Pelvis, Hip, Femur

What SID is used for femur, hip, and pelvis images?

40”

What are breathing instructions for femur, hip, and pelvis images?

suspend breathing

What is Aurora’s pelvis routine?

AP

Explain patient and CR position for AP pelvis

Patient

• supine (or upright)

• true AP (no rotation)

• invert feet 15-20^o

CR

• centered midway between ASIS and pubic symphysis (2 inches below ASIS or 2 inches above symphysis)

  • top of IR 1-1½ inches above crest

• centered at MSP

• perpendicular tube angle

Why do we invert the feet for most AP images?

• overcomes the anteversion of the femoral necks

• places necks parallel to IR

• unsuperimposes greater trochanter and femoral neck

• should not see lesser trochanter

What is demonstrated on an AP pelvis image (film eval)?

• greater trochanters in profile

• head, neck, trochanters, and upper 1/3 of femur

• lesser trochanter not seen

• marker at bottom of image (either R or L)

• no rotation

What are 3 things you can look at on the pelvis to check for rotation?

• obturator foramen are equal

• iliac wings are equal

• symphysis pubis is in line with sacrum

What are some other names for a lateral pelvis image?

bilateral frog, modified cleaves

Explain patient and CR position for lateral pelvis/bilateral frog (not in Aurora’s routine)

patient

• supine

• flex knees and hips 90^o and abduct thighs 40-45^o to put femoral neck parallel to IR

  • brace soles of feet against each other

  • can use a support under the knees

  • can use a sandbag across ankle

CR

• perpendicular 1 inch superior to symphysis pubis (or 3 inches distal to ASIS)

• aligned to MSP

What is demonstrated on a lateral pelvis image (film eval)?

• no rotation

• axiolateral view of both femoral heads, necks, and trochanteric areas

• marker (R or L)

What is Aurora’s hip routine?

AP and lateral

Explain patient and CR position for AP hip

patient

• supine

• true AP (no rotation)

• invert foot 15-20^o

CR

• perpendicular to femoral neck

• top of IR at ASIS

• 10×12 LW

What are two ways you can locate the femoral neck?

1. draw a line from ASIS to symphysis, go 2½ inches perpendicularly distal from the middle of that line

2. 1-2 inches medial to ASIS and 3-4 inches distal

What is demonstrated on an AP hip image (film eval)?

• AP projection of head, neck, trochanters, and upper 1/3 of femoral shaft

• include pubic symphysis

• don’t need to include crest

• entire orthopedic appliances must be demonstrated

• marker lateral and on bottom of image

What are some other names for a lateral hip image?

• modified cleaves unilateral

• unilateral frog leg

Explain patient and CR position for lateral hip

patient

• supine (true AP)

• flex knee and hip 90^o and abduct thigh 40-45^o

CR

• perpendicular to femoral neck

• 3-4 inches distal to ASIS

If a patient can’t abduct their thigh for a lateral hip, what can you do?

frog-leg patient rotation method (roll patient toward affected side)

What is demonstrated on a lateral hip image (film eval)?

• axiolateral view of femoral head, neck, and trochanteric areas

• lesser trochanter in profile medially

• don’t need to include symphysis

What is Aurora’s femur routine?

AP (proximal and distal) and lateral (proximal and distal)

Explain patient and CR position for AP proximal femur

patient

• supine

• rotate leg in 15-20^o

CR

• top of IR at ASIS

• align long axis of CR to long axis of leg

• 10×12 or 14×17 LW

What is demonstrated on an AP proximal femur image (film eval)?

• include entire proximal femur (through the joint)

• try to include soft tissue if patient body habitus allows

• marker lateral

Explain patient and CR position for AP distal femur

patient

• supine

• rotate leg in 5^o to get patella parallel

CR

• bottom of IR 2 inches below knee joint

• align long axis of CR to long axis of leg

What is demonstrated on an AP distal femur image (film eval)?

• overlap between proximal and distal

• entire distal femur (through the joint)

• marker lateral

Explain patient and CR position for lateral proximal femur

patient

• turn onto affected side

• proximal femur in contact with table

• unaffected leg behind patient

  • 10-15^o posterior pelvic rotation

• flex knee 45^o

• patella perpendicular to IR

CR

• perpendicular with top of IR at ASIS

• align long axis of leg to IR

What is demonstrated on a lateral proximal femur image (film eval)?

• marker lateral

• include entire proximal femur (through the joint)

Explain patient and CR position for lateral distal femur

patient

• turn onto affected side

• true lateral

  • pelvis lateral and patella perpendicular to IR

CR

• IR 2 inches below knee joint

• align long axis of leg to IR

What is demonstrated on a lateral distal femur image (film eval)?

• lateral view of ¾ of femur and knee joint

• mark anterior

• knee joint may not be open (due to beam divergence)

What is the sign that usually indicates a broken/displaced hip?

affected leg will be externally rotated

What do you need to do for an AP image if there is a suspected fracture?

take the image with the patient as presented (don’t rotate the leg)

What are other names for the trauma lateral hip?

shoot thru lateral, cross table lateral, Danelius Miller, modified axiolateral

Explain the patient and CR/IR positioning for the Danelius Miller method (trauma hip)

patient

• supine

• elevate pelvis if necessary

• raise unaffected leg so thigh is perpendicular to table

• invert affected foot if possible

CR/IR

• IR placed vertically with top of IR just above crest

• angle lower border of IR to place perpendicular to femoral neck

• use grid (make sure you are using CW grid or put lead strips horizontal)

• angle CR to be perpendicular to IR and femoral neck

What is demonstrated on a lateral trauma hip image (film eval)?

• axiolateral view of head and neck

• “true lateral” hip

• acetabulum visible

• lesser trochanter should be pointing down

What do you have to do extra if a patient has a prosthetic?

include the entire prosthetic

What is a trauma lateral femur routine?

proximal (Danelius Miller) and distal (shoot thru)

What techniques are used for a pelvis?

80 kVp @ 20 mAs

What should the EI # be for pelvis and hip images?

EI: 200-600

S: 200-600

What techniques are used for a hip?

80 kVp @ 12 mAs

What techniques are used for a femur?

proximal: 80 kVp @ 12 mAs

distal: 80 kVp @ 6 mAs

What should the EI # be for femur images?

EI: 200-600

S: 150-400

When is the Clements Nakayama image done?

• when patient has bilateral hip fractures

• bilateral hip arthroplasty

• pt unable to raise unaffected leg

Explain patient, IR, and CR positioning for the Clements Nakayama image

patient

• supine

• affected side near the edge of the table

IR

• grid lines parallel to long axis of femoral neck

• tilt top back 15 degrees

• upper border at iliac crest

CR

• directed 15^o posteriorly

• perpendicular to femoral neck and IR

What is demonstrated on a Clements Nakayama image (film eval)?

• lateral hip

• visualized acetabulum, head, neck, and trochanters of femur

What method is shown in the image?

Clements Nakayama

What is another name for the AP axial outlet projection?

Taylor method

Explain patient and CR positioning for the pelvic outlet image

patient

• supine, true AP

CR

• 1-2 inches distal to upper border of symphysis

• male

  • 20-35^o cephalic angle

• female

  • 30-45^o cephalic angle

What is demonstrated on a pelvic outlet image (film eval)?

• AP projection of pubic and ischial bones, pubic symphysis, obturator foramen

• assess for vertical fractures and displacements

What type of image is this?

pelvic outlet

What type of image will this result in?

pelvic outlet

What is another name for the AP axial inlet projection?

Bridgeman method

Explain patient and CR positioning for the pelvic inlet image

patient

• supine, true AP

CR

• at level of ASIS

• 40^o caudal angle

What is demonstrated on a pelvic inlet image (film eval)?

• axial projection of pubic and ischial bones and symphysis pubis

• pelvic ring

• asses pelvic trauma (anterior and posterior displacement)

What type of image will this result in?

pelvic inlet

What type of image is this?

pelvic inlet

What do the Judet views demonstrate?

• acetabular fractures

• anterior and posterior acetabular rims

Explain the Judet view for the posterior acetabular rim

patient

• 45^o oblique (RPO or LPO)

• affected side up

CR

• perpendicular

• 2 inches distal to ASIS of affected side

What is demonstrated on a Judet (posterior acetabular rim) image (film eval)?

• affected side up (posterior rim of affected acetabulum)

• anterior iliopubic column

• obturator foramen

• iliopubic line

Explain the Judet view for the anterior acetabular rim

patient

• 45^o oblique (RPO or LPO)

• affected side down

CR

• perpendicular

• 2 inches distal and 2 inches medial to ASIS of affected side

What is demonstrated on a Judet (anterior acetabular rim) image (film eval)?

• affected side down (anterior rim of affected acetabulum)

• posterior ilioischial column

• iliac wing

• ilioischial line

In the Judet views, which side will have an open obturatur foramen?

Which side will have a wide iliac wing?

foramen: side up

wing: side down