DRMG2104IMAGE EVALUATION 1

LECTURE 6PELVIC GIRDLE

MOHD IMRAN BIN MOHDBachelor of Diagnostic Imaging & Radiotherapy ( UKM )

RADIOGRAPH EVALUATION

P-PROJECTION/POSITION A-AREA C-COLLIMATION & CR E-EXPOSURE M-MARKER A-ALIGNMENT N-NAME(ID)

SUB TOPIC

HIP PELVIS SI Joint

PELVIS (AP)

PELVIS (AP) Projection/position:-

True AP- ischial spine aligned-pelvic brim Sacrum-coccyx aligned-symphysis pubis Ilia & obturator foramen uniform in size and shape

Leg positioning (15-20° internally) Femoral neck not foreshortened Greater trochanter in profile laterally Lesser trochanter superimposed with femoral

neck

Projection/position AP Hip Rotation detection :-

ischial spine not superimposed with pelvic brim

Sacrum/coccyx not aligned with symphysis pubis

-rotated away from side of rotation Ilium wider on side of rotation Obturator foramen narrower on side of

rotation

AREA : pelvis SIJ , hip joint & symphysis pubis ( sp ) upper femur L5 and L4 Recognized the shielding area ( male /

female ) if necessary.

FEMALE PELVIS-GONAD SHIELD

MALE PELVIS-GONAD SHIELD

FEMALE PELVIS

MALE PELVIS

Collimation : Upper border include : iliac crest Lower border included : ischial tuberosity & upper

femur Lateral border : both rt & lt greater trochanters

Exposure : 75 – 85 kVp , 15 - 25 mAs Penetration : bony trabecular patterns & corticle

outlines of ischial spine, pubis, femoral head, ala Contrast & density : soft tissue & bony structures

seen.

AP PELVIS ( frog leg )position

AP PELVIS ( frog leg )position

Pelvis in true APFemoral positioning:- Knee flexfemur 60-70° from table top

Lesser trochanter demonstrated in profile medially

Femoral neck superimpose the greater trochanter

Femoral abduction 45° from table topFemoral neck partially superimposedGreater trochanter at a transverse level

halfway between femoral head & lesser Tr.

AP PELVIS ( frog leg )position

Effect of Distal Femur elevation Knee not flexed enough:-

Greater trochanter demonstrated laterally Knee flexed too much:-

Greater trochanter demonstrated mediallyEffect of leg abduction: Close to table top:-

Femoral shaft not foreshortened,femoral neck “on-end” 45° to table top

Femoral neck and femoral shaft partially foreshortened 70°to table top:

Femoral neck not foreshortened femoral shaft foreshotened

AP PELVIS ( frog leg )position

HIP (AP)

True AP:- Ischial spine is aligned with pelvic brimSacrum & coccyx aligned with symphysis

pubisObturator foramen is open

Femur positioning:-Leg 15-20° rotate internally:-Femoral neck without foreshortenedGreater trochanter in profile laterallyLesser trochanter superimposed by femoral

neck

HIP (AP)

HIP (AP) Femoral head

Acetabulum

Fovea capitis

Greater trochanter

Lesser trochanter

Femoral neck

Intertrochentric line/crest

Obturator foramen

Male & Female Hip

Femoral neck angulation for male greater than female

HIP ( AXIOLATERAL)@ Inferosuperior Projection

Position/projection:-Femoral neck without foreshortenedLesser & greater trochanter are demonstrated at

about same transverse level. Leg positioning(15-20 °internal rotation):

Lesser trochanter demonstrated in profile posteriorly

Greater trochanter superimposed by femoral neck

HIP ( AXIOLATERAL)@ Inferosuperior Projection

Femoral neck at the center of collimated field

Acetabulum, femoral head & neck, greater & trochanters, ischial tuberosity included in collimated field.

Any orthopedic appliance should be included

HIP ( AXIOLATERAL)@ Inferosuperior Projection

HIP (Rolled Lateral)

Position/projectionRolled to the affected sideLesser trochanter in profile mediallyGreater trochanter superimposed with femoral

neck Ischial spine in profileObturator foramen narrowed

HIP (Rolled Lateral)

•Proximal femur

• femoral head

• ischial spine

• obturator foramen

• half ilium

• SI joint in

SI JOINT (AP)

SI JOINT (AP) Projection/position True AP:-

Median sacral crest aligned with symphysis pubis

Sacrum equal distance from lateral wall of the pelvic brim on either side

Correct CR(25-30 cephalic)-SI joint not foreshortenedSacrum elongatedSymphysis pubis superimposing

inferior sacral segment.

SI JOINT (AP)

Sufficient contrast & density to show bony structures and soft tissue of SI joint

Sufficient penetrationbtb & cto of SI joint and 1st -3rd sacral segments

Second sacral segment @ the center of collimated field

Long axis of median sacral crest is aligned with long axis of collimated field

SI JOINT (AP)

SI JOINT (POSTERIOR OBLIQUE)

Position/projectionSI joint is open (unaffected side midcoronal plane

25-30 to table-top and film). Ilium & sacrum demonstrated without

superimpositionSI joint @ the center of collimated fieldSI joint, sacral ala and ilium inculded in the fieldLong axis of SI joint is aligned with the long axis

of collimated field

SI JOINT (POSTERIOR OBLIQUE)

ABNORMALITIES

Hip fracture

Hip prosthesis

Total hip replacement

The radiograph of total bilateral hip replacement.

# make sure tip of the hip prosthesis included in the radiograph.

DHS

Judet view