HIP & PELVIS- POSITIONING NOTES & DEMO

pelvis nontrauma views

AP & FROG

pelvis trauma views

AP & BOTH OBLIQUES

Hip nontrauma views

AP & FROG

hip trauma views

AP & LATERAL

a cross table lateral should be obtained if….

obvious fracture is present on AP image or pt is unable to do frog

pelvis techniques

85 kVp, 12.5 mAs, outer cells

AP pelvis overview

• Collimation- 17x14 CW

• center to level of soft tissue depression (1.5”) above greater troch (bisect ASIS & symph)

  • top of light 1.5” above crest

• MEDIALLY ROTATE LEGS IN 15-20 DEGREES to tuck the lesser

AP pelvis centering: on avg size patient scenter of IR is about…

2” inferior to ASIS & 2” superior to symph

sid & breathing for all pelvis & hip

40”

SUSPENDED RESPIRATION

AP pelvis evaluation criteria (for me to remember)

*Narrowed obturator foramina indicates rotation in that direction

*from crest to symph!!!

• entire pelvis w/ proximal femora

• sacrum & coccyx aligned w/ symph

• greater in profile

AP pelvis, if lesser troch is visible it means

legs are not medially rotated in

AP pelvis, if rotated…

ala would be turned & obturator foramen will not be equal looking

AP pelvis additional note

proximal orthopedic devices should be seen in entirety

AP oblique modified cleaves method “frog lateral” overview: pelvis

• Collimation- 17x14 CW

• centering- same as AP

• Long axis of femur should form 60-70 degree angle from table

  • Abduct both thighs 45 degrees, turning feet inward

AP oblique modified cleaves method “frog lateral”- evaluation criteria

• Acetabulum, femoral head and femoral neck clearly demonstrated

• RH: As much of the femoral neck should be seen as possible without overlap of the greater trochanter

• Femoral axes extended from the hip bones at equal angles. 

merrills note evaluation criteria for frog lateral pelvis

femoral neck WITHOUT superimposition by greater troch

• excessive abduction causes greater to obstruct the neck

additional nontrauma pelvis frog notes

• if patient has an orthopedic device, entire device must be seen on the AP and frog views

  • Exception to above: If patient has an intramedullary femoral rod, only the proximal aspect of the prosthesis needs to be included.

merrills centering for frog lateral pelvis

center at MSP & 1” superior to symph

pelvis frog lateral: over abduction/ over flexed

femoral necks are superimposed by greater

pelvis frog lateral: rotation

ilioischial column pops out & opposite obturator is more narrow

pelvis RPO & LPO judet method overview

• Collimation- 17x14 CW

• Patient 45 degrees

• Center 1.5”-2” (V-space) medial to elevated ASIS

  • Top of light field should be 1-1.5” above crest of elevated ilium 

• Mark side down for each view, place horizontally in upper corner 

pelvis RPO & LPO judet method evaluation criteria

• Entire pelvis up to and including the lesser trochanters visualized on both sides

• The broad surface of the iliac wing closest to the IR should be demonstrated without rotation

• The acetabulum closest to the IR should be seen in profile

• The hip joints, proximal femur and sacroiliac joint should be clearly demonstrated 

pelvis RPO & LPO judet method: under rotation

iliopubic column not SCOOPED, ilioischial column can NOT see spine

pelvis RPO & LPO judet method: over rotated

on pelvis going OVER the other side of symph

merrills note for pelvis RPO & LPO judet method

ilioischial column & anterior acetabular rim visualized on side DOWN

iliopubic column & posterior acetabular rim visualized on ELEVATED HIP

additional trauma RPO & LPO pelvis judet method notes

• If patient presents due to injury or some type of trauma, you always do trauma routine regardless of patient mobility.

• If patient has an orthopedic device, entire device must be seen on the AP and oblique views

  • Exception to above: If patient has an intramedullary femoral rod, only the proximal aspect of the prosthesis needs to be included.

merrills note for centering for judet method oblique pelvis

perform a unilateral hip view

• centering 2” inferior to elevated ASIS

superioinferior inlet (BRIDGEMAN)-pelvis

40 degree CAUDAD ASIS

• pelvis ring & inlet entirely

what special view is this?

superoinferior axial inlet (Bridgeman method)

outlet taylor pelvis

cephalad angle to see rami without foreshortening

• males= 20-35 degrees

• females= 30-45 degrees

what pelvis special view is this?

AP axial OUTLET projection (Taylor method)

axiolateral cleaves: pelvis

cephalad to femoral shafts(25-45 degrees)

what pelvis special view is this?

axiolateral (original cleaves method)

pelvis special view: lateral (left or right) purpose

lateral lumbosacral junction, sacrum, coccyx, & superimposed hip bones & upper femora

what pelvis special view is this?

lateral pelvis

AP hip & oblique frog lateral technique

85 kVp, 10 mAs, center cell

AP hip overview:

• Collimation- 10x12 LW

• medially rotate legs 15-20 degrees inward

• Centering

  • PERPENDICULAR TO FEMORAL HEAD

    • 1.5” distal to midpoint of bisection of ASIS & symph

AP hip evaluation criteria:

• SYMPH

• Proximal one-third of the femur

• Femoral head, penetrated and seen through the acetabulum

• Any orthopedic appliance should be demonstrated in its entirety 

merrills centering for AP hip/ frog lateral

femoral neck (2 ½” distal to bisection of ASIS & symph)

hip note: if patient has hardware…

entire device must be on both hip views

• unless a femoral rod, only proximal aspect

AP oblique modified cleaves method (FROG LATERAL) overview:

• Collimation- 10x12 LW

• Long axis of femur 60-70 degrees from table

  • 45 degree abduction of thigh (use sponge to support)

• Centering (SAME AS AP)

  • The way techs do it: Have pt bend knee & center where hip joint is

  • 1.5” distal (4 fingers) to bisection of ASIS & symph 

AP oblique modified cleaves method (FROG LATERAL) evaluation criteria:

• No rotation of the pelvis

•  Acetabulum, femoral head, and femoral neck clearly demonstrated 

• Lesser trochanter visible on the medial side of the femur 

• RH: As much of the femoral neck should be seen as possible without overlap of the greater trochanter

• Excessive abduction causes the greater trochanter to obstruct the neck 

• Femoral axes extended from the hip bones at equal angles 

AP oblique: modified cleaves method: merrills note for criteria

femoral neck WITHOUT superimposition by greater troch

rotation for hip frog: too much abduction/ flexion

greater superimposes neck & head

rotation for hip frog: too little abduction/ flexion

greater still in profile

axiolateral danelius miller method (cross table lateral hip): technique

90 kVp, 32 mAs, center cell

axiolateral danelius miller method (cross table lateral hip):

40” SID- gridded free detector

56-60” fwall bucky

12×10 CW

axiolateral danelius miller method (cross table lateral hip): collimation:

12×10 CW

axiolateral danelius miller method (cross table lateral hip): centering : wall bucky

rotated foot end of bed 45 degrees AWAY from IR, center to groin (buttcheek)

axiolateral danelius miller method (cross table lateral hip): centering: free detector

Angle inferior border of detector away from the body 45 degrees so it is parallel with the femoral neck. Angle central ray 45⁰ into the groin to maintain alignment with the free detector. Adjust the detector and beam so they maintain 40” SID and alignment.

joint center note for ischial tuberosity

does NOT need to be included at joint center

hip- special view: modified axiolateral (Clements-nakayama method) purpose

lateral view for fractures or dislocation

hip- special view: modified axiolateral (Clements-nakayama method) angle

15 degree posterior angle

what hip special view is this?

modified axiolateral (Clements-nakayama method)

If a patient presents to the ED with a possible hip fracture with hip/ pelvis and chest x-ray orders…

 hip/pelvis images should be obtained prior to a chest x-ray!