RADT 150 FEMUR, HIP, PELVIS, SI JOINTS

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28 Terms

1
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AP (MId and Distal) Femur


  • CR to midpoint of IR

  • 40” SID

  • 75 – 85 kVp

  • Leg extended

  • Rotate leg 5o internally


  • Bucky or grid

  • Shield and maintain modesty

  • Use full length of IR

  • *Separate AP Hip (proximal femur) included on smaller field size

  • Collimate to sides of femur

  • Include knee joint 2” within edge of IR


2
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AP (MId and Distal) Femur Radiographic Criteria


  • Knee joint included

  • No Rotation


3
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Lateral (MId and Distal) Femur


  • CR to midpoint of IR

  • 40” SID

  • 75 – 85 kVp

  • True lateral

  • Lay on affected side

  • Leg bent approximately 45o

  • Align length of femur to length of table


  • Bucky or grid

  • Shield and maintain modesty

  • Use full length of IR

  • Separate Lateral Hip (proximal femur) included on smaller field size

  • Collimate to sides of femur

  • Include knee joint 2” within edge of IR


4
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Lateral (MId and Distal) Femur Radiographic Criteria


  • Knee joint included (minimum)

  • No Rotation


5
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Lateral (MId and Proximal) Femur Radiographic Criteria


  • Proximal femur not superimposed

  • True lateral

  • Suspend respiration


6
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AP Pelvis


  • CR midway between level of ASIS and symphysis pubis & MSP

  • 40” SID

  • 80 – 90 kVp

  • Supine

  • Legs extended and slightly apart

  • Rotate legs medially 15 – 20o (if non-trauma)

  • Suspend respiration


  • Bucky or grid

  • Shield* and maintain modesty

  • Collimate 14 x 17 landscape


7
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AP Pelvis Radiographic Criteria


  • Entire pelvis and proximal femurs included

  • No rotation of pelvis

  • Lesser trochanters not visible


8
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Hip and Proximal Femur (AP unilateral Hip)


  • CR perpendicular to femoral neck

  • 40” SID

  • 80 – 85 kVp

  • Supine

  • Legs extended and slightly apart

  • Rotate affected leg medially 15 – 20o(if non-trauma)

  • Suspend respiration


  • Bucky or grid

  • Shield* and maintain modesty

  • Collimate 10 x 12 portrait (extend length for history of prosthesis)


9
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Hip and Proximal Femur (AP unilateral Hip) Radiographic Criteria


  • Proximal 1/3 of femur included

  • Hip joint space and acetabulum visualized

  • Lesser trochanter not visible or only slightly visible

  • Total existing orthopedic appliance demonstrated


10
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Unilateral "Frog-Leg” (Non-Trauma)



  • CR perpendicular to mid femoral neck/femoral neck

  • 40” SID

  • 80 – 85 kVp

  • Supine

  • Place the heel (plantar surface) against knee

  • Abduct femur 40-45o (best demonstrated, abduct femur to 90o from vertical)

  • Abduct affected leg 40-45o if non-trauma

  • Suspend respiration


  • Bucky or grid

  • Shield* and maintain modesty

  • Collimate 10 x 12 landscape (extend length for history of prosthesis)


11
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Unilateral "Frog-Leg” (Non-Trauma) Radiographic Criteria


  • Entire femoral head, neck, and trochanters centered to IR

  • Femoral head and neck in profile


12
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AP Bilateral “Frog-Legs” (Non-Trauma)


  • CR 3” below level of ASIS & MSP

  • CR 3 in. below level of ASIS

  • 40” SID

  • 80 – 90 kVp

  • Supine

  • Abduct femurs 40-45o

  • Abduct femurs 40 – 45o if non-trauma

  • Place plantar surface of both feet together

  • Suspend respiration


  • Shield* and maintain modesty

  • Bucky or grid

  • Collimate 14 x 17 landscape


13
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AP Bilateral “Frog-Legs” (Non-Trauma) Radiographic Criteria


  • Pelvic girdle centered horizontally

  • No rotation of pelvis

  • Lesser trochanters equal in size

  • Greater trochanters superimposed over femoral neck


14
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Axiolateral (Inferosuperior) - Danelius-Miller Method)


CR perpendicular to mid femoral neck

15
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Axiolateral Hip (Bedside Mobile Procedure)


  • CR perpendicular to femoral neck and IR (level of mid thigh)

  • 40” SID

  • 80 – 95 kVp

  • Place IR with grid landscape, top edge of IR above Iliac crest

  • Center IR parallel to femoral neck (perpendicular to CR)

  • Raise unaffected leg (maintain modesty*)

  • Prop under affected hip

  • Suspend breath


16
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Axiolateral Hip Radiographic Criteria


  • Entire femoral head, neck, and acetabulum visualized

  • No visible grid lines


17
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Modified Axiolateral Projection (Hip and Proximal Femur)- Clements-Nakayama Method


  • CR perpendicular to femoral neck with 15 – 20 degrees downward angle

  • 40” SID

  • 80 - 90 kVp

  • Place patient near edge of table

  • Place grided IR landscape on Bucky tray parallel with femoral neck and perpendicular to IR

  • Suspend breath


  • Collimate 10 x 12


18
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Modified Axiolateral Hip Radiographic Criteria


  • Entire femoral head, neck, and trochanters centered to IR

  • Femoral head and neck in profile


19
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Posterior Oblique (Acetabulum)- Judet Method


  • CR 2 in. distal and medial to downside ASIS (RPO)

  • CR 2 in. distal to upside ASIS (LPO)

  • 40” SID

  • 80-90 kVp

  • Both obliques of the affected side, 45 degrees

  • Suspend respiration


  • Collimation 10 x 12 portrait


20
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Posterior Oblique (Acetabulum)- Judet Method Radiographic Criteria


  • RPO

    • Anterior rim and posterior ilioschial column demonstrated

  • LPO

    • Posterior rim and anterior iliopubic column demonstrated


21
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AP Axial “Outlet” Projection (Taylor Method)


  • CR 20 – 35 degrees cephalad males, 30 – 45 degrees cephalad females

  • CR 1 – 2” distal to symphysis pubis & MSP

  • 40” SID

  • 80 – 90 kVp

  • Suspend respiration


  • Bilateral assessment of pubis and ischium for fractures and displacement

  • Collimate landscape to area of interest


22
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AP Axial “Outlet” Projection of Pelvis


  • Elongated and magnified public and ischial bones

  • No rotation of pelvis

  • Pubic and ischial bones centered to collimation field


23
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AP Axial “Inlet” Projection


  • CR 40 degrees caudal, at level of symphysis pubis & MSP

  • 40” SID

  • 80 – 90 kVp

  • Suspend respiration


  • Assessment of pelvic trauma for posterior displacement or inward or outward rotation of anterior pelvis

  • Collimate landscape to area of interest


24
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AP Axial “Inlet” Projection Radiographic Criteria


  • Ischial spines demonstrated and equal

  • Pelvic inlet centered

  • Lateral collimation evident


25
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AP Axial SI Joints


  • CR 30 – 35 degrees cephalad

  • CR to MSP, midway between level of ASIS and symphysis pubis

  • 40” SID

  • 80 – 95 kVp

  • Supine, legs extended, support under knees

  • Suspend respiration


  • Collimate 10 x 12 landscape to area of interest


26
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AP Axial SI Joints Radiographic Criteria


  • Sacroiliac joint centered to collimation field

  • Sacroiliac joint spaces and L5-S1 junction open


27
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Posterior Oblique SI Joints


  • CR perpendicular, 1” medial to upside ASIS

  • 40” SID

  • 80 – 95 kVp

  • Elevate affected side 25 – 30 degrees

  • Suspend respiration


  • Collimate 10 x 12 portrait to area of interest

  • RPO to evaluate left SI joint

  • LPO to evaluate right SI joint


28
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Posterior Oblique SI Joints Radiographic Criteria


  • Sacroiliac joint of interest is open

  • Ala of ilium not overlapped over sacrum