MERRILL'S POSITIONING HIP AND PELVIS

HIP LATERAL PROJECTION (LAUENSTEIN AND HICKEY METHODS) MEDIOLATERAL: PURPOSE

to show the hip joint and the relationship of the femoral head to the acetabulum

HIP LATERAL PROJECTION (LAUENSTEIN AND HICKEY METHODS) MEDIOLATERAL: POSITION OF PT

from the supine position, rotate the pt slightly toward the affected side to an oblique position

HIP LATERAL PROJECTION (LAUENSTEIN AND HICKEY METHODS) MEDIOLATERAL: POSITION OF PART

pt flex affected knee and draw the thigh up to a position at nearly a right angle to the hip bone

HIP LATERAL PROJECTION (LAUENSTEIN METHOD) MEDIOLATERAL: CENTRAL RAY

perpendicular through the hip joint, which is located midway between the ASIS and the pubic symphysis

HIP LATERAL PROJECTION (HICKEY METHOD) MEDIOLATERAL: CENTRAL RAY

perpendicular through the hip joint and at a cephalic angle of 20 to 25 degrees and an additional 1 inch more inferior

HIP LATERAL PROJECTION (LAUENSTEIN AND HICKEY METHODS) MEDIOLATERAL: STRUCTURES SHOWN

lateral projection of the hip, including acetabulum, the proximal end of the femur, and the relationship of the femoral head to the acetabulum

HIP AXIOLATERAL PROJECTION (DANELIUS-MILLER METHOD): NOTE

projection is often called the cross-table or surgical-lateral projection

HIP AXIOLATERAL PROJECTION (DANELIUS-MILLER METHOD): POSITION OF PART

for thin pt’s or lying on a soft bed, elevate the pelvis on a firm pillow or folded sheets sufficiently to center the most prominent point of the greater trochanter to the midline of the IR

HIP AXIOLATERAL PROJECTION (DANELIUS-MILLER METHOD): POSITION OF PART

when the pelvis is elevated, support the affected limb at hip level on sandbags or firm pillows

HIP AXIOLATERAL PROJECTION (DANELIUS-MILLER METHOD): POSITION OF PART

flex the knee and hip of the unaffected side to elevate the thigh in a vertical position

HIP AXIOLATERAL PROJECTION (DANELIUS-MILLER METHOD): POSITION OF PART

unless contraindicated, grasp the heel and medially rotate the foot and lower limb of the affected side approximately 15 to 20 degrees

HIP AXIOLATERAL PROJECTION (DANELIUS-MILLER METHOD): POSITION OF IR

place the IR in the vertical position with its upper border in the soft tissue crease above the iliac crest

HIP AXIOLATERAL PROJECTION (DANELIUS-MILLER METHOD): POSITION OF IR

angle the IR away from the body until it is exactly parallel with the long axis of the femoral neck

HIP AXIOLATERAL PROJECTION (DANELIUS-MILLER METHOD): CENTRAL RAY

perpendicular to the long axis of the femoral neck; central ray enters the groin area at a point midway between the anterior and posterior surfaces of the upper thigh and passes through the femoral neck, which is approximately 2.5 inches below the point of intersection of the localization lines

HIP AXIOLATERAL PROJECTION (DANELIUS-MILLER METHOD): STRUCTURES SHOWN

acetabulum, head, neck and trochanters of the femur

MODIFIED AXIOLATERAL PROJECTION (CLEMENTS-NAKAYAMA MODIFICATION): NOTE

when the pt has bilateral hip fractures, bilateral hip arthroplasty or limitation of movement of the unaffected leg, this method can’t be used to

What modification uses a 15-degree posterior angulation of the central ray?

Clements-Nakayama

MODIFIED AXIOLATERAL PROJECTION (CLEMENTS-NAKAYAMA MODIFICATION): POSITION OF PT

pt is supine on the table with the affected side near the edge of the table

MODIFIED AXIOLATERAL PROJECTION (CLEMENTS-NAKAYAMA MODIFICATION): POSITION OF PART

do not rotate lower limb internally, instead the limb remains in a neutral or slightly externally rotated position

MODIFIED AXIOLATERAL PROJECTION (CLEMENTS-NAKAYAMA MODIFICATION): POSITION OF PART

adjust the grid parallel to the axis of the femoral neck and tilt its top back 15 degrees

MODIFIED AXIOLATERAL PROJECTION (CLEMENTS-NAKAYAMA MODIFICATION): CENTRAL RAY

directed 15 degrees posteriorly and aligned perpendicular to the femoral neck and the grid

MODIFIED AXIOLATERAL PROJECTION (CLEMENTS-NAKAYAMA MODIFICATION): STRUCTURES SHOWN

acetabulum and proximal femur-including the head, neck, and trochanters-in lateral profile

PA AXIAL OBLIQUE PROJECTION (TEUFEL METHOD) RAO OR LAO POSITION: POSITION OF PT

pt lie recumbent in an anterior oblique position on the affected side

PA AXIAL OBLIQUE PROJECTION (TEUFEL METHOD) RAO OR LAO POSITION: POSITION OF PART

elevate the unaffected side so that the anterior surface of the body forms a 38-degree angle from the table

PA AXIAL OBLIQUE PROJECTION (TEUFEL METHOD) RAO OR LAO POSITION: CENTRAL RAY

directed through the acetabulum at an angle of 12 degrees cephalad; the central ray enters the body at the inferior level of the coccyx and approximately 2 inches lateral to the MSP toward the side being examined

PA AXIAL OBLIQUE PROJECTION (TEUFEL METHOD) RAO OR LAO POSITION: STRUCTURES SHOWN

fovea capitis and the superoposterior wall of the acetabulum

AP OBLIQUE PROJECTION (JUDET METHOD) RPO OR LPO POSITION

JUDET described two 45-degree posterior oblique positions that are useful in diagnosing fractures of the acetabulum: the internal oblique position (affected side up) and the external oblique position (affected side down); both positions must be performed to demonstrate the entire acetabulum, as well as the iliopubic and ilioischial columns of the affected side

AP OBLIQUE PROJECTION (JUDET METHOD) RPO OR LPO POSITION INTERNAL OBLIQUE

used for a pt with a suspected fracture of the iliopubic column and the posterior rim of the acetabulum

AP OBLIQUE PROJECTION (JUDET METHOD) RPO OR LPO POSITION INTERNAL OBLIQUE: NOTE

iliopubic column (anterior), composed of a short segment of the ilium and the pubis, extends up as far as the anterior spine of the ilium and from the symphysis pubis and obturator foramen through the acetabulum to the ASIS

AP OBLIQUE PROJECTION (JUDET METHOD) RPO OR LPO POSITION INTERNAL OBLIQUE: POSITION OF PT

place the pt in a posterior oblique position with the affected hip up

AP OBLIQUE PROJECTION (JUDET METHOD) RPO OR LPO POSITION INTERNAL OBLIQUE: POSITION OF PART

elevate the affected side so that the MCP of the body forms a 45-degree angle from the table

AP OBLIQUE PROJECTION (JUDET METHOD) RPO OR LPO POSITION INTERNAL OBLIQUE: CENTRAL RAY

perpendicular to the IR and entering 2 inches inferior to the ASIS of the affected side

AP OBLIQUE PROJECTION (JUDET METHOD) RPO OR LPO POSITION EXTERNAL OBLIQUE

used for a pt with a suspected fracture of the ilioischial column (posterior) and the anterior rim of the acetabulum

AP OBLIQUE PROJECTION (JUDET METHOD) RPO OR LPO POSITION EXTERNAL OBLIQUE: POSITION OF PT

place the pt in a posterior oblique position with the affected hip down

AP OBLIQUE PROJECTION (JUDET METHOD) RPO OR LPO POSITION EXTERNAL OBLIQUE: POSITION OF PART

elevate the unaffected side so that the MCP of the body forms a 45-degree angle from the table

AP OBLIQUE PROJECTION (JUDET METHOD) RPO OR LPO POSITION EXTERNAL OBLIQUE: CENTRAL RAY

perpendicular to the IR and entering at the pubic symphysis

AP OBLIQUE PROJECTION (JUDET METHOD) RPO OR LPO POSITION EXTERNAL OBLIQUE: STRUCTURES SHOWN

acetabular rim

AP OBLIQUE PROJECTION (JUDET METHOD) RPO OR LPO POSITION EXTERNAL OBLIQUE: NOTE

ilioischial column (posterior), composed of the vertical portion of the ischium and the portion of the illium immediately above ischium, extends from the obturator foramen through the posterior aspect of the acetabulum

UPRIGHT LEG MEASUREMENT PROCEDURE: POSITION OF PT

stand the pt upright with the back against the vertical imaging stand

UPRIGHT LEG MEASUREMENT PROCEDURE: POSITION OF PART

if the two lower extremities are examined simultaneously, separate the ankles 5 to 6 inches and place the specialized ruler between the pt and the IR, with the top at the level of the pelvis and extending down between the legs

UPRIGHT LEG MEASUREMENT PROCEDURE: POSITION OF PART

if the extremities are examined separately, position the pt with the special ruler behind each extremity

UPRIGHT LEG MEASUREMENT PROCEDURE: LOCALIZATION OF JOINTS

localize each joint and mark the central ray centering point

UPRIGHT LEG MEASUREMENT PROCEDURE: LOCALIZATION OF JOINTS

locate the hip joint by placing a mark 1 to 1 ¼ inches laterodistally and at a right angle to the midpoint of an imaginary line extending from the ASIS to the pubic symphysis

UPRIGHT LEG MEASUREMENT PROCEDURE: LOCALIZATION OF JOINTS

locate the knee joint just below the apex of the patella at the level of the depression between the femoral and tibial condyles

UPRIGHT LEG MEASUREMENT PROCEDURE: LOCALIZATION OF JOINTS

locate the ankle joint directly below the depression midway between the malleoli

UPRIGHT LEG MEASUREMENT PROCEDURE: PROCEDURE 1ST EXPOSURE

exposure field is centered to the pt’s hip

UPRIGHT LEG MEASUREMENT PROCEDURE: PROCEDURE 2ND EXPOSURE

exposure field is centered to the pt’s knee joint

UPRIGHT LEG MEASUREMENT PROCEDURE: PROCEDURE 3RD EXPOSURE

exposure field is centered to the pt’s ankle joint

UPRIGHT LEG MEASUREMENT PROCEDURE: CENTRAL RAY

perpendicular to the center of the IR for the manual procedure

*for the automated procedure, there may be a small cephalad angle for the hip exposure and a small caudad angle for the ankle exposure

UPRIGHT LEG MEASUREMENT PROCEDURE: STRUCTURES SHOWN

a composite of the three exposures digitally stitched into one image, which includes anatomy from the hip joints to the ankle joints