Pelvic Girdle Flashcards
Ap pelvis projection (bilateral hips)
Px position
Part position
Cr
Ss
Px supine arms across superior chest pillow for head and support for under knees, maybe performed erect with correction of lower limbs to rotate proximal femora into anatomical position and no fx is suspected
Align midsagittal plane of px to centerline of table and cr, ensure pelvis is not rotated distance from tabletop to each asis should be equal, separate legs and feet then internally rotate long axes of feet and limbs 15-20*
Perpendicular to IR directed midway between level of ASIS and symphsis pubis apporximately 2in (5cm) inferior to level of ASIS
Pelvic girdle, l5, sacrum and coccyx, femoral head and neck and greater trochanters are visible
Modified cleaves method ap biliateral frog-leg projection pelvis
Px position
Part position
Cr
Ss
Px supine provide pillow for head and place arms across chest
Align px to midline of table and/or IR and to CR, ensure pelvis is not rotated (equal distance of ASIS on tabletop), center ir to cr at level of femoral heads with top of ir approximately at level of iliac crest, flex both knees 90, place plantar feet together and abduct both femora 40-45 from vertical. Ensure both femora are abducted the same ammount and pelvis not rotated
Perpendicular to IR, directed to a pojnt 3 in (7.5cm) below level of ASIS 1in (2.5cm) above symphysis pubis
Femoral heads and neck acetabulum and trochanteric areas are visible
Ap axial outlet projection (for anterior-inferior pelvic bones) taylor method
Px position
Part position
Cr
Ss
Px supine provide pillow for head and extend legs place support under knees for comfort
Align midsagittal plane to CR and to midline of table and/or IR, ensure no rotation of pelvis (ASIS to tabletop distance equal on both sides), center ir projected to CR.
Angle cr cephalad 20-35* for male and 30-45* female, direct to CR to a midline point 1-2 inches (3-5cm) distal to superior border of symphysis pubis or greater trochanters.
Superior and inferior rami of pubis and body and ramus of ischium are demonstrated well with minimal forshadowing or superimpositioning
Ap axial inlet projection pelvis
Px position
Part position
Cr
Ss
Px supine provide pillow for head extend legs and provide support under the knees for comfort
Align midsagittal plane to cr and midline of table and/or ir, ensure no rotation of pelvis (asis to tabletop distance equal on both sides), center ir to projected cr
Angle cr caudad 40* (near perpendicular to plane inlet) direct cr to midline point at level of asis
Axial projection demonstrate pelvic ring or inlet (superior aperture) in its entirety
Posterior oblique pelvis-acetabulum judet method
Px position
Part position
Cr (downside & upside)
Ss (downside & upside)
Px semisupine, provide pillow for head and position for affected side U and D depending on anatomy to demonstrate.
Place px in 45* posterior oblique both pelvis and thorax 45* from tabletop support with wedge sponge, align femoral head and acetabulum of interest to midline of tabletop and/or ir, centered longitudinally to cr at level of femoral head
DOWNSIDE: cr perpendicular and centered 2in (5cm) to distal and 2in (5cm) medial to downside ASIS
UPSIDE: directed perpendicular and centered 2in (5cm) directly distal to upside ASIS
DOWNSIDE: anterior rim of acetabulum and posterior ilioischial column are demonstrated. Iliac wing is also visualized.
UPSIDE: posterior rim of acetabulum and anterior (iliopubic) column are demonstrated. Obturator foramen is also visualized.
Pa axial oblique projection-acetabulum teufel method
Px position
Part position
Cr
Ss
Px in semiprone provide pillow for the head and position for affected side down
Place px in 35-40* anterior oblique with both pelvis and thorax 35-40* from the tabletop, support with wedge sponge, align femoral head and acetabulum to of interest to midline of tabletop and/or ir, center ir longitudinally to CR level of femoral head
Anatomy of interest is downside, cr perpendicular & centered 1in (2.5cm) superior to level of greater trochanter approx 2in (5cm) lateral to midsagittal plane, angle cr 12* cephalad
Centered to downside acetabulum the superoposterior wall of acetabulum is demonstrated
Ap unilateral hip projection: hip and proximal femur
Px position
Part position
Cr
Ss
Px supine, arms in side/across superior chest
Locate femoral neck and align to cr and midline of table and/or ir, ensure no rotation of pelvis (equal distance from table and asis), rotate affected leg internally 15-20* (see warning earlier)
Perepndicular to ir directed 1-2in (2.5-5cm) distal to midfemoral neck to include all orthopedic appliance of hip if present) femoral neck can be located 1-2in (1-3cm) medial and 3-4in (8-10cm) distal from ASIS
Proximal 1/3 of femur should be visualized, along with acetabulum and adjacent parts of pubis, ilium, ischium, any existing orthopedic appliances should be visible in its entirety
Axiolateral inferosuperior projection: hip and proximal femur-trauma (danelius-miller method)
Px position
Part position
Cr
Ss
Px in supine provide pillow for head
Flex and elevate unaffected leg so thigh is near vertical position and outside of collimation field. Support in this position, ensure no rotation of pelvis (equal asis table distance), place ir above iliac crest and adjust parallel to femoral neck and perpendicular cr, use cassette holder/sanbag to hold cassette in place, internally rotate leg 15-20* unless contraindicated by possible fx or other pathologic process
CR Perpendicular to femoral neck and IR
Entire femoral head and neck, trochanter and acetabulum should be visualized.
Unilateral frog-leg projection mediolateral hip and proximal femir (modified cleaves method)
Px position
Part position
Cr
Ss
Px in supine provide pillow for head
Flex knee and hip on affected side with sole of foot against inside of leg if possible near the knee, abduct femur 45* from vertical for general proximal femur region center affected side of femoral neck to cr and midline of ir and tabletop, femoral neck 3-4in (7-10cm) distal to asis
Perpendicular to ir directed to midfemoral neck
Lateral view of acetabulum and femoral head and neck, trochanteric area and proximal 1/3 of femur are visible
Modified axiolateral-possible trauma projection: hip and proximal femur clements-nakayama method
Px position
Part position
Cr
Ss
Px in supine, position affected side near at edge of table with both legs fully extended provide pillow for support and arms across superior chest
Maintain leg in neutral position (15* posterior cr angle compensates for internal leg rotation) rest ir on extended bucky tray place bottom of ir 2in (5cm) below level of tabletop, tilt ir 15* from vertical and adjust alignment of ir to ensure that face of ir is perpendicular to cr to prevent grid cutoff, Center centerline of ir to project cr
Angle cr mediolaterally as needed as it is perpendicular to and centered to femoral neck. Angled posteriorly 15-20* from horizontal
Lat obq views of acetabulum, femoral head and neck and trochanteric areas are visible
