Radiographic Positioning Of Pelvis, SIJ, Hip, Femur and Knee PDF

Radiographic Positioning Of Pelvis ,SIJ, Hip, Femur and Knee Dr. Eman Ragab,MD  Pelvis - AP Position of Patient and Image Receptor The patient lies supine with their median sagittal plane perpendicular to the tabletop. To avoid pelvic rotation, the anterior sup...

Radiographic Positioning Of Pelvis ,SIJ, Hip, Femur and Knee Dr. Eman Ragab,MD  Pelvis - AP Position of Patient and Image Receptor The patient lies supine with their median sagittal plane perpendicular to the tabletop. To avoid pelvic rotation, the anterior superior iliac spines must be equidistant from the tabletop. The limbs are slightly abducted and internally rotated to bring the femoral necks parallel to the image receptor.  Direction and Centring of X-ray Beam In the midline. The vertical central ray is centred to a point midway between the upper border of the symphysis pubis and anterior superior iliac spine. The upper edge of the image receptor should be 5 cm above the upper border of the iliac crest Essential Image Characteristics Iliac crests and proximal femora, including the lesser trochanters, should be visible on the image. No rotation.  Sacro-iliac joints - PA Position of Patient and Image Receptor The patient lies prone, with their median sagittal plane perpendicular to the tabletop. The posterior superior iliac spines should be equidistant from the tabletop to avoid rotation. The midline of the patient should coincide with the centred primary beam and the table Bucky mechanism. The forearms are raised and placed on the pillow. Direction and Centring of X-ray Beam In the midline at the level of the posterior superior iliac spines. 5–15 degrees caudal angulation ( 25 degrees in females)& Collimation.  Hip – AP Position of Patient and Image Receptor As AP of the pelvis. Direction and Centring of X-ray Beam The vertical central ray is directed 2.5 cm distally along the perpendicular bisector of a line joining the anterior superior iliac spine and the symphysis pubis over the femoral pulse. Collimation. Hip – lateral  Hip – frog leg Position of Patient and Image Receptor The patient lies supine on the X-ray table, with the anterior superior iliac spines equidistant from the tabletop to avoid rotation of the pelvis. The median sagittal plane is perpendicular to the table and coincident with the centre of the table Bucky mechanism. The hips and knees are flexed and the limbs rotated laterally through approximately 60 degrees. This movement separates the knees and brings the plantar aspect of the feet in contact with each other. Direction and Centring of X-ray Beam The vertical central ray is centred midline at the level of the femoral pulse, with the central ray perpendicular to the image receptor.  Femur - AP Position of Patient and Image Receptor The patient lies supine on the X-ray table, with both legs extended. The affected limb is rotated to centralize the patella over the femur. Sandbags are placed below the knee to help maintain the position. The image receptor is positioned in the Bucky tray immediately under the limb, adjacent to the posterior aspect of the thigh to include both the hip and the knee joints. Alternatively, the image receptor is positioned directly under the limb, against the posterior aspect of the thigh to include the knee joint.  Direction and Centring of X-ray Beam Centre to the middle of the image receptor, with the vertical central ray at 90 degrees to an imaginary line joining both femoral condyles. Essential Image Characteristics The hip and knee joints should both be included on the image where possible.  Femur - lateral Position of Patient and Image Receptor From the AP position, the patient rotates onto the affected side, and the knee is slightly flexed. The pelvis is rotated backwards to separate the thighs. The position of the limb is then adjusted to vertically superimpose the femoral condyles. Pads are used to support the opposite limb behind the one being examined. The image receptor is positioned in the Bucky tray under the lateral aspect of the thigh to include the knee joint and as much of the femur as possible. Direction and Centring of X-ray Beam The vertical central ray is centred to the middle of the image receptor, with the vertical central ray parallel to the imaginary line joining the femoral condyles.