Unit 2 (Pelvis/Hip)

ischial tuberosity

Bears most of body weight when sitting

ASIS; Superior aspect of iliac Crest; Greater Trochanter

What are all topographic landmarks for hip and pelvis in your textbook

Fractures; lesions; degenerative disease

Pathological Indications for AP Pelvis (Bilateral Hip)

Fractures; bone lesions, dislocations

Pathological indications for AP/Lateral Femur

Orthopedic placement; Exam of acetabulum femoral head/neck; & greater trochanter

Pathological indications for AP Unilateral Hip(& Proximal Femur)

Anterior

Hip bones

Anterior

Sacrum

Anterior

Coccyx

Anterior

Pubis

Anterior

Pubis

Anterior

Acetabulum

Anterior

Ischium

Anterior

ASIS

Anterior

Anterior inferior iliac spine

Anterior

Ilium

Posterior

PSIS

Posterior

Ala (wing)

Posterior

Posterior inferior iliac spine

Thin & flared part of ilium

Ala ( wing )

Crest of ilium

Superior margin of ilium; Goes from ASIS to PSIS

ASIS; iliac crest

Bony prominence used as landmark for hip

Greater Trochanter

Bony prominence use as landmark for femoral head

Greater Sciatic Notch

Deep notch on ischial spine

Ramus Body of each ischium; Pubis

what forms the obturator foramen

Osteopetrosis

Abnormally dense bone; Result of fracture, leads to obliteration of marrow space

Paget's Disease

Bone destruction followed by overproduction of dense yet soft bones

Osteoporosis

Reduction in quantity of bone ar atrophy of skeletal tissue

Congenital hip dysplasia

Hip dislocations due to conditions @birth

Danelius - Miller Method

Axiolateral (Inferosuperior) Projection: Trauma Hip

Unilateral Frog-Leg

Mediolateral Projection-Hip + Proximal Femur

Bilateral Frog-Leg

Bilateral Projection-Hips (Modified Cleaves Methad)

Flex & elevate unaffected leg so thigh is near vertical support w/pad
Place IR in crease above iliac crest o adjust it parallel to femoral neck

how to perform and position for a trauma lateral hip

CR - 2 in ( 5 cm ) below ASIS

CR for: AP Pelvis (Bilateral Hips)

CR- 3 in (8 cm) below ASIS

CR for: AP Bilateral (Hips)

CR: 3-4 in (8-10 cm) below ASIS & 2 in (5cm) medial

CR for: AP Unilateral (Hip)

CR- Midfemoral neck

CR for: Unilateral Frog-Leg

Perpendicular to femoral neck

Danelius-Miller Method (Trauma)

CR @ midline point @ lvl of ASIS; CR: 40° caudad

CR for: AP Axial Inlet Projection

CR @ midline 1-2 in (2.5-5cm) distal to superior border of greater trochanter; & Angled 20-35° cephalad for males; 30°-45° for females

CR for: AP Axial Outlet Method

Suspend breathing

breathing instructions for pelvis/hip exams

Pt supine; Both feet internally rotated 15°-20°

Pt position & degree of pt rotation: AP Pelvis (Bilateral Hips)

Affected side Knee flexed; Abduct leg 45° from vertical

Pt position & degree of pt rotation: Unilateral Frog

Pt supine, Rotate affected leg 15°-20° internally

Pt position & degree of pt rotation: AP Unilateral Hip

Pt supine; Flex both Knees 90%; abduct both legs 45° from vertical

Pt position & degree of pt rotation: AP Bilateral Pelvis

Pt supine; Non-injured leg elevated; no rotation

Pt position & degree of pt rotation: Danelius-Miller Method (Trauma)

• ASIS are both parallel with each other
• Femoral epicondyles parallel with each other

When performing an AP Pelvis , or any other exam involving the pelvis , how do we check for rotation and ensure patient is in true AP position when positioning

Femoral epicondyles parallel

When looking at a radiograph of an AP pelvis how can one determine if the legs where properly positioned

Both legs rotated internally 15°-20°; If there is any foreshortening or elongation of pelvis

AP pelvis how should appear if positioned properly and how should the legs be positioned to be correct ? Also , how can a technologist examine an image for rotation of the pelvis ?

Level of S1 (1st sacral vertebra)

Which level of the spine is the ASIS located

Level of L4-L5

What vertebral level is the Iliac Crest located

Posterior Oblique Projection: Pelvis-Acetabulum (Judet Method)

What method and projection will best visualize the anterior AND posterior rim of the acetabulum

• Axiolateral (Inferosuperior) Projection (Danelius-Miller Method)
• Could result in significant displacement of fracture Fragments

For a Trauma patient with hip pain , what exam is performed first and why

Axiolateral (Inferosuperior) Projection (Danelius-Miller Method)

would a be Trauma done patient with lateral hip hip pain and obvious signs of deformity which projection

Mediolateral Projection: Hip & Proximal femur

What t i is the proper name for a unilateral frog - leg projection

Perpendicular (Horizontal)

When performing the Axiolateral inferosuperior projection the CR should be how in relation to the IR and femoral neck

• ASIS; Iliac Crest
• Greater Trochanter

What are the 2 bony landmarks palpated for localization of the hip? Femoral head?

AP Bilateral Projection (Hips) ; AP Pelvis

When checking a pediatric patient for developmental dysplasia and congenital abnormalities like dislocation of the hip what 2 basic projections are performed

Greater Trochanter

When displaying an axiolateral inferosuperior ( Danelius - Miller method ) image of the hip on the monitor what landmark is useful for correctly hanging the image for viewing

15°-20° anterior angle in relation to body of femur

How is the femoral head and neck located ?

2 in (5 cm) below ASIS

What is the CR location for an AP pelvis

Midfemoral neck

What is the CR location for unilateral frog leg hip

Pt rotated 45° posterior oblique (pelvis & thorax 45° from tabletop)

How much is the patient rotated for the Judet method

CR : 2 in (5 cm) distal & 2 in (5 cm) medial to downside ASIS (Affected down)
CR: 2 in (5cm) directly distal to upside ASIS (affected side up)

What is the CR for Judet Method

IR: Table bucky; KVp: 80-90

How is IR placed for the Judet method? What is the kVp?

Overall shape; Angle of pubic arch; Ischial spines

Criteria to identify female pelvis & male pelvis

male pelvis

Narrower, deeper, less flared pelvic inlet & more oval or heart shaped

male pelvis

Narrower angle (50°-60 °)

male pelvis

More protrusion (inlet)

female pelvis

Wider, more shallow & flared Pelvic inlet = rounder

female pelvis

Wider angle (80°-85°)

female pelvis

Less protrusion (inlet)

45 °

For an AP bilateral frog leg projection how much are the femurs abducted

Parallel

How is the IR placed in relation to the femoral neck in the axiolateral projection

ASIS ; Iliac Crest

What are the two radiographic landmarks found on the ilium

The pt is rotated twd the left

What positioning error has occurred if the left iliac wing is elongated on an AP pelvis radiograph

Sacroiliac joints

located between the sacrum and each ilium

Symphysis pubis

connects the right and left pubic bones

Union of acetabulum

a temporary growth joint that solidifies during the teenage years

Hip joints

connect the head of the femur to the acetabulum of the pelvis

Sacroiliac joint

Synovial; Limited movement; Irregular gliding

Symphysis pubis

Cartilaginous; Amphiarthrodial; Limited

Union of acetabulum

Cartilaginous; Synarthrodial (for adults); Nonmovable

Hip joint

Synovial; Diarthrodial; Ball and socket (spheroidal)

Femoroacetabular impingement (FAI)

Hip joint defects causing pain , with types like pincer (extra acetabulum bone), cam (mis-shaped femur head), or both

Metastatic carcinoma

Cancer that spreads to bones, often to areas with red marrow like the spine and pelvis .

Osteoarthritis

Joint cartilage wears down, common in aging, leading to pain and stiffness, especially in hips

Chondrosarcoma

A cancerous tumor in cartilage, mostly in men over 45, usually in the pelvis or long bones, which may be removed if it doesn't respond to treatment

Developmental dysplasia of the hip ( DDH ) :

Hip dislocations present from birth, often needing frequent X - rays

Pelvic ring fractures

Severe trauma to one side of the pelvis can cause fractures on the opposite side, known as contrecoup injury .

Proximal femur ( hip ) fractures

Common in older adults with weakened bones, often from minimal trauma due to osteoporosis or blood loss .

Ankylosing spondylitis

disease first fuses the sacroiliac joints and then causes the spine to calcify, creating a "bamboo spine" look on X-rays; It mostly affects men

Avulsion fractures of the pelvis

Painful fractures often in young athletes from forceful muscle contractions, usually affecting sites like the iliac spine and iliac crest .

Slipped capital femoral epiphysis (SCFE) :

Occurs in teenagers during growth spurts, causing hip issues due to a slipping femur head

ASIS to PSIS

Iliac crest goes from

ankylosing spondylitis

Identify:

Avulsion fractures of pelvis

Identify:

Chondrosarcoma

Identify:

Developmental dysplasia of hip (DDH)

Identify:

Slipped Capital Femoral Epiphysis (SCFE)

Identify:

Metastatic carcinoma

Identify: