Knee, patella, femur, hip and pelvis positioning

AP knee

patient is supine or seated on table

leg should be fully extended

3-5 degree medial rotation

the femoral condyles should be equidistant to the IR

AP internal oblique knee

patient in semi- supine position with entire body and leg rotated partially away from side of interest

rotate entire leg internally 45 degrees (interepicondylar line should be 45 degrees to plane of the IR)

AP external oblique knee

patient in the semi-supine position with entire body and leg rotated partially away from side of interest

rotate entire leg externally 45 degrees (interepicondylar line should be 45 degrees with the plane of the IR)

Lateral knee

patient in lateral recumbent position, affected side down

affected knee flexed 20-30 degrees

femoral condyles and patella perpendicular to IR

inferosuperior patella

patient in supine position on table

affected knee is slowly flexed to 45 degrees

ensure no leg rotation

foot resting on heel

patient holds IR on edge, resting on mid- thigh at an angle that aligns it perpendicular with the patella and CR

settegast patella

patient seated on table

affected knee is slowly flexed to a minimum of 90 degrees

ensure no leg rotation

foot in plantar flexion

patient holds IR on edge, resting on mid-thigh at an angle that aligns it perpendicular with the patella and CR

superoinferior patella (modified merchant)

patient seated or standing by upright bucky

angle upright bucky to 45 degrees

affected knee is slowly flexed past 90 degrees and placed at center and as close to the IR as possible

shaft of femur running parallel with the floor

ensure no leg rotation

AP mid and proximal femur

patient supine

locate femoral neck and align to CR and to midline of table and/or IR

rotate affected leg internally 15-20 degrees

Adjust opposite leg posteriorly with hip lateral

adjust IR to include hip joint (palpate ASIS) and place upper IR margin at the level of this landmark

AP mid and distal femur

patient supine

unless contraindicated, rotate leg internally 3-5 degrees to place femoral condyles equidistant to IR

lateral mid and proximal femur

patient in lateral recumbent position, with affected side down

flex affected knee about 45 degrees and align femur to midline of table

extend and support unaffected leg behind affected knee and have patient roll back posteriorly about 15 degrees

lateral mid and distal femur

patient in lateral recumbent lying of affected side with knee slightly flexed about 45 degrees , femur centered to IR

femoral condyles perpendicular to IR

adjust opposite leg anteriorly with condyles perpendicular

shield gonads

ap hip

patient supine

locate femoral neck and align to CR and to midline of table and or IR

ensure no rotation of pelvis

rotate affected leg internally 15-20 degrees

shield unaffected hip

lateral hip, unilateral

with patient supine, position affected hip area to be aligned to CR and midline of table and or IR

flex knee and hip on affected side with sole of foot against inside of opposite leg, near knee if possible

center affected femoral neck to CR and midline of IR and tabletop

ap pelvis

patient supine with MSP centered on grid

top of cassette 1 inch above iliac crest

hips and shoulders equidistant to table, ensure no rotation the distance from the ASIS to the table should be equal

separate feet slightly

internally rotate legs 15 degrees and immobilize

bilateral hip, lateral "frog-leg"

patient supine, pillow provided for head and place arms across chest

align patient to midline of table

ensure pelvis is not rotated by evaluating the ASIS

center IR to CR at level of femoral heads, top of IR at level of iliac crest

flex both knees 90 degrees

place plantar surfaces of feet together and abduct both femurs 40-45 degrees from vertical

ensure both femurs are abducted the same amount and that pelvis is not rotated

axiolateral projection crossfire lateral hip

may be done on stretcher or bedside if patient cannot be moved

patient supine, with pillow

elevate pelvis 1-2 inches by placing support under their pelvis

flex and elevate unaffected leg so that thigh is near vertical position and outside collimation field

support leg in this position

ensure no rotation of pelvis

place IR in crease above iliac crest and adjust so that is parallel to femoral neck and perpendicular to IR

Use IR holder

internally rotate affected leg 15-20 degrees unless contraindicated

inlet pelvis

patient supine with MSP centered to grid

hips and shoulders equidistant to table, ensure no rotation. the distance from the ASIS to the table should be equal

outlet pelvis

patient supine with MSP centered to grid

hips and shoulders equidistant to table, ensure no rotation. the distance from the ASIS to the table should be equal