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Positioning

Chapter 8

QuestionAnswer
The longest and strongest bone in the entire body is? The femur bone. This bone and the associated joints are a frequent source of pathology when trauma occurs.
The proximal femur consists of four essential parts, what are they? The head, the neck, the greater and lesser trochanters.
The head of the femur is rounded and smooth for articulation with the hip bones. Near the center is a depression or pit called? The fovea capitis.
What are the two aspects of the ischium? Body and ramus
The greater trochanter is located? superiorly and laterally to the femoral shaft and is palpable as a bony landmark.
What is the intertrochanteric crest? The junction where trochanters are joined posteriorly.
The angle of the neck to the shaft on the average person is? 125 degrees with a + or - variance of 15 degrees
On a shorter, wider person the angle of the neck to the shaft is going to be? 110 - 115 degrees
On an average adult in the anatomic position the longitudinal plane of the femur is about how many degrees from vertical? 10 degrees
the head and neck of the femure is angled how many degrees anteriorly in relation to the shaft? 15 - 20 degrees
The 15 - 20 degree anterior angle of the femoral head and neck causes the true AP - Pelvis to have what type of rotation? A 15 - 20 degree internal rotation of the femur and leg.
PELVIS: The pelvis consists of four bones, what are they? Two hip bones (ossa coxae, also called innominate bones) one sacrum, and one coccyx.
How many bones does the pelvic girdle contain? What are they? Two. The right and the left hip bone.
Each hip bone is composed of three divisions. What are they? Ilium, ischium and pubis.
The ilium, ischium and pubis are seperate bones in children but fuse together during middle teens. This are of fusion is called? Acetabulum
The acetabulum is a deep, cup-shaped cavity that accepts the head of the femur to form what? The hip bones
The ilium consists of? The iliac crest, the ala or wings, the Anterior Superior Iliac Spine (ASIS), the Posterior Superior Iliac Spine (PSIS), the anterior inferior iliac spine, the posterior inferior iliac spine, the greater sciatic notch and about 2/5 of the acetabulum.
The ischium consists of? The body, the ischial tuberosity, the ischial spine, the lesser sciatic notch and the ramus of the ischium.
The pubis consists of? The body, the superior ramus of pubis, the inferior ramus of pubis, the obturator foramen, the symphysis pubis.
A plane through the brim of the pelvis divides the pelvic area into how many cavities? Two. The false or greater pelvis and the lesser or true pelvis.
The lower abdominal organs as well as the fetus rest on the floor of? The false or greater pelvis.
The lesser or true pelvis forms what? The actual birth canal.
During delivery the baby's head first travels? Through the inlet to midcavity to outlet.
Cephalopelvimetry exams were used in the past to measure baby's head and mother's pelvis. This exam has been replaced by? Ultrasound, sonography
What are the characteristics of the male pelvis? Narrower, deeper, less flared. Acute angle (<90) is more oval or heart-shaped
What are the characteristics of the female pelvis? Wider, more shallow, more flared obtuse angle (>90) more round, larger
What classification and mobility type is the sacroiliac joint? Synovial; amphiarthrodial
What classification and mobility type is the symphysis pubis? Cartligenous; amphiarthrodial
What classification and mobility type is the union of acetabulum? Cartligenous; synarthrodial (in adults)
What classification, mobility type and movement type is the hip joint? Synovial; diarthrodial, spheroidal (ball and socket)
Calcification of anterior longitudinal ligament of the spinal column. Also known as "bamboo spine" is? Ankylosing spondylitis
A malignant tumor of cartilage, usually affecting men over 45 is called? Chondrosarcoma
DDH stands for? Developmental Dysplasia of the Hip.
DDH are hip dislocations that are present? at birth
Avusion fractures occur? in adolescent athletes who experience a sudden forceful or unbalanced contraction of the tendinous and muscular attachments.
Common aseptic or ischemic necrosis. Legions usually involve only one hip. Predominately occurs in boys 10 -15 years of age. Legg-Calve-Perths disease
Maligancy spread through circulatory or lymphatic systems. Common metastatic sites are the skull, spine, ribs, pelvis. Metastatic carcinoma.
SCFE stands for? Slipped capital femoral epiphysis.
SCFE is a condition that usually occurs in? 10 - 16 year olds during rapid growth period.
With SCFE the epiphysis appears ? and the epiphyseal plate appears ? Shorter; wider with smaller margins.
Why must the lower leg be rotated 15 to 20 degrees internally for AP hip projections? To place femoral neck parallel to the film.
Which bones fuse together to form the acetabulum? The ilium, ischium and pubis
What bony structure cannot be palpated? The ischial spine
Which bone of the pelvic girdle forms the anterior inferior aspect? Pubis
The symphysis pubis provides limited movement only? during pelvic trauma and childbirth.
The two bony landmarks that are palpated for hip localization are? the ASIS and symphysis pubis.
Using the ASIS and symphysis pubis landmarks, the femoral head can be located? 1 1/2 inches distal/below the midpoint of the imaginary line between the two bony landmarks.
Gonadal shielding of the male patient for the AP pelvis radiograph requires that the shield NOT extend above the level of the: Inferior border of the pubis.
A common condition of the femur that elderly patients develop that leads to frequent fractures of the hip is? Avascular necrosis or proximal femur hip fractures.
The use of 80kVp rather than 90 for an AP pelvis will have what affect on the patient dose? Will increase the dose by about 30%
Which ionization chamber in an AEC system should be selected for an AP projection of the hip? The center chamber only
Where is the CR placed for an AP projection of the pelvis? Midway between ASISs and symphysis pubis
What is the amount of abduction of the femurs recommended for an AP bilateral frog-leg projection? 40 to 45 degrees.
AP Bilateral "Frog-Leg" Projection is also known as? The modified cleaves method.
What position best demonstrates the superior and posterior rim of the acetabulum? Anterior oblique (Teufel method)
What projection provides the greatest amount of gonadal dose for a male patient (without the use of shielding). Axiolateral/inferosuperior projection (Danelius-Miller Method)
AP Axial "Outlet Projection" is also known as? The Taylor Method
Posterior Oblique Pelvis - Acetabulum is also known as? The Judet Method
PA Axial Obique Projection - Acetabulum is also known as? Teufel Method
Axiolateral Inferosuperior Projection: Hip and Proximal Femur - Trauma is also known as? Danelius Miller Method
Modified Axiolateral - Possible Trauma Projection is also called? Clements - Nakayama Method. ( Katie's NACHO MAMA Method)
What CR angle should be used for an AP axial (Taylor Method) projection for a male patient? 20 to 35 degree cephalad
How much obliquity of the body should be utilized for the anterior oblique projections for the sacroiliac (SI) joints? 25 to 30 degrees
Ture or False: The RAO position for the SI joint will demonstrate the right joint? True
True or False: The anterior oblique (Teufel Method) for the acetabulum requires a 10 to 15 degree obliquity. False. Requires 34 to 40 degree obliquity.
Only a small part, if any, of the lesser trochanter will be visible on a well postitioned axiolateral (inferosuperior) lateral hip. True
What projection would be ideal for a patient with trauma to both proximal femurs (in addition to AP pelvis)? Modified axiolateral (Clements-Nakayama Method)
The proper name method for the unilateral frog - leg projection is the? Modified Lauenstein and Hickey (Also known as modified cleaves method)
True or False: the male pelvis is more round than a female False
True or False: The pubic arch of the female is usually less than 90 degrees? False. It is usually greater than 90 degrees.
A radiograph of an AP pelvis reveals the lesser trochanters are not visualized. this pelvis was performed for non-traumatic reason. what should be done to correct this problem on repeat? Nothing. Accept the radiograph and do not repeat.
A radiograph of an AP pelvis reveals that the right iliac wing is foreshortened as compared with the left side. What specific postitioning problem is present on this radiograph? left rotation
A unilateral frog leg radiograph shows greater trochanter superimposed over femoral neck. Concern of femoral neck fracture, what can Tech do to improve visibility of femoral neck region? angle CR 20 to 25 degree cephalad
A radiograph of axiolateral projection of the hip reveals soft tissue seen across the affected hip. Artifact prevents clear view of femoral head and neck. What must the tech do to eliminate this artifact? Increase the elevation and flexion of unaffected leg.
A radiograph of an LPO projection for SI joints reveals that the ilium is superimposed over the involved SI joint. What type of positioning error is present? Excessive rotation or obliquity.
A radiograph of an axiolateral (inferosuperior) projection reveals there is excessive amount of grid lines present. What will correct this problem? Keep cassette perpendicular to CR.
A patient enters the ER with trauma to the pelvis. The patients main concern is about her left hip. What projection should be taken first to rule out fracture? AP Pelvis
A non-trauma patient comes to radiology with history of chronic pain of the right hip. The patient is ambulatory and hasn't had previous radiographs taken. What routine would be best suited for this patient? AP pelvis and lateral frog-leg projections of the right hip.
True or False: Generally gonadal shielding for females cannot be used for either an AP hip or an AP pelvis due to the probability of covering pertinent anatomy. False. You can use shielding for the AP hip but not the pelvis
True or Fase: The gonadal dose for an AP hip with good collimation and correctly placed shielding is 3 to 5 times greater for the male than the female. True
True or False: A patient with excessive external rotation of the foot may indicate a hip fracture. True
A radiograph of an AP axial (Taylor) projection reveals that the obturator foramina are not symmetrical. What type of positioning problem is present? Rotation of pelvis
A patient enters ER with a possible separation of the symphysis pubis due to trauma. The AP pelvis is inconclusive for determining the extent of the injury. What other projection can be taken to evalate this region? AP axial (Taylor) projection
Request for right hip study. the patient is from extended care facility confused about cause of injury. An AP pelvis is taken, the lateral frog-leg causes severe pain. What other projection can be preformed instead of lateral frog-leg? the axiolateral/inferosuperior projection instead. Also called (Danelius Miller Method)
Patient enters ER with possible bilateral fractured hips. What routine should be performed? AP Pelvis and the modified axiolateral inferosuperior projection for both hips. Also known as the Clements-Nakayama Method.
what is the name of the joint found between the superior rami of the pubic bones? Symphysis pubis
What are two additional terms for the hip bones? ossa coxae and innominate bones
which bony landmark is found on the most inferior aspect of the posterior pelvis? Ischial tuberosity
The upper margin of the greater trochanter is approximately how far above the level of the superior border of the symphysis pubis? approximately 1 inch above
The ischial tuberosity is approximatetly how far below the superior border of the symphysis pubis? 1 1/2 to 2 inches below
An imaginary plane that divides the pelvic region into the greater and lesser pelvis is called? the brim of pelvis or pelvic rim
Which imaging modality is most sensitive in diagnosing early signs of metastatic carcinoma of the pelvis? nuclear medicine
Now referred to as Developmental Dysplasia of the Hip. congenital dislocation
a fracture resulting from a severe blow to the pelvis pelvic ring fracture
What device will improve overall visibility of the proximal hip demonstrated on an axiolateral (inferosuperior) projection? Compensating filter
Which of the following modalities will best demonstrate a possible pelvic ring fracture? A CT Scan
True or False: Both joints must be included in an AP and lateral projection of the femur even if a fracture of the proximal femure is suspected? True
Which ionization chamber(+s) should be used when using AEC for an AP pelvis projection Upper right and left chambers
What positioning error has occured if the left iliac wing is elongated on an AP pelvis? rotation toward the left side.
What positioning error has occured if the left obturator foramen is more open than the right side on an AP pelvis? rotation of pelvis toward the right side
Is Danelius-Miller Method for Trauma or non-trauma?(axiolateral/inferosuperior hip) Trauma
Is Unilateral frog-leg trauma or non trauma? (Lauenstein/Hickey Method or Modified Cleaves Method) non-trauma
Is modified cleaves (bilateral frog-leg) trauma or non-trauma non-trauma
Is Modified axiolateral (Clements-Nakayama) trauma or non-trauma trauma
Is exam for Anterior pelvic bone? trauma
What projection is recommended to demonstrate the superoposterior wall of the acetabulum? PA axial oblique (Teufel Method)
How many degrees are the femurs abducted (from vertical plane) for the bilateral frog-leg (modified cleaves method)? 40 to 45 degrees
Where is the central ray placed for a unilateral frog leg projection? mid femoral neck
what size cassette is used for adult frog leg projection? 14 x 17 crosswise
Where is central ray placed for AP bilateral frog leg projection? 3 inches below ASIS and 1 inch superior to sympnysis pubis
What CR angle is required for the "outlet" projection (Taylor Method) for a female patient? 30 to 45 degree cephalad
What type of pathologic feature is best demonstrated with the Judet method? Acetabulum fracture
How much obliquity of the body is required for the Judet method? 45 degrees
What type of CR angle is used for a PA axial oblique (Teufel) projection? 12 degree cephalad
how is the pelvis (body) positioned for a PA axial oblique (Teufel) projection? PA 35 to 40 degree toward affected side
True or False: Any orthopedic device or appliance of the hip should be seen in its entirety on an AP hip radiograph? True
The axiolateral (inferosuperior) projection is designed for what kind of situations? Traumatic
How is the unaffected leg positioned for the axiolateral hip projection? flexed and elevated to prevent superimpositon over the affected hip
do you use gonadal shielding on the male patient during an axiolateral (inferosuperior) projection of the hip? no you can not.
True or False: During an axiolateral (inferosuperior) projection of the hip the male patient recieves more than 20 times the gonadal dose than a female. True
The modified axiolateral requires the CR angle to be? posteriorly 15 to 20 degrees from horizontal.
Which special projection of the hip demonstrates the anterior and posterior rims of the acetabulum and the ilioischial and iliopubic columsn? Judet Method, posterior oblique projections of acetabulum
What CR angle is used for the Judet method? No CR angle
What is the name of the special AP axial projection of the pelvis used to assess trauma to pubic and ischial structures? AP axial outlet projection, Taylor Method
Another name for Axiolateral (inferosuperior) Danelius-Miller Method
Another name for the Modified axiolateral Clements-Nakayama Method
Another name for Bilateral or Unilateral Frog-Leg Modified Cleaves Method Unilateral is also called Modified Lauenstein/Hickey Method
Another name for PA axial oblique for acetabulum? Teufel Method
Another name for the AP axial "outlet" projection? Taylor Method
Another name for the Posterior oblique for acetabulum? Judet
What is the optimal amount of hip abduction applied for the unilateral "frog-leg" projection to demonstrate the femoral neck without distortion? 20 to 30 degrees from vertical
True or False: The Lauenstein/Hickey method for the unilateral frog-leg will produce distortion of the femoral neck? True
How much is the cassette tilted for the modified axiolateral projection of the hip? 15 degree from vertical
True or False: Gonadal shielding can be used for males for the axiolateral/inferosuperior projection of the hip? False
An AP pelvis reveals the lesser trochanters are seen on the medial side of the femur. Which positioning modification needs to be made to prevent this positioning error? rotate limbs 15 to 20 degrees internally
An axiolateral/inferosuperior projection reveals the posterior aspect of the acetabulum and femoral head were cut off. What needs to be done on the repeat exam to better define this region? If possible elevate patient 2" by placing sheets or blanket under the pelvis.
An AP axial projection for anterior pelvic bones reveals that the pubic & ischial bones are not elongated. The tech used CR angle of 20 to 30 degrees cephalad for a female patient. What error was made? The CR angle for females is 30 to 45 degrees cephalad. 20 to 30 degrees is for a male patient
A patient enters ER with a pelvis injury due to MVA. The AP pelvis demonstrates possible defect or fracture of the acetabulum. No other fractures and patient can move comfortably. What additional projections will demonstrate possible acetabular fractures? PA Axial Oblique (Teufel Method) or the Posterior Oblique (Judet Method)
A radiograph from a modified axiolateral projection reveals excessive grid lineso n the image which also appears underexposed. What can be done to avoid this problem during the repeat exposure? Make sure CR is centered to midline of cassette and the face of the cassette is perpendicular to CR.
A patient with hip pain from a fall enters ER. the physician orders a left hip study. When moved to the radiographic table, the patient complains very loudly about pain in hip. Which positioning routine should be used on this patient? AP pelvis and axiolateral/inferosuperior projection.
A young patient comes to the radiology department with chronic pain near the ASIS. She is an active athlete who was injured running hurdles. Her physician suspects avulsion fracture. Which position may best diagnose this condition? Will kV change? AP pelvis and possibly posterior oblique (Judet Method). Decrease kV to 65 or 70.
A technologist notices that his AP pelvis projections often demonstrate a moderate degree of rotation. What positioning technique can he/she perform to eliminate rotation of the AP pelvis projections? Palpate both ASISs and make sure they are equal distance to the tabletop.
A very young child comes to the radiology department with clinical history of DDH. What is the most common positioning routine for this condition? AP Pelvis and bilateral frog-leg (Modified Cleaves Method).
How many of the hip/pelvis projections require CR angle? Which ones? 4 projections. The Taylor Method (AP Axial "outlet"), AP Axial "Inlet", Teufel Method (PA Axial Oblique), Clements-Nakayama (Modified Axiolateral).
Teufel Method (PA Axial Oblique) CR angle is? 12 degree cephalad
Taylor Method (AP Axial "Outlet") CR angle is? 20 to 35 degree cephalad for male, 30 to 45 degree cephalad for female
AP Axial "Inlet" CR angle is? 40 degrees caudad.
Clements-Nakayama (Modified Axiolateral) CR angle is? posteriorly 15 to 20 degrees from horizontal.
Body Angles: Unilateral Frog Leg (Modified Lauenstein/Hickey Method). Angle leg 45 degree from vertical
Body Angles: Teufel Method (PA Axial Oblique) body angle is? 35 to 40 degree anterior oblique, affected side down.
Body Angles: Judet Method (Posterior Oblique) body angle is? 45 degree posterior oblique, affected side up.
Body Angles: Modified Cleaves Method (Bilateral Frog Leg) body angle is? abduct both femora 40 to 45 degree from vertical.
Body Angles: AP Pelvis rotate both femora and lower leg internally 15 to 20 degrees.
AP Bilateral "frog-leg" projection: Pelvis is also called? Modified Cleaves Method
AP Axial "outlet" projection: Pelvis is also called? Taylor Method
Posterior Oblique Pelvis-Acetabulum is also called? The Judet Method
PA Axial Oblique Projeciton: Acetabulum The Teufel Method
Axiolateral Inferosuperior Projection: Hip and proximal femur-trauma is also called? Danelius-Miller Method
Unilateral "frog-leg" Projection-Mediolateral: Hip and proximal Femur is also called? Modified Cleaves Method
Modified Axiolateral-Possible Trauma Projection: Hip and proximal femur is also called? Clements-Nakayama Method
Created by: Baker RAD 2012