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Rad2012

Pelvic Girdle

QuestionAnswer
What does the head of the proximal femur articulate with? The acetabulum of pelvis to form the hip joint
What is the fovea capitius? A depression or pit located in the center of the femoral head; allows for the attachment of a ligament
Where is the greater trochanter located? Superiorly and Laterally; can be palpated as a landmark
Lesser trochanter smaller than the greater and located more medially and posteriorly than the greater trochanter
What is the intertrochanteric line or crest? A thick ridge of bone that joins the two trochanters together posteriorly
What is the angle from the neck to the shaft of the proximal femur on an average person? Approximately 125 degrees; a person with long legs and narrow pelvis would probably have an angle 15 degrees less; a shorter person with a wider pelvis would have an angle 15 degrees more.
The femur lies in the thigh at an angle of approximately _____ degrees from vertical; this would increase more (____) if a person is short and has a wide pelvis. *10 *15 degrees
The head of the femur articulates with the pelvis at an anterior angle of _______ degrees. 15-20
How many bones make up the pelvis? What are they? *4 *2 innominate bones (hip bones), 1 sacrum, 1 coccyx
How many bones make up the pelvic girdle? 2 hip bones
What are the three divisions that make up each hip bone? ilium, ischium, and pubis
The three divisions of the hip bone are separate bones, but fuse together in the _____ years in the area of the ______. *middle teen *acetabulum
What is the acetabulum? the deep, cup shaped fossa that articulates with the femoral head to form the hip joint
Where is the body of the ilium located? More inferior and includes the upper two fifths of the acetabulum
What is the ala (wing)? the thin, flared portion of the upper ilium
Iliac crest upper curved area of the ala that extends from the ASIS to the PSIS; one of the most palpable bony landmarks used for abdominal positioning; usually only use the top or most superior portion
ASIS Anterior superior iliac spine- bony prominence located anteriorly at the anterior end of the iliac crest; also used as a landmark for positioning
PSIS Posterior superior iliac spine- bony prominence located posteriorly at the end of the iliac crest; not used for positioning
AIIS Anterior inferior iliac spine- small prominence located inferior to the ASIS
PIIS Posterior inferior iliac spine- small prominence located inferior to the PSIS
Where is the body of the ischium located? upper body forms the posteroinferior two fifths of the acetabulum; lower portion of body projects caudally and medially from the acetabulum
Ischial tuberosity rough, rounded area located at the end of the lower body; area in which our body rests when in a seated position; may be used as a bony landmark when performing prone abdomen projections
Ramus projects anteriorly from the ischial tuberosities
Ischial spine Posterior to the acetabulum; cannot be palpated; may see a small portion of this projection in an AP pelvis projection
Greater sciatic notch deep notch located directly above the ischial spine
Lesser sciatic notch smaller notch located directly below the ischial spine
Where is the body of the pubis located? Anteriorly and inferiorly to the acetabulum and includes the anteroinferior one fifth of the acetabulum.
Superior ramus extends anteriorly and medially for the body; the two meet at the midline to form the symphysis pubis joint
Inferior ramus extends downward and posterior from the symphysis pubis to joint the ramus of the ischium
Obturator foramen largest foramen or opening in the body;formed by the ischium and the pubis
How is the ASIS used as a positioning landmark? By placing each ASIS equal distances to the tabletop, it will confirm that the patient is in a true AP position and will not be rotated. Also used to help identify the location of the femoral head and neck
How is the greater trochanter used as a positioning landmark? Upper margin may be palpated in the upper thigh; lies approximately at the same horizontal level as the upper margin of the symphysis pubis or 1 and 1/2 inch superior.
How is the ischial tuberosities used as a landmark for positioning? usually lies 1 and 1/2 to 2 inches below the level of the symphysis and may be used to assist in positioning of the prone abdomen; not frequently utilized due to embarrassment and modesty
How is the symphysis pubis used as a postioning landmark? corresponds to the lowest level of the abdomen; used in conjuction with the ASIS to locate the head and neck of the femur
Pelvic brim defined by the upper margin of the symphysis anteriorly and by the prominent portion of the sacrum posteriorly; and imaginary plane drawn through this area allows for the location of a cavity above and beneath
Greater or false pelvis refers to the cavity that lies above the pelvic brim; it is formed by the iliac wings of the hip bones and contains lower abdominal organs as well as the fetus in a pregnant female.
Lesser or true pelvis refers to the cavity that lies beneath the pelvic brim; surrounded by bony structures; forms the actual birth canal in the female.
Inlet or superior aperture the area of the true pelvis defined by the pelvic brim
Cavity area located between the inlet and the outlet
Outlet or inferior aperture The area defined by the two ischial tuberosities and the coccyx; during birth, the fetus travels first through the inlet, then the cavity, and exits the outlet of the true pelvis
Cephalopelvimetry radiographic exams performed in the past to measure the baby's head in relation to the inlet and outlet of the mother's pelvis; ultrasound is the most common method used today and produces no ionizing radiation risks
Female pelvis characteristics usually wider and more flared in the area of the iliac wings; angle of the pubic arch is obtuse or greater than 90 degrees; shape of inlet or pelvic brim is usually larger and more round in appearance
Male pelvis characteristics usually more narrow and deep (tall) and less flared in the area of the iliac wings; angle of the pubic arc is acute or less than 90 degrees; shape of the inlet or pelvic brim is usually more narrow and heart shaped
Sacroiliac joints Synovial/Amphiarthrodial
Symphysis pubis Cartilaginous/Amphiarthrodial
Union of the acetabulum Cartilaginous/Synarthrodial for adults
Hip joint Synovial/Diarthrodial- ball and socket movement or spheroidal
Location of the femoral head and neck determine an imaginary line from the ASIS and the upper margin of the symphysis pubis; locate the midpoint of that line and proceed inferior 1 and 1/2 inches to locate the femoral head and 2 and 1/2 inches to locate the femoral neck
Internal rotation of the leg in order to obtain a true AP view of the proximal femur, you must internally rotate the entire leg 15 to 20 degrees; this action places the femoral head and neck parallel to the image receptor and prevents foreshortening
True or False. If rotaion of the leg is successful, the lesser trochanter of the femur will not be visible on the completed radiograph. true. this is necessary due to the head of the femur articulating with the acetabulum at an anterior angle of 15-20 degrees
Evidence of hip fractures Hip is a common fracture site, especially for elderly patients; a typical sign is the external rotation of a foot or leg; never rotate a patient's leg internally if this sign is present or if the patient is in pain from a traumatic injury
What is the largest and strongest bone in the body? Femur
A small depression located in the center of the femoral head is called the ______. Fovea capitius
The lesser trochanter is located on the ____ (medial or lateral) aspect of the proximal femur. Medial
The lesser trochanter projects _____ (anteriorly or posteriiorly) from the junction between the neck and the shaft. Posteriorly
Because of the alignment between the femoral head and pelvis, the lower limb must be rotated _____* internally to place the femoral neck parallel to the plane of the IR to achieve a true AP projection. 15-20*
True/False: According to Grey's Anatomy reference textbook, the terms pelvis and pelvic girdle are not synonymous. True
What are the two important radiographic landmarks found on the ilium? ASIS and the iliac crest
Which bony landmark is found on the most inferior aspect of the posterior pelvis? ischial tuberosity
What is the name of the joint found between the superior rami of the pubic bones? Symphysis pubis
The ______ of the pelvis is the largest foramen in the skeletal system. Obturator foramen
The upper margin of the greater trochanter is approximately ___ above the level of the superior border of the symphysis pubis, and the ischial tuberosity is about ____ below. 1" , 1 and 1/2 to 2"
An imaginary plane that divides the pelvic region into the greater and lesser pelvis is called the _____. Pelvic brim
List the alternate names for the greater and lesser pelvis. greater= False ; lesser= True
List the major function of the greater and lesser pelvis. Greater- supports lower abdominal organs and fetus Lesser- forms the actual birth canal
List the 3 aspects of the lesser pelvis, which also describe the birth route during the delivery process. A. Inlet B. Outlet C. Cavity
Ilium Ala, Posterior superior iliac spine (PSIS), Anterior superior iliac spine (ASIS), Articulates with the sacrum to form the SI joints
Ischium Posses a large tuberosity found at the most inferior aspect of the pelvis, Lesser sciatic notch
Pubis Possesses a slighly movable joint, Forms the anterior, inferior aspect of the lower pelvic girdle
In the past, which radiographic examination was performed to measure the fetal head in comparison with the maternal pelvis to predict possible birthing problems? Cephalopelvimetry
Which two bony landmarks need to be palpated for hip localization? ASIS and symphysis pubis
From the midpoint of the imaginary line created by the ASIS and the symphysis pubis, where would the femoral neck be located? Approximately 2" below the midpoint of the line
A second method for locating the femoral head is to palpate the ____ and go _____ inches medial at the level of ____ which is _____ inches distal to the orginial palpation point. ASIS; 1 to 2"; symphysis pubis and/or greater trochanter; 3 to 4"
To achieve a true AP position of the proximal femur, the lower limb must be rotated ____* internally. 15-20*
Which structures on an AP pelvis or hip radiograph indicate whether the proximal head and neck are in position for a true AP projection? Lesser Trochanter should not be visible or should only be seen slightly visible on the radiograph
Which physical sign may indicate that a patient has a hip fracture? Foot rotated externally
Which projection should be taken first and reviewed by a radiologist before attempting to rotate the hip into a lateral position (if trauma is suspected)? AP pelvis
Gonadal shielding should be used for all patients of reproductive age, unless ____. It covers anatomic structures of primary interest
Should a gonadal shield be used for a hip study on a young female? Yes, use a shaped ovarian shield with top of shield at level of ASIS and bottom at symphysis pubis
Should a gonadal shield be used for a hip study on a young male? If yes describe how it should be placed on the patient. Yes, the top of the shield should be placed at the inferior margin of the symphysis pubis
What is the advantage of using 90kV rather than 80kV range for hip and pelvis studies on younger patients? It reduces patient dose approximately 30%
What is the disadvantage of using 90kV for hip and pelvis studies, especially on older patients with some bone mass loss? It reduces radiographic contrast
Which condition is a common clinical indication for performing pelvic and hip examinations on a pediatric (newborn) patient? Development dysplasia of hip (DDH)
True/False: Geriatric patients are more prone to hip fractures because of their increased incidence of osteoporosis. True
Which imaging modalities can be used on a newborn to assess hip joint stability during movement of the lower limb? Sonography
Which imaging modalities is most sensitive in diagnosing early signs of metastatic carcinoma of the pelvis? Nuclear medicine
Metastatic carcinoma Malignacy spread to bone via the circulatory and lymphatic systems or direct invasion
Ankylosing spondylitis A disease producing extensive calcification of the longitudinal ligament of the spinal column
Congenital dislocation Now referred to as developmental dysplasia of the hip
Chondrosarcoma A malignant tumor of the cartilage of hip
Proximal hip fracture Most common fracture in older patients because of high incidence of osteoporosis or avascular necrosis
Pelvic ring fracture A fracture resulting from a severe blow to one side of the pelvis
Osteoarthritis A degenerative joint disease
Which device will improve overall visibility of the proximal hip demonstrated on an axiolateral(inferosuperior) projection? Compensating filter
Which modality will best demonstrate a possible pelvic ring fracture? CT
True/False: Both joints must be included on an AP and lateral projection of the femur even if a fracture of the proximal femur is evident. True. If an AP and lateral femur study is ordered, both joints must be demonstrated.
Where is the central ray placed for an AP pelvis projection? Midway between ASIS and symphysis pubis
Which ionization chamber(s) should be activated when using AEC for an AP pelvis projection? Upper right and left chambers
Which specific positioning error is present when the left iliac wing is elongated on an Ap pelvis radiograph? Rotation towards the left side
Which specific positioning error is present when the left obturator foramen is more open than the right side on an AP pelvis radiograph? Right rotation
Traumatic Danelius-Miller projection, Clements-Nakayama, Anterior pelvic bones
Not traumatic Unilateral frog leg, Modified Cleaves (bilateral frog-leg)
Which projection is recommended to demonstrate the superoposteriorwall of the acetabulum? PA axial oblique
When gonadal shielding is not used, _____ receive a greater gonadal dose with an AP pelvis projection. Females (nearly 3 times more)
How many degrees are the femurs abducted (from the vertical plane) for the bilateral frog-leg projection? 40-45*
Where is the central ray placed for a unilateral frog-leg projection? Midfemoral neck
Which cassette size should be used for an adult bilateral frog-leg projection? 14X17 crosswise
Where is the central ray placed for an AP bilateral frog-leg projection? 1" superior to the symphysis
Which central ray angle is required for the "outlet" projection (Taylor Method) for a female patient? 30-45* cephalad
Which type of pathologic feature is best demonstrated with the Judet method? Acetabular fractures
How much obliquity of the body is required for the Judet method? 45*
What type of CR angle is used for a PA axial oblique (Teufel) projection? 12* cephalad
How is the pelvis (body) positioned for a PA axial oblique (Teufel) projection? PA 35-40* toward affected side
True/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 _______ (traumatic or nontraumatic) situations. Traumatic
How is the unaffected leg positioned for the axiolateral hip projection? It is flexed and elevated to prevent it from being superimposed over the affected hip
Which factor does not apply to an axiolateral projection of the hip on a male patient? Use of gonadal shielding
True/False: An AP pelvis projection using 90kV and 8 mAs results in a patient dose of approximately 30% less than a projection using 80kV and 12 mAs (for both males and females). True
True/False: During an axiolateral projection of the hip, a male patient receives more than 20 times the gonadal dose than a female. True
The modified axiolateral requires the CR to be angled _______* posteriorly from horizontal. 15-20
Which special projection of the hip demonstrates the anterior and posterior rims of the acetabulum and the ilioischial and iliopubic columns? Which CR angle is used? Posterior oblique projections of the acetabulum (Judet method) 0* (perpendicular)
What is the name of the special AP axial projection of the pelvis is used to assess trauma to pubic and ischial structures? AP axial outlet projection (Taylor method)
Judet Posterior oblique for acetabulum
Taylor AP axial for pelvic "outlet" bones
Clements-Nakayama Modified axiolateral
Danelius-Miller Axiolateral (inferosuperior)
Teufel PA axial oblique for acetabulum
Modified Cleaves Bilateral or unilateral frog-leg
What is the optimal amount of hip abduction for the unilateral "frog-leg" projection to demonstrate the femoral neck without distortion? 20-30* from vertical
True/False: The Lauenstein/Hickey method for the unilateral "frog-leg" projection will produce distoration of the femoral neck. true
How much is the cassette tilted for the modified axiolateral projection of the hip? 15* from the vertical
True/False: Gonadal shielding can be used for males for the axiolateral projection of the hip. False
AP Mid-Distal Femur Patient is placed supine on exam table with legs extended; rotate the leg internally 5* for a true AP to place the femoral epicondlyes parallel to the IR. CR is perpendicular to mid-femur. Should demonstrate the distal 2/3 of the femur including the knee
Lateral Mid-Distal Femur Have the patient lying on affected side; affected knee should be flexed about 45* with the femoral epicondlyes perpendicular to the IR. CR is perpendicular to mid femur. Femoral condyles superimposed; lateral view of distal femur
AP pelvis Patient supine with their MSP in alignment w/the center of table; check for rotaion making sure the ASISs are equal distances from tabletop; patient should rotate feet and legs internally 15-20* in order to place the femoral necks parallel to IR
AP pelvis CR will be perpendicular to a point midway between the level of the ASISs and the symphysis pubis or 2" superior to the symphysis; top of IR will be about 1 to 1 and 1/2" above the iliac crest; 14X17 IR transverse; 40" SID
AP pelvis should demonstrate an AP projection of the pelvis including the head, neck, trochanters, and proximal third of the femurs; lesser trochanters should not be seen or barely visible on film
AP pelvis To check for rotation: obturator foramina and iliac wings should be symmetrical in appearance, if either is elongated, then the patient was rotated in that direction.
AP Unilateral Projection (Affected Hip only) Patient should be placed supine, no rotation, MSP in alignment with the center of table; internally rotate affected foot and leg 15-20*. CR is perpendicular to femoral neck; 10X12 IR lengthwise; 40" SID.
AP Unilateral Projection (Affected Hip only) AP view of the proximal 1/3 of the femur, hip joint, and acetabulum; lesser trochanter usually not demonstrated or barely visible
AP Bilateral "Frog-leg" (Modified Cleaves) Patient supine no rotation MSP to center of table have the patient flex their knees & draw their feet towards their body; w/the plantar surfaces of the feet together, the thighs should be abducted approx 45* from vertical; places femoral necks parallel IR
AP Bilateral "Frog-leg" (Modified Cleaves) CR perpendicular to 1 and 1/2" superior to the symphysis pubis (level of femoral heads); 14X17 IR transverse; 40" SID
AP Bilateral "Frog-leg" (Modified Cleaves) Should demonstrate the acetabulum, femoral neck and head, lesser trochanter seen on the medial side of the femur; femoral neck should have little superimposition of the greater trochanter
Unilateral Frog-leg (separate modification- Lauenstein/Hickey) Patient supine and have them flex knee of the affected side and abduct leg approx 45* (Places thigh at right angle to leg) the sole of foot should rest against opposite knee; pelvis may be rotated somewhat toward affected side
Unilateral Frog-leg (separate modificaion- Lauenstein/Hickey) CR perpendicular to femoral neck; 10X12 IR lengthwise; 40" SID. same as bilateral method, demonstrates greater trochanter superimposed over femoral neck
Axiolateral Inferosuperior (Danelius/Miller) patient supine; pelvis elevated to place the hip toward the center of IR; unaffected leg flexed until thigh is near vertical and placed out of CR path.
Axiolateral Inferosuperior (Danelius/Miller) the cassette should be positioned vertically along the crease of the iliac crest; this places the IR parallel to the long axis of the femoral neck; CR is perpendicular to the IR and femoral neck; 10X12 IR crosswise; 40" SID
Axiolateral Inferosuperior (Danelius/Miller) will demonstrate the acetabulum, femoral head, neck, and trochanters; ischial tuberosity will be demonstrated below the femoral head
Modified Axiolateral Inferosuperior (Clements/Nakayama) patient supine with affected side closest to edge of table; place the grid/IR at a level lower than hip and tilt the top backward approx 15*; the IR should be placed parallel to the femoral neck. CR 15* posteriorly to be perpendicular to femoral neck
Modified Axiolateral Inferosuperior (Clements/Nakayama) 10X12 IR crosswise with grid; 40" SID; hip joint with the acetabulum, femoral head, neck, and trochanters
Created by: danielle89