column. Iliac wing is well visualized.
  • Upside:* Posterior rim of acetabulum and the iliopubic column. Obturator foramen.
107
Q

Posterior Oblique Position - Acetabulum: Judet Method. Position: Signs of proper obliquity:

A

Open and uniform hip joint.
Obturator foramen closed for downside and open for upside.
Acetabulum centered to IR and collimation field (for 10x12”)
Collimation to area of interest.

108
Q

PA Axial Oblique Projection- Acetabulum: Teufel Method:

Clinical Indications:

A
  • Acetabular fractures especially the superior posterior wall of the acetabulum.
  • PA oblique projections centered to the downside.
  • Fovea capitis is demonstrated, along with the super posterior wall of the acetabulum.
109
Q

PA Axial Oblique Projection- Acetabulum: Teufel Method:

Minimum SID:

A

40” (102cm)

110
Q

PA Axial Oblique Projection- Acetabulum: Teufel Method:

IR size:

A

10x12” (24x30cm) lengthwise

111
Q

PA Axial Oblique Projection- Acetabulum: Teufel Method:

Grid?

A

yes

112
Q

PA Axial Oblique Projection- Acetabulum: Teufel Method:

kV range:

A

Analog: 70-80 kV

Grid systems 80-85 kV

113
Q

PA Axial Oblique Projection- Acetabulum: Teufel Method:

Pt position:

A

Semiprone on the affected side.

114
Q

PA Axial Oblique Projection- Acetabulum: Teufel Method:

Part position:

A
  • Anterior surface of the body (pelvis and thorax) forms a 35º-40º angle from the tabletop.
  • Femoral head and acetabulum aligned to midline of IR.
  • Center cassette longitudinally to CR at level of femoral neck.
115
Q

PA Axial Oblique Projection- Acetabulum: Teufel Method:

Central Ray:

A
  • Directed at a point 1 inch superior to level of greater trochanter, and approximately 2” lateral to the MSP.
  • Angle CR 12º cephalad.
116
Q

PA Axial Oblique Projection- Acetabulum: Teufel Method:

Recommended collimation:

A

4 sides to anatomy of interest.

117
Q

PA Axial Oblique Projection- Acetabulum: Teufel Method:

Respiration:

A

Suspend for exposure.

118
Q

PA Axial Oblique Projection- Acetabulum: Teufel Method:

Evaluation Criteria: Anatomy demonstrated:

A

Anatomy demonstrated: Superoposterior wall of acetabulum.

119
Q

PA Axial Oblique Projection- Acetabulum: Teufel Method:

Evaluation Criteria: Position:

A
  • Visualization of fovea capitis indicates correct degree of obliquity.
  • Obturator foramen open with correct obliquity.
  • Acetabulum centered to IR and collimated field.
  • Collimation to area of interest
120
Q

AP Unilateral Hip Projection: Hip and Proximal Femur.

Clinical Indications:

A
  • Postoperative or follow up exam.
  • Demonstrates acetabulum, femoral head, neck, and greater trochanter.
  • Demonstrates condition and placement of any existing appliance.
121
Q

AP Unilateral Hip Projection: Hip and Proximal Femur.

Minimum SID:

A

40” (102cm)

122
Q

AP Unilateral Hip Projection: Hip and Proximal Femur.

IR size:

A

10x12” (24x30cm) lengthwise.

123
Q

AP Unilateral Hip Projection: Hip and Proximal Femur.

Grid?

A

yes

124
Q

AP Unilateral Hip Projection: Hip and Proximal Femur.

kV range:

A

Analog: 80 ± 5 kV
Digital: 80 - 85 kV

125
Q

AP Unilateral Hip Projection: Hip and Proximal Femur.

Pt Postion:

A

Pt is supine with arms at side or access superior chest.

126
Q

AP Unilateral Hip Projection: Hip and Proximal Femur.

Part position:

A

Locate femoral neck and align to CR and midline of IR.
Equal ASIS distance from table.
Rotate affected leg internally 15º to 20º

127
Q

AP Unilateral Hip Projection: Hip and Proximal Femur.

Central Ray:

A

Perpendicular to IR and directed 1-2 inches distal to midfemoral neck.
Include all appliances.
REcall femoral nect is 1-2 inches medial and 3-4 inches distal to ASIS.

128
Q

AP Unilateral Hip Projection: Hip and Proximal Femur.

Evaluation Criteria: Anatomy demonstrated:

A

Proximal third of femur
Acetabulum
Adjacent pubis, ischium and ilium
Orthopedic appliance should be visible in its entirety.

129
Q

AP Unilateral Hip Projection: Hip and Proximal Femur.

Position:

A
  • Greater trochanter & femoral head & neck in full profile without foreshortening.
  • Lesser trochanter should not project beyond medial border of femur; tip may be seen on some patients.
  • Collimated field demonstrates entire hip joint and any orthopedic appliance in its entirety.
  • Collimation to area of interest.
130
Q

AP Unilateral Hip Projection: Hip and Proximal Femur.

Exposure:

A

Margins of femoral head and acetabulum visualized through pelvic strictures without overexposing proximal femur or pelvic structures.

131
Q

Axiolateral Inferosuperior Projection: Hip & Porximal Femur – Trauma: Danelius Miller Method.
DO NOT:

A

internally rotate leg for initial trauma exam.
Common projection for trauma, surgery and post surgery pt’s and for other pts who can’t move or rotate affected leg for frog lateral.

132
Q

Holy shit…just shoot me now.

A

Can we be done already?!?

133
Q

Axiolateral Inferosuperior Projection: Hip & Porximal Femur – Trauma: Danelius Miller Method.
Clinical Indications:

A

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

134
Q

Axiolateral Inferosuperior Projection: Hip & Porximal Femur – Trauma: Danelius Miller Method.
Minimum SID:

A

40” (102cm)

135
Q

Axiolateral Inferosuperior Projection: Hip & Porximal Femur – Trauma: Danelius Miller Method.
IR size:

A

10x12” (24x30cm) crosswise.

136
Q

Axiolateral Inferosuperior Projection: Hip & Porximal Femur – Trauma: Danelius Miller Method.
Grid?

A

Yes

137
Q

Axiolateral Inferosuperior Projection: Hip & Porximal Femur – Trauma: Danelius Miller Method.
kV range:

A

Analog: 80 ± 5 kV
Digital: 80-85 kV

138
Q

Axiolateral Inferosuperior Projection: Hip & Porximal Femur – Trauma: Danelius Miller Method.
Pt position:

A

Supine.

If pt is very thin or lying on a soft bed the pelvis may need to be elevated to place the hip in the center of the IR.

139
Q

Axiolateral Inferosuperior Projection: Hip & Porximal Femur – Trauma: Danelius Miller Method.
Part position:

A
  • Unaffected leg is flexed and elevated so thigh is near vertical and outside collimated field .
  • Support leg in this position.
  • Equal ASIS table distance.
  • IR is place in crease above iliac crest and adjusted so that it is parallel to the femoral neck and perpendicular to the CR.
  • Unless contraindicated, internally rotate affected leg 15º-20º
140
Q

Axiolateral Inferosuperior Projection: Hip & Porximal Femur – Trauma: Danelius Miller Method.
Central Ray:

A

Perpendicular to femoral neck.

141
Q

Axiolateral Inferosuperior Projection: Hip & Porximal Femur – Trauma: Danelius Miller Method.
Evaluation Criteria: Anatomy Demonstrated.

A

Entire femoral head, neck, trochanter and acetabulum.

142
Q

Axiolateral Inferosuperior Projection: Hip & Porximal Femur – Trauma: Danelius Miller Method.
Evaluation Criteria: Position:

A
  • Only a small portion of lesser trochanter is visualized with inversion of affected leg.
  • Only distal part of femoral neck should be superimposed by greater trochanter.
  • No soft tissue from unaffected leg.
  • No grid lines- be careful not to tip IR backwards.
143
Q

Axiolateral Inferosuperior Projection: Hip & Porximal Femur – Trauma: Danelius Miller Method.
Exposure:

A

Entire femoral head and acetabulum is visualized without overexposing neck and proximal femoral shaft.

144
Q

Unilateral “Frog-leg” projection - Mediolateral: Hip and Proximal Femur- Nontrauma. Modified Cleaves Method.
Clinical Indications:

A

Lateral view to assess hip joint and proximal femur for non trauma hip situations.

145
Q

Unilateral “Frog-leg” projection - Mediolateral: Hip and Proximal Femur- Nontrauma. Modified Cleaves Method.
Minimum SID

A

40” (102cm)

146
Q

Unilateral “Frog-leg” projection - Mediolateral: Hip and Proximal Femur- Nontrauma. Modified Cleaves Method.
IR size:

A

10x12” (24x30cm) crosswise.

147
Q

Unilateral “Frog-leg” projection - Mediolateral: Hip and Proximal Femur- Nontrauma. Modified Cleaves Method.
Grid?

A

Yes

148
Q

Unilateral “Frog-leg” projection - Mediolateral: Hip and Proximal Femur- Nontrauma. Modified Cleaves Method.
kV range:

A

Analog: 80 ± 5 kV
Digtal: 80-85 kV

149
Q

Unilateral “Frog-leg” projection - Mediolateral: Hip and Proximal Femur- Nontrauma. Modified Cleaves Method.
Pt position:

A

Supine with affected hip area aligned to IR

150
Q

Unilateral “Frog-leg” projection - Mediolateral: Hip and Proximal Femur- Nontrauma. Modified Cleaves Method.
Part position:

A

Knee and hip of affected hip is flexed with sole of foot against inside of opposite leg, near knee if possible.
Abduct femur 45º from vertical for general proximal femur region.

151
Q

Unilateral “Frog-leg” projection - Mediolateral: Hip and Proximal Femur- Nontrauma. Modified Cleaves Method.
Modification: Lauenstein/Hickey method:

A

Pt is rotated onto affected side until femur is in contact and parallel to IR.
Foreshortens the next region but may demonstrate the head and acetabulum.

152
Q

Unilateral “Frog-leg” projection - Mediolateral: Hip and Proximal Femur- Nontrauma. Modified Cleaves Method.
Central Ray:

A

Perpendicular to IR, directed to midfemoral neck.

153
Q

Unilateral “Frog-leg” projection - Mediolateral: Hip and Proximal Femur- Nontrauma. Modified Cleaves Method.
Evaluation Criteria: Anatomy Demonstrated:

A

Lateral views of acetabulum and femoral head, neck, trochantic area and proximal one-third of femur.

154
Q

Unilateral “Frog-leg” projection - Mediolateral: Hip and Proximal Femur- Nontrauma. Modified Cleaves Method.
Evaluation Criteria: Position:

A

Proper abduction demonstrated by femoral neck in profile, superimposed by greater trochanter.

Femoral neck at center of collimated field indicates correct centering.

155
Q

Unilateral “Frog-leg” projection - Mediolateral: Hip and Proximal Femur- Nontrauma. Modified Cleaves Method.
Evaluation Criteria: Exposure:

A

Margins of femoral head and neck visualized through overlying pelvic structures without overexposure of proximal femur indicates optimal exposure.

156
Q

Modified Axiolateral -Possible trauma projection: Hip and Proximal Femur: Clements-Nakayama Method.
Clinical Indications:

A

Lateral oblique useful for assessment of possible hip fracture or with arthroplasty when pt has limited movement in both lower limbs & the inferosuperior projection cannot be performed.

157
Q

Modified Axiolateral -Possible trauma projection: Hip and Proximal Femur: Clements-Nakayama Method.
Minimum SID:

A

40” (102cm)

158
Q

Modified Axiolateral -Possible trauma projection: Hip and Proximal Femur: Clements-Nakayama Method.
IR size

A

10x12” (24x30cm) crosswise.

159
Q

Modified Axiolateral -Possible trauma projection: Hip and Proximal Femur: Clements-Nakayama Method.
Grid?

A

Yes. (IR on edge with 15º tilt; grid lines lengthwise)

160
Q

Modified Axiolateral -Possible trauma projection: Hip and Proximal Femur: Clements-Nakayama Method.
kV range:

A

Analog: 80 ± 5 kV

Digital 80- 85 kV

161
Q

Modified Axiolateral -Possible trauma projection: Hip and Proximal Femur: Clements-Nakayama Method.
Pt position:

A

Pt supine affected side near edge of table with both legs fully extended.
Arms across upper chest.

162
Q

Modified Axiolateral -Possible trauma projection: Hip and Proximal Femur: Clements-Nakayama Method.
Part position:

A
  • Leg is in anatomic position (15º posterior CR angle compensates.)
  • IR rests on extended Bucky tray which places bottom of IR 2 inches below level of tabletop.
  • IR tilted 15 º from vertical and face of IR perpendicular to CR
  • Center centerline of IR to projected CR.
163
Q

Modified Axiolateral -Possible trauma projection: Hip and Proximal Femur: Clements-Nakayama Method.
Central Ray:

A

Angled mediolaterally as needed so that it is perpendicular to and centered to femoral neck. IT should be angled 15º to 20º from horizontal.

164
Q

Modified Axiolateral -Possible trauma projection: Hip and Proximal Femur: Clements-Nakayama Method.
Evaluation Criteria: Anatomy demonstrated:

A

Lateral oblique view of acetabulum, femoral head and neck and trochanteric area.

165
Q

Modified Axiolateral -Possible trauma projection: Hip and Proximal Femur: Clements-Nakayama Method.
Evaluation Criteria: Position:

A
  • Femoral head and neck seen in profile with only minimal superimposition by greater trochanter.
  • Lesser trochanter seen projected posterior to femoral shaft.
  • Femoral neck and trochanters centered to mid-image area.
166
Q

Modified Axiolateral -Possible trauma projection: Hip and Proximal Femur: Clements-Nakayama Method.
Evaluation Criteria: Exposure:

A

Femoral head and neck without overexposing proximal femoral shaft.
No excessive grid lines.

Radiographic Positioning (23 decks)

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