Femur and Pelvic Girdle

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Chapter 5

Femur and Pelvic Girdle

• Radiation protection

• Location of femoral head and neck

Femur

AP (R)

Lateral (R)

AP and lateral critique

Trauma lateral (horizontal beam) (S)

Proximal Femora (Hips)

AP bilateral hips (R)

AP unilateral hip (R)

AP unilateral hip critique

Lateral Hip (Nontrauma)

Unilateral “frog-leg” modified Cleaves method (R)

Bilateral “frog-leg” modified Cleaves method (R)

AP bilateral “frog-leg” critique

Lateral Hip (Trauma)

Axiolateral projection (Danelius-Miller method) (R)

Axiolateral projection critique

Pelvis

AP pelvis (R)

AP pelvis critique

AP axial “inlet” and “outlet” projections (S)

AP axial “inlet” and “outlet” critique

Acetabulum

Posterior oblique (Judet method) (S)

Posterior oblique critique

PA axial oblique (Teufel method) (S)

PA axial oblique critique

Pediatric

• AP and lateral hips and pelvis (S)

(R) Routine, (S) Special

Femur and Pelvic Girdle

Radiation Protection

Location of Femoral Head and Neck

First Method:

Location of the femoral head and neck regions can be accurately determined by first drawing an imaginary line between two landmarks, the ASIS and the symphysis pubis. The midpoint of this line is determined, from which a perpendicular imaginary line is drawn to locate the head and/or neck. The femoral head (A) is approximately 1.5″ (4 cm) down on this line. The midfemoral neck (B) is approximately 2.5″ (6-7 cm) down, as shown in the photo below.

Second Method:

A second method for locating the femoral neck (B) is ≈1-2″ (3-5 cm) medial to the ASIS at the level of the proximal or upper margin of the symphysis pubis, which is 3-4″ (8-10 cm) distal to the ASIS.

Fig. 5-3 A, Femoral head. B, Femoral neck.

AP Femur ^*

Fig. 5-4 AP, midfemur and distal femur.

• 35 × 43 cm L.W. (14 × 17″)

• Grid

• Hip at cathode end (anode heel effect)

Note: For adults, a second smaller IR of either the hip or the knee should be taken on trauma patients to demonstrate both knee and hip joints to rule out possible fractures.

Position

• Supine, femur centered to midline of table or grid IR

• Rotate entire lower limb internally ≈5° for AP of midfemur and distal femur, and 15° internally for true AP to include hip.

• Lower border of IR ≈5 cm (2″) below knee to include knee joint adequately (see AP Unilateral Hip for proximal femur, p. 156).

• Shield gonads for both male and female

Central Ray:

CR ⊥, to mid-IR

SID:

40-44″ (102-113 cm)

Collimation:

Long, narrow collimation to femur area

Lateral Femur ^*

Fig. 5-5 Lateral, midfemur, and distal femur.

Fig. 5-6 Lateral, midfemur, and proximal femur.

Warning: Take horizontal beam lateral if fracture is suspected.

• 35 × 43 cm L.W. (14 × 17″)

• Grid

• Hip at cathode end (anode heel effect)

Note: For adults, take a second smaller IR of lateral hip or lateral knee if both joints are areas of interest.

Position

• Lateral recumbent, with unaffected leg placed behind to prevent over-rotation

• Include sufficient amount of either knee or hip at one end of IR.

• Shield gonads as possible.

Central Ray:

CR ⊥, to mid-IR

SID:

40-44″ (102-113 cm)

Collimation:

Long, narrow collimation to femur area

AP and Lateral Midfemur and Distal Femur

Fig. 5-7 AP.

Fig. 5-8 Lateral.

Evaluation Criteria

Anatomy Demonstrated:

AP and Lateral:

• Distal ⅔ of femur, including knee joint

Position:

AP:

• No rotation, femoral and tibial condyles appear symmetric in size and shape

Lateral:

• True lateral, femoral condyles appear superimposed

Exposure:

AP and Lateral:

• Optimal density and contrast

• Sharp borders and trabecular markings; no motion

Horizontal Beam Lateral Femur ^*

(Trauma Midfemur and Distal Femur)

Fig. 5-9 Horizontal beam trauma projection (midfemur and distal femur).

• 35 × 43 cm L.W. (14 × 17″)

• Portable grid

Note: For proximal femur injuries, take axiolateral (Danelius-Miller method) hip.

Position

• Without moving trauma patient from the supine position, gently lift injured leg and place support under knee and leg.

• Place vertical IR between legs, as far superiorly as possible, but include knee distally. Use tape to hold grid IR in position.

• Shield gonads for both male and female.

Central Ray:

CR horizontal beam, ⊥ to mid-IR

SID:

40-44″ (102-113 cm)

Collimation:

Four sides to area of interest

AP Bilateral Hips ^*

Warning: Do not attempt to rotate leg if fracture is suspected. Take “as is” bilateral hips for comparison purposes.

Note: For AP pelvis centering, see p. 291 in text.

• 35 × 43 cm C.W. (14 × 17″)

• Grid

Fig. 5-10 AP bilateral hips.

Position

• Supine, aligned and centered to CR and IR, both legs extended and equally rotated internally 15°-20° (see warning above)

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Male:

Female:

kV Range:

Location of Femoral Head and Neck

First Method:

Second Method:

AP Femur ^*

Position

Central Ray:

SID:

Collimation:

Lateral Femur ^*

Position

Central Ray:

SID:

Collimation:

AP and Lateral Midfemur and Distal Femur

Evaluation Criteria

Anatomy Demonstrated:

Position:

Exposure:

Horizontal Beam Lateral Femur ^*

Position

Central Ray:

SID:

Collimation:

AP Bilateral Hips ^*

Position

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