CLASS 9 TEST (Femur, Hip, and Pelvis)

What positioning landmark is the same level as the pubic symphysis?

Greater trochanters

How much should the feet and lower limbs be inverted on an AP pelvis?

15-20 degrees

What is the method name for an AP oblique hip?

Modified Cleaves method

What is the method name for an Axiolateral hip?

Danelius-Miller method

What is the method name for a lateral hip?

Lauenstein method

What is the difference btwn the Lauenstein and Hickey methods?

The Hickey method has a 20-25 degree cephalic angle

CR location for a Lateral femur:

CR perpendicular and 1/3 from the anterior surface of the femur.

CR location for an AP pelvis:

CR perpendicular and 1/2 way btwn the pubic symphysis and the ASIS at the MSP.

CR location for an AP hip:

CR perpendicular to the femoral neck.

CR location for an AP oblique hip:

CR perpendicular to the femoral neck. (1" superior to PS)

CR location for a Lateral hip (Lauenstein):

CR perpendicular to the femoral neck

CR location for an Axiolateral hip:

CR is horizontal and perpendicular to the femoral neck.

The central ray for an AP pelvis is directed perpendicular to the center of the IR. The central-ray entrance point will be about _____ inches _____ to the pubic symphysis.

2; superior

How many degrees should the feet and lower limbs be internally rotated for an AP pelvis radiograph?

15 to 20 degrees

The respiration phase for the axiolateral projection of the hip (Danelius-Miller) is:

suspended respiration

Which of the following methods will demonstrate the hip in a lateral projection?

Lauenstein, Hickey

Which of the following methods demonstrate the hip in an axiolateral projection?

Danelius-Miller

The neck of the femur projects anteriorly at an approximate angle of _____ degrees.

15 to 20

Where is the central ray directed for the AP oblique projection (modified Cleaves) of the femoral necks?

1 inch superior to the pubic symphysis

Which of the following describes the direction of the central ray for an axiolateral projection of the hip (Danelius-Miller)? 1. Perpendicular to the IR 2. Perpendicular to the long axis of the femoral neck 3. Perpendicular to the long axis of the femur

1 and 2

Which of the following will be shown "in profile" if the lower limbs are in correct position for an AP pelvis?

Greater trochanters

Which of the following methods will demonstrate the femoral necks in the AP oblique projection?

Modified Cleaves

Which of the following describes the position of the IR for the axiolateral projection of the hip (Danelius-Miller)? 1. Parallel with the long axis of the femoral neck 2. Its upper border in the crease above the iliac crest 3. Perpendicular to the long axis of the femur

1 and 2

Unless contraindicated, the lower limb and leg should be internally rotated for an axiolateral projection of the hip (Danelius-Miller). How many degrees of rotation are required?

15-20

Which of the following is an important and frequently used radiographic positioning reference point?

Anterior superior iliac spine

The hip bone is composed of which of the following? 1. Ilium 2. Pubis 3. Ischium

1, 2, and 3

Where is the IR centered for an AP pelvis?

Midway between the ASIS and the pubic symphysis

The ilia articulates with the sacrum posteriorly at the:

sacroiliac joints

The strongest bone in the body is the:

femur

What positioning error is evident in the image below?

The lower limbs were not internally rotated

The part identified on the ilium above is the _____ iliac spine.

anterior superior

What anatomy is labeled as letter C in the image below?

ASIS

What anatomy is labeled as letter B in the image below?

Lesser trochanter

The area identified on the bone shown above is the:

intertrochanteric crest

Which projection of the hip is shown in the figure above?

Axiolateral

The area of anatomy indicated on the figure above is the:

obturator foramen

What anatomy is labeled as letter A in the image below?

Acetabulum

AOI: Axiolateral Hip (Cross Table)

- hip

- acetabulum

- head

- neck

-trochanters of femur

Foot/Leg Inversion:

- AP Femur (Proximal)

- AP Pelvis

- AP Hip

- Axiolateral Hip

No Foot/Leg Inversion:

- AP Femur (Distal)

- Lateral Femur

- AP Oblique Hip

- Lateral Hip

AOI: AP Femur (Proximal/Distal)

- femur

- both joints

AOI: Lateral Femur (Proximal/Distal)

- 3/4 of femur

- adjacent joint

AOI: AP Pelvis

- pelvis

- head

- neck

- proximal 1/3 of femur

AOI: AP Hip

- head

- neck

- trochanters

- proximal 1/3 of femur

AOI: AP Oblique Hip (Modified Cleaves)

- oblique projection of hip

- head

- neck

- trochanter

AOI: Lateral Hip (Lauenstein Method)

- lateral projection of hip

- acetabulum

- proximal femur

IA Positioning: AP Femur (Proximal)

- leg internally rotated (10-15 degrees)

- femoral neck not foreshortened

- only a small amount of lesser trochanter visible beyond medial border

- greater trochanter in profile

IA Positioning: AP Femur (Distal)

- condyles are symmetrical (indicates no rotation)

IA Positioning: Lateral Femur (Proximal)

- knee flexed 45 degrees

- greater trochanter super-imposed over femoral neck

- lesser trochanter visible beyond medial border

IA Positioning: Lateral Femur (Distal)

- knee flexed 45 degrees

- anterior/posterior condyles superimposed

- open patellofemoral space

- patella in profile

IA Positioning: AP Pelvis

- leg internally rotated (15-20 degrees)

- femoral neck not foreshortened

- only a small amount of lesser trochanter visible beyond medial border

- greater trochanter in profile

- crests on same level and symmetrical

- symmetrical obturator foramen

- ischial spine seen/not seen (equally on both sides)

- sacrum and coccyx aligned to PS

IA Positioning: AP Hip

- leg internally rotated (15-20 degrees)

- greater trochanter in profile

- femoral neck not foreshortened

- only a small amount of lesser trochanter visible beyond medial border

- 1/3 of proximal femur should be seen

IA Positioning: AP Oblique Hip (Modified Cleaves)

- no rotation of pelvis

- femur approx. 25-45 degree angle from table

- femoral neck is seen without super-imposition of greater trochanter

- lesser trochanter visible beyond medial border

IA Positioning: Lateral Hip (Lauenstein Method)

- femur is parallel to IR

- femoral neck is super-imposed by greater trochanter

IA Positioning: Axiolateral Hip

- femoral neck seen without overlap of the greater trochanter

- ischial tuberosity seen below the femoral head

- soft tissue of unaffected thigh without overlap of AOI

- small amount of lesser trochanter visible on posterior side

- small amount of greater trochanter visible on anterior and posterior portions of femur

Method Name: Axiolateral Hip

Danelius-Miller Method

Method Name: AP Oblique Hip

Modified Cleaves

Method Name: Lateral Hip

Lauenstein Method

What is the purpose of inverting the foot/feet on an AP hip or AP pelvis?

To show the head, neck and proximal femur

To place the femoral neck parallel to the IR

To place the femoral neck perpendicular to the IR

To reduce scatter and improve contrast

To place the femoral neck parallel to the IR

Where should the top of the IR be placed on an AP proximal femur?

Iliac crest

2" below the crest

ASIS

1" superior to the iliac crest

ASIS

What positioning landmark is located at the same level as the pubic symphysis?

Iliac crest

Greater trochanter

Lesser trochanter

Ischial tuberosity

Greater trochanter

What is the method name for the AP oblique hip projection (frog leg)?

Danelius-Miller

Lauenstein

Modified Cleaves

Judet

Modified Cleaves

What is the purpose of using a grid on a hip and pelvis?

To improve contrast and reduce scatter

So you will use less mAs

To increase scatter

To reduce contrast

To improve contrast and reduce scatter

What is the anatomy of interest on a Danelius-Miller?

Distal femur

Pelvis

Ischial tuberosity

Head, neck and proximal femur

Pubis bone

Head, neck and proximal femur

What is the projection on the Danelius-Miller method?

Lateral

AP oblique

Axiolateral

AP

Axiolateral

How much should the lower legs and feet be inverted on an AP pelvis or an AP hip?

10-15 degrees

15-20 degrees

20-30 degrees

25 degrees

15-20 degrees

If an AP oblique hip is contraindicated, what projection should be done instead?

Lateral hip

Modified Cleaves

Axiolateral (Danelius-Miller)

Lauenstein

Axiolateral (Danelius-Miller)

Where should you place the bottom of the IR for a distal lateral femur?

At the knee joint

2" above the popliteal line

At the popliteal line

2" below the popliteal line

2" below the popliteal line

On an axiolateral "cross-table" hip, the central ray should be __________ to the IR and the neck of the femur.

Parallel

Perpendicular

15-30 degree medial angle

20-40 degree medial angle

Perpendicular

What is the projection on the Lauenstein method of the hip?

AP oblique

AP

Axiolateral

Lateral

Lateral

For the Lauenstein method, the femur should be positioned ____________ to the IR.

Perpendicular

Parallel

Obliqued

Horizontal

Parallel

Where is the top of the IR placed on an AP pelvis?

2" superior to the crest

At the pubic symphysis

1 1/2" superior to the crest

At the crest

1 1/2" superior to the crest

What is the position of the femur on a Modified Cleaves projection?

Lateral

AP

25-45 degree angle from table/IR

Obliqued 75 degrees

25-45 degree angle from table/IR

What should be included in it's entirety (in addition to the AOI) on a post-surgery hip exam?

Any hardware or prosthesis

The entire femur

Both hips for comparison

The entire pelvis

Any hardware or prosthesis

What is the routine for a trauma hip?

AP pelvis or hip and modified Cleaves

AP pelvis or hip and Lauenstein

PA pelvis or hip and modified Cleaves

AP pelvis or hip and axiolateral hip

AP pelvis or hip and axiolateral hip

In localizing the femoral neck a line is first drawn from the _________ to the superior pubic symphysis.

Top of the crest

ASIS

Greater trochanter

Lesser trochanter

ASIS

In localizing the femoral neck, the second line is drawn from 1" inferior to the _____________ to the midpoint of the first line.

Top of the crest

ASIS

Greater trochanter

Lesser trochanter

Greater trochanter

Where should the bottom of the IR be placed for an AP distal femur?

At the popliteal line

1" above the popliteal line

2" below the popliteal line

At the level of the apex of the patella

2" below the popliteal line

Using the localization method, after the first and second lines are drawn, then center ____________ below the intersection of the localization lines for the femoral neck.

1"

1 1/2"

2 1/2"

3"

2 1/2"

Identify the projection:

AP Hip

Axiolateral Hip (Danelius-Miller)

AP oblique hip (Modified Cleaves)

Lateral hip (Lauenstein)

AP oblique hip (Modified Cleaves)

Identify the projection:

AP Hip

Axiolateral Hip (Danelius-Miller)

AP oblique hip (Modified Cleaves)

Lateral hip (Lauenstein)

Lateral Hip (Lauenstein)

Identify the projection:

AP hip

AP oblique hip

AP pelvis

Lateral hip

AP Pelvis

Identify the projection:

AP hip

AP oblique hip

Lateral hip

Axiolateral hip

Axiolateral Hip

For the AP oblique hip (Modified Cleaves) the CR is:

15-20 degrees cephalic

20-25 degrees caudal

Perpendicular

15 degrees caudal

Perpendicular

The ilia articulate with the sacrum posteriorly at the:

Hip joint

Pubic symphysis

Sacroiliac joints

L5-S1 area

Sacroiliac joints

How many degrees should the foot and lower limb be internally rotated for an AP femur radiograph?

5-10 degrees

15-20 degrees

20-30 degrees

10-15 degrees

10-15 degrees

Identify the anatomy marked A:

Pubis bone

Head of the femur

Femoral neck

Ischial tuberosity

Coccyx

Ischial tuberosity

The anatomy marked with #6 is the:

Acetabulum

Lesser trochanter

Obturator foramen

Greater trochanter

Ischial spine

Ischial spine

Identify the anatomy marked with #7:

Pubic symphysis

Ischial tuberosity

Pubic bone

ilium

Pubic bone

Is this pelvis rotated?

Yes

No

I'm not sure

Yes

Identify this projection:

AP femur

AP pelvis

AP hip

Modified Cleaves

AP hip

Choose three reasons why the inferior condyles are not SI on this image:

The med condyle is inferior to the lat condyle

Poor positioning

No angle on the CR

Poor centering

The divergence of the beam

The med condyle is inferior to the lat condyle

No angle on the CR

The divergence of the beam

The anatomy marked with #3 is the:

Acetabulum

Lesser trochanter

Obturator foramen

Greater trochanter

Ischial spine

Greater trochanter