Chapter 7: Femur & Pelvic Girdle

Which of the following structures is not an aspect of the proximal femur?

A. Intertrochanteric crest

B. Fovea capitis

C. Obturator foramen

D. Lesser trochanter

C. Obturator foramen

Which of the following structures is considered to be most inferior or distal?

A. Fovea capitis

B. Lesser trochanter

C. Neck

D. Greater trochanter

B. Lesser trochanter

Why must the lower limbs be rotated 15 to 20 degrees internally for AP pelvis projection (nontrauma)?

To place the femoral necks parallel to the image receptor (True AP)

Which bones fuse to form the acetabulum?

The ilium, ischium, and pubis.

Which of the following bony positioning landmarks cannot be palpated?

A. Ischial spine

B. ASIS

C. Ischial tuberosity

D. Symphysis pubis

A. Ischial spine

Which bone of the pelvis forms the anterior inferior aspect?

The pubis.

The lesser sciatic notch is an aspect of the:

Ischium

The sacroiliac joints are classified as ____ joints with ____ mobility.

synovial, gliding

The symphysis pubis provides limited movement during pelvic trauma and during:

childbirth.

The two bony landmarks that are palpated using the hip localization method are the:

anterior superior iliac spine and the greater trochanter.

Select the correct gender to correspond with the following pelvic characteristics. More oval (anthropoid) or heart-shaped (android) pelvic inlet:

Male

Select the correct gender to correspond with the following pelvic characteristics. Wider and shallow (platypelloid) general shape of pelvis:

Female

Select the correct gender to correspond with the following pelvic characteristics. An 80- to 85-degree angle of pubic arch.

Female

Select the correct gender to correspond with the following pelvic characteristics. Gynecoid pelvic inlet.

female

Select the correct gender to correspond with the following pelvic characteristics. Narrower, deeper and less flared shape of pelvis with android pelvic inlet.

Male

Select the correct gender to correspond with the following pelvic characteristics. Ischial spines more protruding into the pelvic cavity.

Male

Gonadal shielding of the male patient for the AP pelvis projection requires that the top of the shield is not extended above the level of:

the pubic symphysis.

A common condition of the femur that develops in elderly patients, leading to frequent fractures of the hip (proximal femur), is:

avascular necrosis.

Which imaging modalitie can be performed on a newborn to assess hip joint stability during movement?

Sonography

Which of the following conditions will produce the radiographic sign erred to as “bamboo spine”?

Ankylosing spondylitis.

Which of the following pathologic conditions often occurs in males older than the age of 45 years?

A. Legg-Calvé-Perthes disease

B. Ankylosing spondylitis

C. Metastatic carcinoma

D. Osteoarthritis

A. Legg-Calvé-Perthes

Which of the following conditions will produce shortening of the epiphyses but widening of the epiphyseal plate?

A. Osteoarthritis

B. Legg-Calvé-Perthes disease

C. Slipped capital femur

D. Chondrosarcoma

C. Slipped capital femur

The use of the 80- to 90-kVp technique (as opposed to 70 kVp) with a corresponding mAs change for an AP pelvis projection will result in:

less gonadal dose

Where is the CR placed for an AP projection of the pelvis?

Midway between the ASIS and the symphysis pubis

What is the ideal amount of abduction of the femurs recommended for an AP bilateral modified Cleaves projection that minimizes foreshortening of the femoral necks?

20-30 n degrees

Which of the following positions will best demonstrate signs of developmental dysplasia of the hip?

A. Posterior oblique (Judet method)

B. Axiolateral, inferosuperior (Danelius-Miller method)

C. AP axial (Taylor method)

D. AP Bilateral modified Cleaves method projection

D. AP Bilateral modified Cleaves method projection

Which of the following positions will best demonstrate the posterior (ilioischial) column and anterior (iliopubic) column of the pelvis?

A. Posterior oblique (Judet method)

B. AP axial (Taylor method)

C. PA axial oblique (Teufel method) projection

D. Modified axiolateral (Clements-Nakayama method)

A. Posterior oblique (Judet method)

What type of CR angle must be used for an AP axial (Taylor method) “outlet” projection for a male patient?

20-35 degrees cephalad.

How much rotation of the body is required for posterior axial oblique projection for acetabulum (Teufel method)?

35-40 degrees

What type of CR angle is required for the posterior axial oblique projection for the acetabulum (Teufel method)?

12 degrees cephalad.

Which of the following projections would be best for a patient with limited movement of both lower limbs (in addition to the AP pelvis)?

A. Modified axiolateral (Clements-Nakayama method)

B. Axiolateral (inferosuperior)

C. Posterior axial oblique (Teufel method)

D. AP axial (Taylor method)

A. Modified axiolateral (Clements-Nakayama method)

The proper name of the method used for the unilateral hip projection that minimizes foreshortening of the femoral neck is the _____ method

modified cleaves

What type of CR angle is required for the AP axial, inlet projection?

40 degrees caudad

A radiograph of an AP pelvis reveals that the lesser trochanters are not visualized. This pelvis projection was performed for nontraumatic reasons. What should the technologist do (if anything) to correct this on the repeat exposure?

Nothing; this is an acceptable image

A radiograph of an AP pelvis reveals that the right iliac wing is foreshortened as compared with the left side. What specific positioning problem is present on this radiograph?

left rotation

A radiograph of an AP pelvis reveals that the left obturator foramen is more open or elongated as compared with the right. What is the specific positioning error present on this radiograph?

right rotation

A radiograph of a unilateral modified Cleaves method projection reveals that the femoral neck is foreshortened and distorted. The radiologist is concerned about pathology involving the neck. What can the technologist do to improve the visibility of the femoral neck without foreshortening during the repeat exposure?

A. Use a 20- to 25-degree cephalad CR angle.

B. Decrease the abduction of the femur to 20 to 30 degrees from vertical.

C. Oblique the patient 35 to 45 degrees toward the affected side with femur abducted to be in contact with tabletop.

D. Increase the abduction of the femur to about 60 to 70 degrees from vertical.

B. Decrease femur abduction to 20 to 30 degrees from vertical.

A radiograph of an axiolateral (inferosuperior) projection of the hip reveals a soft tissue artifact seen across the affected hip. This artifact prevents a clear view of the femoral head and neck. What must the technologist do to eliminate this artifact or its effect during the repeat exposure?

A. Increase the kVp.

B. Ensure that the CR is centered to the grid to prevent grid cutoff.

C. Increase the elevation and flexion of the patient’s unaffected leg.

D. Slightly rotate the patient toward the affected side and angle 5-degree caudad.

C. Increase the elevation and flexion of the patient’s unaffected leg.

A PA axial oblique projection (Teufel method) is performed on a patient. The resultant radiograph demonstrates distortion of the acetabulum. The following positioning factors were used: 40-degree anterior oblique, 12-degree cephalad CR angle, and CR centered to the upside hip (acetabulum). What needs to be modified during the repeat exposure?

A. Increase CR angle to 15-degree cephalad.

B. Change CR angle to 12-degree caudad.

C. Increase rotation of anterior oblique to 45 degrees.

D. Center CR to downside hip (acetabulum).

D. Center CR to downside hip (acetabulum).

A radiograph of an axiolateral (inferosuperior) projection reveals that there is an excessive amount of grid lines present. A 6:1 linear grid was used. Which of the following points will correct this problem on the repeat exposure?

A. Use a screen rather than a grid.

B. Decrease the SID.

C. Keep the image receptor and grid parallel to the femoral neck and perpendicular to the CR.

D. Keep the image receptor and grid perpendicular to the femoral neck.

C. Keep the image receptor and grid parallel to the femoral neck and perpendicular to the CR.

A patient enters the emergency department (ED) having sustained trauma to the pelvis. The patient’s main complaint is about her left hip. Which of the following projections should be taken first to rule out fracture or dislocation?

A. AP pelvis

B. AP projection of the left hip

C. Axiolateral (inferosuperior) projection of the left hip

D. Unilateral modified Cleaves projection of the left hip

A. AP pelvis

A nontrauma patient comes to radiology with a history of chronic pain of the right hip. The patient is ambulatory but has not had previous radiographs taken of that hip. Which of the following routines would be best suited for this patient?

A. AP and axiolateral (inferosuperior) projections of the right hip

B. AP pelvis and axiolateral modified Cleaves projections of the right hip

C. AP pelvis and modified axiolateral (Clements-Nakayama) projections of the right hip

D. AP pelvis and AP axial (Taylor method) projections of the right hip

B. AP pelvis and axiolateral modified Cleaves projections of the right hip

A radiograph of an AP axial (Taylor method) “outlet” projection reveals that the obturator foramina are not symmetric. What type of positioning error is present on this radiograph?

Rotation of the pelvis

During a repeat study of the AP axial (Taylor method) outlet projection, both obturator foramina are symmetric but the ischial and pubic rami are not elongated. Which of the following positioning modifications must be performed to correct this error?

A. Increase the cephalic CR angulation.

B. Increase the caudad CR angulation.

C. Correct for rotation.

D. Use a perpendicular CR.

A. Increase the caudad CR angulation.

A patient enters the ED with a possible fracture of the inferior ischial ramus caused by trauma. The AP pelvis projection is inconclusive for determining the extent of the injury. What other projection can be taken to evaluate this region without excessive movement of the patient?

A. Posterior oblique (Judet method) projection

B. AP axial “inlet” projection

C. Axiolateral (inferosuperior) projection

D. AP axial (Taylor method) outlet projection

D. AP axial (Taylor method) outlet projection

A patient comes to radiology with a request for a right hip study. He is from an extended care facility and is confused about the cause of the injury. The technologist takes an AP pelvis, and when the lateral modified Cleaves projection is attempted, the patient complains loudly about the pain in his affected hip. What should the technologist do to complete the study?

Perform the axiolateral (inferosuperior) projection.

A patient enters the ER with possible bilateral fractured hips. Which of the following routines should be performed?

A. AP pelvis and axiolateral (inferosuperior) projections for both hips

B. AP pelvis and modified axiolateral (Clements-Nakayama method) projections for both hips

C. AP pelvis and bilateral modified Cleaves projections

D. AP pelvis and posterior oblique (Judet method) projections

B. AP pelvis and modified axiolateral (Clements-Nakayama method) projections for both hips.

A patient comes to the ER with a possible fracture of the pelvic inlet region. The initial AP pelvis projection is inconclusive. What other projection(s) can be taken to assist with the diagnosis?

A. AP axial (40-degree caudad) projection

B. AP, bilateral modified Cleaves method projection

C. Modified axiolateral (Clements-Nakayama method) projection

D. PA axial oblique (Teufel method) projection

A. AP axial (40-degree caudad) projection

A radiograph of an AP pelvis demonstrates that the right obturator foramen is foreshortened but the left foramen is open. What positioning error is present on this radiograph?

right rotation

A patient enters the ER with a possible pelvic ring fracture due to an MVA. The initial pelvis projections do not reveal any fracture or dislocation, but the ER physician is concerned about a possible right acetabular fracture. Which of the following projections will best demonstrate the right acetabulum?

A. AP axial inlet projection

B. Axiolateral inferosuperior projection (Danelius-Miller method)

C. Modified axiolateral projection (Clements-Nakayama method)

D. Posterior oblique pelvis projection (Judet method)

D. Posterior oblique pelvis projection (Judet method)

Which of the following lateral hip projections cannot be performed on a trauma patient with a possible hip fracture?

A. Modified Cleaves method

B. Clements-Nakayama

C. Danelius-Miller

D. AP axial inlet projection

A. Modified Cleaves method

Which of the following projections requires that the IR be tilted 15 degrees from the vertical plane?

A. AP axial inlet projection

B. Axiolateral inferosuperior projection (Danelius-Miller method)

C. Modified axiolateral projection (Clements-Nakayama method)

D. Posterior axial oblique projection (Teufel method)

C. Modified axiolateral projection (Clements-Nakayama method)

Which of the following imaging modalities will best detect early signs of bone infection of the pelvis?

A. Radiography

B. CT

C. Nuclear medicine

D. MRI

C. Nuclear medicine

A study of a prosthetic hip demonstrates that the end of the prosthesis is cut off on the AP projection, but the entire device is demonstrated on the lateral projection. What should the technologist do next?

Repeat the AP projection only

How much CR angle, from the horizontal, is required for the modified axiolateral (Clements-Nakayama) projection?

15-20 degrees

Which of the following projections can be performed to rule out a subtle fracture of the lower pelvic ring?

A. Danelius-Miller projection

B. Inlet projection

C. Teufel method

D. Bilateral Judet method

D. Bilateral Judet method

Which one of the following projections will best demonstrate a possible impingement issue between the acetabulum and aspects of the femoral head?

A. AP bilateral hip (modified Cleaves method) projection

B. AP oblique (Judet method) projections

C. AP oblique (false profile) projection

D. PA axial oblique (Teufel method) projection

C. AP oblique (false profile) projection

A malignancy spread to bone via the circulatory, lymphatic systems, or direct invasion is called:

metastatic carcinoma

A disease producing extensive calcification of the longitudinal ligament of the spinal column

Ankylosing spondylitis

Degenerative joint disease is called:

osteoarthritis

A malignant tumor of the cartilage is called:

chondrosarcoma

Is now referred to as “developmental dysplasia of the hip”

Congenital dislocation of the hip

A fracture resulting from a severe blow to one side of the pelvis is called:

Pelvic ring (contre coup) fracture

Fractures that occur in adolescent athletes who experience sudden, forceful, or unbalanced contraction of the tendinous and muscular attachments on the bony pelvis

avulsion fractures

True or False The term pelvic girdle refers to the total pelvis including lumbar spine.

False; the pelvic girdle specifically refers to the bony ring formed by the pelvic bones, excluding the lumbar spine.

True or False Gonadal shielding should be used on both male and female for AP pelvis projection.

False; gonadal shielding is recommended only for male patients.

True or False An AP pelvis and posterior oblique (Judet method) projection, is recommended to rule out a possible pelvic ring fracture.

True

True or False The posterior oblique (Judet method) for the acetabulum requires a 10- to 15-degree rotation of the body

False; the posterior oblique (Judet method) typically requires a 45-degree rotation of the body to obtain optimal visualization of the acetabulum.

True or False Only a small part of the lesser trochanter, if any, will be visible on a well-positioned axiolateral (inferosuperior) lateral hip.

True

True or False The image receptor must be placed parallel to the femoral neck for the axiolateral (inferosuperior) projection of the hip.

True

True or False AN AP hip projection must be repeated if the prosthetic hip device is not included in its entirety.

True

True or False Less abduction of femora of only 20 to 30 degrees from vertical provides will minimize distortion of the femoral necks when performing the AP bilateral modified Cleaves projection.

True

True or False If a patient has excessive external rotation of one foot, a fractured hip may be indicated.

True

True or False The modified false profile projection requires internal rotation of the dependent lower limb of 45 degrees away from the IR.

False; the dependent limb should be internally rotated 45 degrees toward the IR.