Femur and Hip

What is the angle of the femur slant and which way does it lie?

The femur slants 5-10 degrees medially

How can the leg rotation effect the femur?

• Femoral neck visualisation

• Trochanter visualisation

External rotation of the leg allows for ___?

Better visibility of the lesser trochanter

Internal rotation of the leg allows for ___?

Better visibility of the greater trochanter and femoral neck

What’re the most common reasons for imaging the femur?

• Trauma

• Bone pain

• Femoral plates

• Joint replacements

• Soft tissue calcifications (bone spurs)

• Osteosarcoma (bone cancer)

• Metastases

Imaging pathway for hip trauma

Plain radiographs —> CT —> MRI/Bone scan

What is the most common imaging modality for arthritis?

Plain radiographs

What is avascular necrosis/osteonecrosis?

Failed blood supply to the bone, this can lead to cell death and bone collapse (bone dies) if left untreated

How would you adjust if the patient has metal prosthetics in their leg?

Do manual exposures, don’t use automatic settings

What is the imaging view series for femur trauma?

1. Pelvis

2. AP femur (proximal and distal)

3. HBL femur ((proximal and distal)

What is the imaging view series for femur non-trauma?

1. AP femur with 15 degree internal rotation (proximal and distal)

2. Mediolateral femur (proximal and distal)

AP Proximal Femur

• Collimation:

• Centering point:

• Leg rotation

Collimation:

• Top of image should be 2cm above the ASIS

• Include hip joint

• Skin margins

Centering point: Mid femur

Leg rotation: 15 degrees internally (non-trauma)

AP Distal Femur

• Collimation:

• Centering point:

• Leg rotation

Collimation:

• Include 5cm below knee joint

• Overlap with previous proximal image

• Skin margins

Centering point: Mid femur

Leg rotation: 15 degrees internally (non-trauma)

Name this view

AP hip

Name this view

AP proximal femur

Name this view

AP distal femur

Name this view

Mediolateral proximal femur

Name this view

Lateral hip

Name this view

Mediolateral proximal femur

Name this view

Mediolateral distal femur

Name this view

HBL hip/proximal femur (axiolateral)

What angle should the detector and tube be for a HBL?

45 degrees

HBL Proximal Femur/Hip

• Collimation:

• Centering point:

• Leg rotation:

Collimation: Include ASIS at the hop of image

Collimation: Perpendicular to the femoral neck

Leg rotation: 15 degrees (ONLY IF THEY CAN)

Name this view

HBL distal femur

What is osteosarcoma?

Bone cancer caused by malignant tumor due to transformed cells in the bone