Pelvis and Upper Femora PDF

🥹PELVIS AND UPPER FEMORA🥹 PROJECTION POSITION OF THE FILM SIZE REFERENCE CENTRAL RAY STRUCTURE EVALUATION CRITERIA PATIENT AND POINT SHOWN...

🥹PELVIS AND UPPER FEMORA🥹 PROJECTION POSITION OF THE FILM SIZE REFERENCE CENTRAL RAY STRUCTURE EVALUATION CRITERIA PATIENT AND POINT SHOWN PATIENT AP PROJECTION POSITION OF THE 35 x 43 cm Midway between the Perpendicular to the Shows an AP - Entire pelvis along with the PATIENT: crosswise ASIS and the pubic midpoint of the IR. projection of the proximal femora symphysis. pelvis and of the - Lesser trochanters, if seen, Patient supine on top - The center of the IR head, neck, demonstrated on the medial of the table will be about 2 inches trochanters, and border of the femora (5 cm) inferior to the proximal one third or - Femoral necks in their full POSITION OF THE ASIS and 2 inches (5 one fourth of the shaft extent without PART: cm) superior to the of the femora. superimposition pubic symphysis in - Greater trochanters in profile Center the MSP of average-sized - Both ilia equidistant to the the body to the patients. edge of the radiograph midline of the table. - Both greater trochanters Unless equidistant to the edge of contra-indicated, the radiograph rotate the feet and - Lower vertebral column lower limb 15-20 centered to the middle of the degrees medially to radiograph place the femoral - Symmetric obturator foramina neck parallel with the - Ischial spines equally IR demonstrated - Symmetric ilia alae - Sacrum and coccyx aligned with the pubic symphysis LATERAL POSITION OF THE 35 x 43 cm At the level of Perpendicular to a Shows a lateral Entire pelvis and the proximal PROJECTION PATIENT: lengthwise the soft tissue point centered at the radiograph of the femora. RIGHT OR LEFT depression just level of lumbosacral junction, Sacrum and coccyx. POSITION -Patient in lateral above the greater the soft tissue sacrum, coccyx, and Superimposed posterior recumbent, dorsal trochanter depression just superimposed hip margins of the ischium and decubitus or upright (approximately 2 above the greater bones and upper ilium. position. inches (5 cm) and to trochanter femora. Superimposed femora. POSITION OF THE the (approximately 2 Superimposed acetabular PART: midpoint of the image inches (5 cm) and to shadow receptor. the The larger circle of the fossa -Patient in lateral with midpoint of the image (farther from the IR) will be the mid-coronal plane receptor. equidistant from the smaller centered to -Center the IR to the circle of the fossa nearer the IR midline of the grid, central ray throughout their circumference.  thigh extended, pelvis Pubic arch unobscured by the in lateral with femora the ASIS lying in the same vertical plane NOTE: CONGENITAL DISLOCATION OF THE HIP - Martz and Taylor recommended Two AP projections of the pelvis for demonstration of the relationship of the femoral head and the acetabulum in patient with congenital hip dislocation. 1st Central ray perpendicular to the symphysis pubis to detect any lateral or superior displacement of the femoral head. 2nd Central ray angulated 45 degrees cephalic to the symphysis pubis to cast the shadow of an anteriorly displaced femoral head above the acetabulum and posteriorly displaced femoral head below the acetabulum 🥹PELVIS AND HIP JOINTS🥹 PROJECTION POSITION OF THE FILM SIZE CENTRAL RAY STRUCTURE EVALUATION CRITERIA PATIENT AND REFERENCE SHOWN PATIENT POINT AXIAL PROJECTION POSITION OF THE 35 x 43 cm Lumbosacral region at Perpendicular Shows an axial Femoral head and acetabula CHASSARD-LAPINE PATIENT: crosswise the level through the projection of the Entire pelvis along with the METHOD of the greater lumbosacral region pelvis, demonstrating proximal femora - Patient seated on trochanter at the level the Symmetric hip bones side or end of of the greater relationship between Greater trochanters radiographic table trochanter. the femoral heads equidistant to the sacrum with the back of the and the acetabula, knees in contact with -When flexion of the the edge of the table the body is pelvic bones, and any restricted, Direct the opacified structure POSITION OF THE central ray anteriorly, within the pelvis PART: perpendicular to the -This method was coronal plane of the devised for the -If seated at the side pubic symphysis. purpose of measuring of the table, place the the horizontal, or longitudinal axis of bi-ischial, diameter in the IR perpendicular pelvimetry. to the MSP. -Some radiographers - If seated at the end use this method to of the table, center determine the MSP of the body to relationship of the the midline of the femoral head to the table. acetabulum, and -Abduct the thigh as others employ it to far as the table demonstrate the permits to prevent it opacified recto from limiting the sigmoid portion of the flexion of the body. colon. -Ask the patient to lean forward until the -Contraindicated for symphysis pubis patient with touched the table, suspected fractures grasping the ankle for and pathologic support condition 🥹 FEMORAL NECKS🥹 PROJECTION POSITION OF THE FILM SIZE REFERENCE CENTRAL RAY STRUCTURE EVALUATION CRITERIA PATIENT AND POINT SHOWN PATIENT AP OBLIQUE POSITION OF THE 35 x 43 cm at the level I inch -Perpendicular to Shows an AP oblique - No rotation of the pelvis, as PROJECTION PATIENT: crosswise (2.5 cm) superior to enter the patient's projection of the evidenced by a MODIFIED CLEAVES the pubic midsagittal plane femoral heads, symmetric appearance. METHOD -Patient in supine symphysis at the level I inch (2.5 necks, and - Acetabulum, femoral head, position cm) superior to the trochanteric areas and femoral neck. pubic symphysis projected onto one - Lesser trochanter on the POSITION OF THE radiograph for medial side of the femur. PART: -For the unilateral comparison - Femoral neck without position, flex the hip superimposition by the greater -Center the MSP of and knee of the trochanter. the body to the affected side and draw - Excess abduction causes the midline of the grid. the foot up to the greater trochanter to -Flex the patient hips opposite side, obstruct the neck. and knees, draw the abduct the thigh - Femoral axes extended from feet up and abduct approximately 45 the hip bone at equal the thigh as much as degrees and direct angles. possible. the central ray to the femoral neck AXIOLATERAL POSITION OF THE 35 x 43 cm femoral shafts Parallel with the Shows an axiolateral - Axiolateral projections of the  PROJECTION PATIENT: crosswise femoral shafts. projection of the femoral neck ORIGINAL CLEAVES -Patient in supine Accordjng to Cleaves, femoral heads, necks, - Femoral necks without METHOD position. the angle may vary and trochanteric overlap from the greater between 25 and 45 areas. trochanter POSITION OF THE degrees, depending - Small parts of the Iesser PART: on how vertical the trochanters on the femora can be placed posterior surfaces of the femur -Same part position - Small amount of the greater as the modified trochanters on both cleaves method the posterior and anterior - Before having the surfaces of the femur. -Contraindicated for patient abduct the patient with thigh, direct the tube suspected fracture or parallel to the long pathologic condition. axes of the femoral shafts. -Adjust the IR so the midpoint coincide with the central ray. 🥹 HIP 🥹 PROJECTION POSITION OF THE FILM SIZE REFERENCE CENTRAL RAY STRUCTURE EVALUATION CRITERIA PATIENT AND POINT SHOWN PATIENT AP PROJECTION POSITION OF THE 24 x 30 cm femoral neck -Perpendicular to the Shows the head, - Femoral head, penetrated and PATIENT: lengthwise femoral neck. neck, trochanters, seen through the -Using the localizing and proximal one acetabulum. - Patient in supine technique previously third of the body of - Regions of the ilium and pubic described, place the the femur. bones adjoining the POSITION OF THE central ray pubic symphysis. PART: approximately 2 - Any orthopedic appliance in its inches (6.4 cm) entirety. -Place the ASIS distal on a line draw - Hip joint. equidistant from the perpendicular to the - Greater trochanter in profile. table to prevent midpoint - Entire long axis of the femoral pelvis rotation. neck not -Rotate the lower limb foreshortened. and foot - Proximal one third of the approximately femur. 15-20 degrees to - Lesser trochanter is usually place the femoral not projected beyond the  neck parallel to the IR medial border of the femur, or only a very small amount of the trochanter is seen. LATERAL POSITION OF THE 24 x 30 cm hip joint -Perpendicular Show a lateral - Hip joint centered to the PROJECTION PATIENT: crosswise through the hip joint, projection of the hip, radiograph Mediolateral which is located including the - Hip joint, acetabulum, and LAUENSTEIN AND -From the supine midway between the acetabulum, the femoral head HICKEY METHODS position rotate the ASIS and the pubic proximal end of the - Femoral neck overlapped by patient slightly toward symphysis for the femur, and the the greater trochanter in the affected side to an Lauenstein method relationship of the the Lauenstein method oblique position. and at a cephalic femoral head to the - With cephalic angulation in the angle of 20 to 25 acetabulum Hickey method, the POSITION OF THE degree for the Hickey femoral neck is free of PART: method. superimposition. -Center the affected -Center the IR to the hip to the midline of central ray. the grid then flex the NOTE: affected knee and -This examination is draw the thigh up in contraindicated for nearly right angle to patient with a the hip bone and suspected fracture or extend the opposite pathologic condition. limb and support it at hip level. -These methods are used to demonstrate the hip joint and the relationship of the femoral head to the acetabulum. AXIOLATERAL POSITION OF THE 24 x 30 cm Long axis of the Perpendicular to the - Femoral neck PROJECTION PATIENT: lengthwise femoral neck. The long axis of the without overlap from DANELIUS-MILLER central ray enters femoral neck. The the greater METHOD - Patient in supine midthigh and passes central ray enters trochanter Position of through the femoral midthigh and passes - Small amount of the POSITION OF THE IR neck about 2 1/2 through the femoral lesser trochanter on PART: inches (6.4 cm) neck about 2 1/2 the Place the IR below the point of inches (6.4 cm) below posterior surface of -Elevate the pelvis on in vertical intersection of the the point of the femur. a firm pillow and position with localization lines. intersection of the - Small amount of the  center the most the upper localization lines. greater trochanter on prominent point of the border at the greater trochanter to the level of anterior and posterior the midline of the iliac crest. surfaces of the grid. The support Angle the proximal femur must not extend lower border when the femur is beyond the lateral away from properly inverted surface of the body. the body - Soft tissue shadow -Flex the hip and until the IR of the unaffected knee of the is parallel to thigh not unaffected side to the femoral overlapping the hip elevate the thigh in neck joint or proximal vertical position and femur rest the unaffected - Hip joint with the leg in a suitable acetabulum A, Axiolateral hip: support. - Any orthopedic Danelius-Milier -Unless appliance in its method, IR supported contra-indicated, entirety with sandbags. grasp the heel and - Ischial tuberosity B, Same projection, medially rotate the below the femoral patient holding IR. foot and lower limb of head Note that the affected side the foot is on a 15-20 degrees. footrest. AXIOLATERAL POSITION OF THE 24 x 30 cm the femoral neck Directed 15 degrees This leg position - Hip joint with the acetabulum PROJECTION PATIENT: posteriorly and demonstrates a - Femoral head, neck, and CLEMENTS-NAKAY Position of aligned perpendicular lateral hip image trochanter AMA MODIFICATION -Patient in supine IR: to the femoral neck because the central - Any orthopedic appliance in its with the affected side and grid IR ray is angled 15 entirety near the edge of the -Support a degrees posterior table grid IR on instead of the toes the bucky being medially POSITION OF THE tray so that rotated. This also PART: the lower shows the margin is acetabulum and the -For this position do below the proximal femur, inc. not rotate the lower patient. the head, neck, and - When the patient limb internally. -Position it trochanters in lateral has bilateral hip -The limb should so that it‘s profile. fractures, bilateral remain in neutral or in line is hip arthroplasty slightly external parallel to (plastic surgery of position. the floor. the hip joints), or -Adjust the limitation of grid parallel movement of the to the axis unaffected leg, the of femoral Danelius-Miller neck and tilt method cannot be its top back used. Clements and 15 degrees Nakayama' described a modification using a I5-degree posterior angulation of the central ray 🥹ACETABULUM🥹 PROJECTION POSITION OF THE FILM SIZE REFERENCE CENTRAL RAY STRUCTURE EVALUATION CRITERIA PATIENT AND POINT SHOWN PATIENT PA AXIAL OBLIQUE POSITION OF THE 8 x 10 inch Acetabulum -Directed through the Shows the fovea - Hip joint and acetabulum near PROJECTION PATIENT: (18 X 24 -The central ray enter acetabulum at an capitis and the center of the radiograph - TEUFEL METHOD cm) the body at the angle of 12 degree particularly the Femoral head in profile to show RAO OR LAO -Patient in lengthwise inferior level of the cephalad. supero-posterior wall the concave area of the fovea POSITION semi-prone on the coccyx and -The central ray enter of the acetabulum. capitis - Supero-posterior wall of affected side. approximately 2 the body at the the acetabulum inches (5 cm) lateral inferior level of the POSITION OF THE to the midsagittal coccyx and PART: plane toward the side approximately 2 -Elevate the being examined inches (5 cm) lateral unaffected side so to the midsagittal that the anterior plane toward the side surface of the body is being examined forming 38 degrees from the table and center the affected hip to the midline of the grid. -Patient support the body on the forearm and flexed knee of the elevated side  AP OBLIQUE INTERNAL 24 x 30 Cm INTERNAL INTERNAL The resulting image -Acetabulum should be centered PROJECTION OBLIQUE: lengthwise OBLIQUE: OBLIQUE: shows the to the IR. ACETABULUM -For a patient with a -2 inches inferior to -Perpendicular to the acetabular rim. - The ilio-pubic column and the JUDET METHOD - suspected fracture of the ASIS of the IR and entering 2 posterior rim of the RPO OR LPO the ilio-pubic column affected side inches inferior to the affected acetabulum are seen on POSITION (anterior) and the ASIS of the affected the internal posterior rim of the EXTERNAL side oblique. INTERNAL (LPO): acetabulum. OBLIQUE: - The ilioi-schial column and the -at the pubic EXTERNAL anterior rim of the POSITION OF THE symphysis OBLIQUE: acetabulum are seen on the PATIENT: -Perpendicular to the external oblique. IR and entering at the -Patient in pubic symphysis semi-supine with affected hip up. POSITION OF THE PART: -Align the body and center the affected hip to the midline of the IR. EXTERNAL (RPO): -Elevate the affected side so that the -Described as 24 x 30 anterior surface forms Cm lengthwise a 45 degree angle that are useful in from the table. diagnosing fracture of the acetabulum: the EXTERNAL internal oblique OBLIQUE: position (affected side For a patient with a up) and the external suspected fracture of oblique position the ilio-ischial (affected side down). column (posterior) and the anterior rim of the acetabulum POSITION OF THE PATIENT: -Patient in semi-supine with affected side down.  POSITION OF THE PART: -Align the body and center the affected hip to midline of the IR. -Elevate the unaffected side so that the anterior surface forms 45 degree angle from the table 🥹 ANTERIOR PELVIC BONE 🥹 PROJECTION POSITION OF THE FILM SIZE REFERENCE CENTRAL RAY STRUCTURE EVALUATION CRITERIA PATIENT AND POINT SHOWN PATIENT PA PROJECTION POSITION OF THE 8 x 10 inch midpoint of the IR -Perpendicular to the Shows a PA - Pubic and ischial bones not PATIENT: (18 X 24 -distal coccyx and the midpoint of the IR. projection of the magnified or cm) pubic symphysis -The central ray pubic symphysis and superimposing the sacrum or Patient in prone with crosswise enters the distal ischia, including the coccyx MSP to the midline of coccyx and exits the obturator foramina - Pubic and ischial bones near the grid pubic symphysis. the center of the radiograph POSITION OF THE - Hip joints PART: - Symmetric obturator foramina -IR on the bucky tray center to the level of the greater trochanter. AP AXIAL POSITION OF THE 24 x 30 cm MALES MALES Shows the rami - Pubic and ischial bone "OUTLET" PATIENT: crosswise -centered to a point 2 -Directed 20 to 35 without the magnified with pubic bones PROJECTION inches (5 cm) distal to degrees cephalad foreshortening seen superimposed over the sacrum TAYLOR METHOD -Patient in supine the superior border and centered to a in a PA or AP and coccyx of the pubic point 2 inches (5 cm) projection (due to the - Symmetric obturator foramina POSITION OF THE symphysis. distal to the superior CR more - Pubic and ischial rami near the PART: border of the pubic perpendicular to the center of the radiograph FEMALES symphysis. rami). - Hip joints -MSP of the body -centered to a point 2  centered to the inches (5 cm) distal to FEMALES midline of the grid the upper border of - Directed 30 to 45 and adjust the body the pubic symphysis degrees cephalad so that the pelvis is and centered to a not rotated. point 2 inches (5 cm) -ASIS equidistant distal to the upper from the table. With border of the pubic IR adject on the symphysis bucky tray PA AXIAL "INLET" POSITION OF THE 8 x 10 inch Pubic symphysis on Directed 35 degrees Shows a PA axial -Medially superimposed superior PROJECTION PATIENT: (18 x 24 the midsagittal plane cephalad exiting the projection of the and inferior rami of the pubic STAUNIG METHOD cm) anteriorly at the level pubic symphysis on pubic and ischial bones -Patient in prone crosswise of the greater the midsagittal plane bones and the pubic - Nearly superimposed lateral trochanters. anteriorly at the level symphysis. The two thirds of the pubic and POSITION OF THE of the greater appearance of this ischial bones PART: trochanters. radiograph will be - Symmetric pubes and ischia nearly id - Pubic and ischial bones -MSP of the body centered to the radiograph centered to the - Hip joints midline of the table. -Adjust the body so that pelvis is not rotated. -With IR on the bucky tray adjust the position so that midpoint of IR will coincide with central ray. 🥹ILIUM (AP AND PA OBLIQUE PROJECTIONS)🥹 PROJECTION POSITION OF THE FILM SIZE REFERENCE CENTRAL RAY STRUCTURE EVALUATION CRITERIA PATIENT AND POINT SHOWN PATIENT RPO & LPO Position POSITION OF THE 24 x 30 cm Center the IR at the Perpendicular to the AP OBLIQUE: - Entire ilium PATIENT: lengthwise level of the ASIS midpoint of the IR. -The AP oblique - Hip joint, proximal femur, and image shows an sacroiliac joint -Patient in supine unobstructed projection of the ala AP OBLIQUE PROJECTION POSITION OF THE and sciatic notches - Broad surface of the iliac wing  PART: and a profile image without rotation - Center the sagittal of the acetabulum. plane passing through the hip joint of the affected side to the midline of the grid. Elevate the unaffected side approximately 40 degrees to place the broad surface of the wing of the affected ilium parallel with the plane of the IR. -Adjust the position of the uppermost limb to place the ASIS on the same transverse plane. -Center the IR at the level of the ASIS RAO & LAO POSITION OF THE 24 x 30 cm Center the IR at the Perpendicular to the PA OBLIQUE: - Entire ilium PATIENT: lengthwise level of the ASIS midpoint of the IR. -The PA oblique - Hip joint, proximal femur, and image shows the sacroiliac joint -Patient in prone ilium in profile and the femoral head PA OBLIQUE PROJECTION POSITION OF THE within the - Ilium in profil PART: acetabulum. -Center the sagittal plane passing through the hip joint of the affected side to the midline of the grid. Elevate the unaffected side about 40 degrees to place the affected ilium perpendicular to the plane of the IR. -Patient rest on the forearm and flexed knee of the elevated side. -Adjust the position of the uppermost thigh to place the iliac crest on the same horizontal plane. -Center IR at the level of the ASIS.