pelvis

Section 1: Exercise 5 Chapter 7: Pelvis and Upper Femora Section 1: Exercise 6 1. a 2. c 3. j 4. e 5. d 6. i 7. k 8. g 9. h 10. f

1.Osteoporosis 2.Osteopetrosis 3.Osteoarthritis 4.Paget disease 5.Chondrosar- coma 6.Slipped epiphysis 7.Multiple myeloma 8.Ankylosing spondylitis 9.Congenital hip dysplasia 10. Legg-Calvé- Perthes disease a..Loss of bone density b.Benign tumor consisting of cartilage c.Increased density of atypically soft bone d.Malignant tumor arising from carti- lage cells e.Thick, soft bone marked by bowing and fractures f.Flattening of the femoral head as a result of vascular interruption g.Rheumatoid arthritis variant involving the sacroiliac (SI) joints and spine h.Malformation of the acetabulum causing i.displacement of the femoral head j.Proximal portion of femur dislocated from distal portion at the proximal epiphysis Form of arthritis marked by progressive cartilage deterioration in synovial joints and vertebrae k.Malignant neoplasm of plasma cells in- volving the bone marrow and causing destruction of bone

10. A. Iliopubic column B. Acetabulum C. Femoral head D. Pubis E. Obturator foramen F. Ischium

10. Identify each lettered structure shown in Fig. 7-16. A. _____________________________________________ B. _____________________________________________ C. _____________________________________________ D. _____________________________________________ E. _____________________________________________ F. _____________________________________________

10. Sacrum and coccyx

10. What structures form the posterior part of the pelvis?

12. a,b,c,d,e,f,g,h,i,k,n a. The iliac alae should be symmetric. b. The obturator foramina should be symmetric. c. The ischial spines should be equally demonstrated. d. The greater trochanters should be fully demonstrated. e. Both ilia should be equidistant to the edge of the image. f. The entire pelvis should be included along with the proximal femora. g. The sacrum and coccyx should be aligned with the pubic symphysis. h. The lower vertebral column should be centered to the middle of the image. i. Both greater trochanters should be equidistant to the edge of the image. k. The femoral necks should be demonstrated in their full extent without superimposition. n. If seen, the lesser trochanters should be demonstrated on the medial borders of the femora.

12. From the following list, circle the 11 evaluation cri- teria that indicate the pelvis was properly positioned for an AP projection. a. The iliac alae should be symmetric. b. The obturator foramina should be symmetric. c. The ischial spines should be equally demonstrated. d. The greater trochanters should be fully demonstrated. e. Both ilia should be equidistant to the edge of the image. f. The entire pelvis should be included along with the proximal femora. g. The sacrum and coccyx should be aligned with the pubic symphysis. h. The lower vertebral column should be centered to the middle of the image. i. Both greater trochanters should be equidistant to the edge of the image. j. Each greater trochanter should be seen superimposed with the femoral neck. k. The femoral necks should be demonstrated in their full extent without superimposition. l. The femoral necks should not be well demon- strated to their full extent because of superim- position. m. If seen, the lesser trochanters should be demon- strated on the lateral borders of the femora. n. If seen, the lesser trochanters should be demonstrated on the medial borders of the femora.

13. A. Iliac crest B. Ala of the ilium C. ASIS D. SI joint E. Anterior inferior iliac spine F. Femoral head G. Greater trochanter H. Obturator foramen I. Pubic symphysis J. Lesser trochanter

13. Identify each lettered structure shown in Fig. 7-7. A. _____________________________________________ B. _____________________________________________ C. _____________________________________________ D. _____________________________________________ E. _____________________________________________ F. _____________________________________________ G. _____________________________________________ H. _____________________________________________ I. _____________________________________________ J. _____________________________________________

15.d. Cephalically 20 to 25 degrees

15. How should the central ray be directed for the Hickey method of a lateral hip projection? a. Perpendicularly b. Caudally 20 to 25 degrees c. Medially 20 to 25 degrees d. Cephalically 20 to 25 degrees

17. d. Greater trochanter

17. Which process is located at the superolateral aspect of the proximal femoral shaft? a. Lesser tubercle b. Lesser trochanter c. Greater tubercle d. Greater trochanter

20. c. On the medial side of the femur

20. Where should each lesser trochanter appear in the image? a. Superimposed on the femur b. On the lateral side of the femur c. On the medial side of the femur

21. The IR should be placed in a vertical position with its upper border in the crease above the iliac crest and its lower border should be angled away from the body so that the IR is parallel with the long axis of the femoral neck.

21. Describe the placement of the IR.

21. False (The patient must be supine.)

21. True or false. The patient may be positioned either supine or upright.

21. ASIS and superior margin of the pubic symphysis

21. What are the two palpable bony points of localiza- tion for the hip joint?

22. Make a line from the ASIS to the upper margin of the pubic symphysis. At the midpoint of that line, extend a second line at a right angle and inferolater- ally toward the femur. The long axis of the femoral neck lies parallel with the second line.

22. Describe how to use the two points identified in question 21 to locate the femoral neck.

22. False (The gonads should be carefully shielded to ensure that the shield does not superimpose the hip.)

22. True or false. The gonads should not be shielded for the AP oblique projection.

23. False (The greater sciatic notch extends from just below the posterior inferior iliac spine to the ischial spine.)

23. True or false. The greater sciatic notch is located on the anterior border of the ilium.

23. a. Horizontally, parallel with the long axis of the femoral neck

23. With reference to the femoral neck, how should the lead strips of the grid be placed? a. Horizontally, parallel with the long axis of the femoral neck b. Vertically, perpendicular with the long axis of the femoral neck

25. a. Any orthopedic appliance should be completely demonstrated.

25. What is the general rule concerning demonstration of any orthopedic appliance with this projection? a. Any orthopedic appliance should be completely demonstrated. b. Ensure that the orthopedic appliance does not superimpose the acetabulum.

26. False (The pelvis should be adjusted so no rotation exists.)

26. True or false. The pelvis should be rotated approxi- mately 15 to 20 degrees.

27. False (The foot should be rotated medially if the patient's condition permits the maneuver.)

27. True or false. The foot and lower limb should be rotated laterally 15 to 20 degrees.

28. False (Only a small amount of the lesser trochanter should be seen on the posterior surface of the femur.)

28. True or false. The entire lesser trochanter should be demonstrated on the lateral surface of the femur.

29. False (No part of the unaffected thigh should super- impose the affected femur.)

29. True or false. A small area of soft tissue overlap from the thigh of the unaffected lower limb is permitted.

3. d. Rotate the foot and lower limb medially 15 to 20 degrees.

3. Which positioning maneuver should be performed to place the femoral neck parallel with the plane of the IR? a. Abduct the femur laterally 15 to 20 degrees. b. Abduct the femur medially 15 to 20 degrees. c. Rotate the foot and lower limb laterally 15 to 20 degrees. d. Rotate the foot and lower limb medially 15 to 20 degrees.

3. d. Ilium, pubis, and ischium

3. Which three names refer to the major bone that makes up the right or left half of the pelvis? a. Ilium, hip bone, and ischium b. Ilium, pubis, and innominate c. Os coxae, pubis, and ischium d. Ilium, pubis, and ischium

30. A. Acetabulum B. Femoral head C. Femoral neck D. Greater trochanter E. Lesser trochanter

30. Identify each lettered structure shown in Fig. 7-14. A. _____________________________________________ B. _____________________________________________ C. _____________________________________________ D. _____________________________________________ E. _____________________________________________ Fig. 7-14 Axiolateral hip, Danelius-Miller method.

4. 40 degrees caudad

4. The superoinferior axial "inlet" projection (Bridgeman method) requires the central ray be directed ____________________.

4. c. Place a support under the knee and a sandbag across the ankle.

4. What procedure should help the patient keep the affected lower leg in the required position? a. Place a compression band across the pelvis. b. Place a foam cushion or folded blanket under the pelvis. c. Place a support under the knee and a sandbag across the ankle.

4. The internal oblique position of the Judet method demonstrates the iliopubic column (anterior) of the pelvis and the posterior rim of the acetabulum.

4. What specific portion of the acetabulum and pelvis is demonstrated by the internal oblique position of the Judet method?

4. b. Iliac crest and anterior superior iliac spine (ASIS)

4. Which two prominent structures found on the ilium are frequently used as radiographic positioning refer- ence points? a. Iliac crest and inferior superior iliac spine b. Iliac crest and anterior superior iliac spine (ASIS) c. Pubic symphysis and inferior superior iliac spine d. Pubic symphysis and ASIS

5. b. Midsagittal

5. Which plane of the body should be positioned on the midline of the table and grid? a. Horizontal b. Midsagittal c. Midcoronal

6. Figure A is the LPO position and places the affected side up in an internal oblique position, demonstrat- ing the right iliopubic pelvic column and the poste- rior rim of the right acetabulum.

6. Which figure (A or B) depicts the proper patient posi- tion to demonstrate a suspected fracture of the right iliopubic column and posterior rim of the acetabulum?

6. Lesser

6. Which trochanter (greater or lesser) is not usually demonstrated beyond the border of the femur?

6. Midway between the ASIS and the pubic symphysis (approximately 2 inches [5 cm] above the pubic symphysis)

6. With reference to the patient, where should the IR be centered?

7. Figure B is the RPO position and places the affected side down in an external oblique position, demon- strating the right ilioischial pelvic column and the posterior rim of the right acetabulum.

7. Whichfigure(AorB)depictstheproperpatientposi- tion to demonstrate a suspected fracture of the iliois- chial column and anterior rim of the acetabulum?

8. False (The patient should suspend breathing.)

8. True or false. The exposure should be performed with the patient breathing shallowly.

8. Ischium and pubis

8. What bones of the hip bone form the obturator foramen?

8. The central ray should enter the patient perpendicu- lar to the IR at a point 2 inches inferior to the ASIS of the affected side.

8. Where should the central ray enter the patient as positioned in Fig. 7-15, A?

8. Fig. 7-5

8. Which image demonstrates correct positioning of the proximal femora?

9. The lesser trochanters are minimally seen on the medial border of the femora; the greater trochanters are fully demonstrated; and the femoral necks are demonstrated in their full extent without anteversion.

9. State the image characteristics that lead you to believe the patient was properly positioned for that image.

9. True

9. True or false. An initial radiographic study of a frac- tured hip may include an AP projection of the pelvic girdle and proximal femora to demonstrate bilateral hip joints.

9. Acetabulum

9. What structure of the hip bone is formed by the fusion of three bones?

11. a. Acetabulum

Examine Fig. 7-11 as you answer the following ques- tions. Items 11-16 pertain to the Lauenstein method and Hickey method for lateral projections. Fig. 7-11 Mediolateral hip, Lauenstein method. 11. A lateral projection image obtained by the Lauenstein method or the Hickey method is used to demonstrate the hip joint and the relationship of the head of the femur with the: a. Acetabulum b. Femoral shaft c. Greater trochanter

2. a. To ensure that the pelvis is not rotated

Examine Fig. 7-9 as you answer the following questions. Items 2-10 pertain to the AP projection. 2. Why should a radiographer ensure that the distance from the ASIS to the tabletop on each side of the pelvis is the same? a. To ensure that the pelvis is not rotated b. To align the midsagittal plane to the midline of the table c. To demonstrate the lesser trochanter beyond the medial border of the femur

Section 2: Exercise 4: Projections for Demonstrating the Anterior Pelvic Bones 1. The superoinferior axial "inlet" projection (Bridgeman method)

Exercise 4: Projections for Demonstrating the Anterior Pelvic Bones The AP axial "outlet" projection (Taylor method) and the AP axial "inlet" projection (Bridgeman method) are used to image the anterior pelvic bones. The following questions pertain to these projections. 1. Which projection demonstrates the superior and inferior rami of the pubic bones superimposed medially

17. "Cross-table" lateral and "surgical-lateral"

Fig. 7-12 Mediolateral hip, Lauenstein method. Examine Fig. 7-13 as you answer the following ques- tions. Items 17-30 pertain to the axiolateral projection, Danelius-Miller method. Fig. 7-13 Axiolateral hip, Danelius-Miller method. 17. List two common names used to denote the axi- olateral projection (Danelius-Miller) of the hip.

Section 1: Exercise 1 A. Iliac crest B. Anterior superior iliac spine C. Anterior inferior iliac spine D. Acetabulum E. Ischium F. Obturator foramen G. Ilium (or the ala of the ilium) H. Auricular surface I. Posterior superior iliac spine J. Posterior inferior iliac spine K. Ischial spine L. Pubis

Identify each lettered structure shown in Fig. 7-1. A. ________________________________________________ B. ________________________________________________ C. ________________________________________________ D. ________________________________________________ E. ________________________________________________ F. ________________________________________________ G. ________________________________________________ H. ________________________________________________ I. ________________________________________________ J. ________________________________________________ K. ________________________________________________ L. _______________________________________

Section 1: Exercise 2 A. Posterior superior iliac spine B. Posterior inferior iliac spine C. Greater sciatic notch D. Ischial spine E. Lesser sciatic notch F. Ischial tuberosity G. Ischium H. Ischial ramus I. Ilium (or the ala of the ilium) J. Iliac crest K. Anterior superior iliac spine L. Anterior inferior iliac spine M. Acetabulum N. Superior ramus of the pubis O. Obturator foramen P. Pubis Q. Inferior ramus of the pubis

Section 1: Exercise 2 Identify each lettered structure shown in Fig. 7-2. A. ________________________________________________ B. ________________________________________________ C. ________________________________________________ D. ________________________________________________ E. ________________________________________________ F. ________________________________________________ G. ________________________________________________ H. ________________________________________________ I. ________________________________________________ J. ________________________________________________ K. ________________________________________________ L. ________________________________________________ M. ________________________________________________ N. ________________________________________________ O. ________________________________________________ P. ________________________________________________ Q. ________________________________________________

Section 1: Exercise 3 A. Greater trochanter B. Neck C. Head D. Lesser trochanter E. Body F. Fovea capitis G. Intertrochanteric crest

Section 1: Exercise 3 Identify each lettered structure shown in Fig. 7-3. A. ________________________________________________ B. ________________________________________________ C. ________________________________________________ D. ________________________________________________ E. ________________________________________________ F. ________________________________________________ G. ________________________________________________

Section 1: Exercise 4 A. Iliac crest B. Anterior superior iliac spine (ASIS) C. Ischial spine D. Greater trochanter E. Lesser trochanter F. Inferior ramus of pubis G. Pubic symphysis H. Obturator foramen I. Ischium J. Acetabulum K. Sacrum L. Sacroiliac (SI) joints M. Ala

Section 1: Exercise 4 Identify each lettered structure shown in Fig. 7-4. A. ________________________________________________ B. ________________________________________________ C. ________________________________________________ D. ________________________________________________ E. ________________________________________________ F. ________________________________________________ G. ________________________________________________ H. ________________________________________________ I. ________________________________________________ J. ________________________________________________ K. ________________________________________________ L. ________________________________________________ M. ________________________________________________

CHAPTER 7: SECTION 2: POSITIONING OF THE PELVIS AND UPPER FEMORA Section 2: Exercise 1: Projections for the Pelvis and Femoral Necks (Your answers for "Key patient/part positioning points" may be different than those provided. This area should re- ect positioning reminders to help your learning the most.) 1. AP Pelvis Collimate to 17 inches wide 3 14 inches long (43 3 35 cm) Supine; shoulders and hips in same plane; ASIS equidistant from table; lower limbs internally rotated 15 to 20 degrees ASIS equidistant from table; MSP aligned with long axis of table Perpendicular to MSP at level midway between ASIS and pubic symphysis AP oblique—femoral necks (modi ed Cleaves) Collimate to 17 inches wide 3 14 inches long (43 3 35 cm) Supine; shoulders and hips in same plane; ASIS equidistant from table; hips and knees flexed with feet drawn up as much as possible; thighs abducted n ASIS equidistant from table; MSP aligned with long axis of table Perpendicular to MSP at level 1 inch (2.5 cm) superior to the pubic symphysis

Section 2: Exercise 1: Projections for the Pelvis and Femoral Necks This exercise pertains to the essential projections of the pelvis and femoral necks. Provide a short answer, select the answer from a list, or identify structures for each item. 1. List the essential projections for the pelvis and femo- ral necks, and describe the positioning steps used for each, as follows: Essential projection Size of collimated field: Key patient/part positioning points: Anatomic landmarks and relation to IR: CR orientation and entrance point: Essential projection: __________________________________ ( ________________________________________________ method) Size of collimated field: Key patient/part positioning points: Anatomic landmarks and relation to IR: CR orientation and entrance point:

Section 2: Exercise 2: Projections for Demonstrating the Hip (Your answers for "Key patient/part positioning points" may be different than those provided. This area should re- ect positioning reminders to help your learning the most.) 1. AP n 10312inches(24330cm) n n n Supine; shoulders and hips in same plane; ASIS equidistant from table; affected lower limb inter- nally rotated 15 to 20 degrees ASIS equidistant from table; MSP aligned with long axis of table Perpendicular to MSP at the femoral neck (located 21⁄2 inches (6.4 cm) distal on a line drawn perpen- dicular to the midpoint of a line between the ASIS and the pubic symphysis) Lateral (Lauenstein, Hickey) n 12 inches wide 3 10 inches long (30 3 24 cm) n Patient supine and slightly obliqued toward af- fected hip; ex knee and draw thigh up to right angle to hip; abduct thigh n N/A n Lauenstein method—perpendicular to hip joint, lo- cated halfway between ASIS and pubic symphysis n Hickey method—20 to 25 degrees cephalic enters hip joint Axiolateral (Danelius-Miller) n 12 inches wide 3 10 inches long (30 3 24 cm) n Supine with unaffected lower limb elevated enough to avoid being imaged; if not contraindicated, in- ternally rotate affected limb 15 to 20 degrees n IR is vertically placed parallel to femoral neck of affected hip; no rotation of pelvis n Horizontal; enters midthigh perpendicular to IR and femoral neck

Section 2: Exercise 2: Projections for Demonstrating the Hip This exercise reviews the essential projections of the hip. Identify structures, provide a short answer, select from a list, or choose true or false (explaining any statement you believe to be false) for each item. 1. List the essential projections for the hip, and describe the positioning steps used for each, as follows: Essential projection: Size of collimated field: Key patient/part positioning points: Anatomic landmarks and relation to IR: CR orientation and entrance point: Essential projection: __________________________________ ( ________________________________________________ method) Anatomic landmarks and relation to IR: CR orientation and entrance point: Size of collimated field: Key patient/part positioning points: Essential projection: __________________________________ ( ________________________________________________ method) Size of collimated field: Key patient/part positioning points: n Anatomic landmarks and relation to IR: CR orientation and entrance point:

Section 2: Exercise 3: Projection for Demonstrating the Acetabulum (Your answers for "Key patient/part positioning points" may be different than those provided. This area should re ect positioning reminders to help your learning the most.) 1. AP oblique (Judet) n 10312inches(24330cm) n Internal oblique—45-degree posterior oblique posi- tion with affected side elevated; external oblique— 45-degree posterior oblique position with affected side down n MSP at 45-degree angle to plane of IR n Perpendicular for both obliques; internal oblique enters at 2 inches (5 cm) inferior to ASIS of af- fected side; external oblique enters at pubic sym- physis

Section 2: Exercise 3: Projection for Demonstrating the Acetabulum This exercise reviews the essential projection for demon- stration of the acetabulum. Provide a short answer, select the correct answer, or identify labeled structures on im- ages for the following questions. 1. List the essential projection for the acetabulum, and describe the positioning steps used as follows: Essential projection: __________________________________ ( ________________________________________________ method) Size of collimated field: Key patient/part positioning points: Anatomic landmarks and relation to IR: CR orientation and entrance point:

Section 2: Exercise 5: Pelvic Girdle Image Evaluation 1. The orthopedic appliance is not included in its entirety. This image must be repeated using a larger IR or col- limated field to demonstrate the entire appliance.

1. Explain why the image in Fig. 7-20 must be repeated. Fig. 7-20 AP hip with improper positioning. Fig. 7-21 is an image of an AP pelvis. Examine this image and answer the questions that follow. Fig. 7-21 AP pelvis with improper positioning.

Section 1: Exercise 7 1. Pelvis

1. The structure of the body that serves as a base for the trunk and as a girdle for the attachment of the lower limbs is known as the ___________________.

10. Fully extended and rotated medially 15 to 20 degrees

10. Describe how the lower limbs were positioned in Fig. 7-5.

10. A. Ilium B. Acetabulum C. Femoral head D. Greater trochanter E. Femoral neck F. Pubic symphysis G. Lesser trochanter H. Femoral body

10. Identify each lettered structure shown in Fig. 7-10. A. _____________________________________________ B. _____________________________________________ C. _____________________________________________ D. _____________________________________________

11. Fully extended with the feet rotated laterally into a naturally relaxed position

11. Describe how the lower limbs were positioned in Fig. 7-6.

11. A. Acetabulum B. Femoral head C. Ilioischial column D. Lesser trochanter E. Ischium

11. Identify each lettered structure shown in Fig. 7-17. A. _____________________________________________ B. _____________________________________________ C. _____________________________________________ D. _____________________________________________ E. _____________________________________________ Fig. 7-17 AP oblique (Judet), external oblique. Section 2:

11. Greater (false) pelvis and lesser (true) pelvis

11. Name the two parts a pelvis is divided into by the brim of the pelvis.

11. b. 2 inches (5 cm) above the pubic symphysis

11. Where on the midline of the patient should the cen- tral ray enter for the AP projection of the pelvis? a. 2 inches (5 cm) above the iliac crest b. 2 inches (5 cm) above the pubic symphysis c. At the level of the ASIS d. 2 inches (5 cm) above the level of the ASIS

21. c. AP oblique projection (Judet method)

21. Which of the following best demonstrates suspected fractures of the acetabulum? a. AP axial "inlet" projection (Bridgeman method) b. AP axial "outlet" projection (Taylor method) c. AP oblique projection (Judet method) d. Axiolateral projection (Danelius-Miller method)

12. Flex the affected knee and draw the thigh up to a nearly right-angle position relative to the affected hip centered to the midline of the table.

12. Describe how the affected thigh and leg should be positioned for lateral projections of the hip.

12. a. Above b. Below

12. With reference to the brim of the pelvis, identify the location of the greater (false) pelvis and the lesser (true) pelvis as either "above" or "below." a. Greater pelvis: ________________________________ b. Lesser pelvis: __________________________________

13. Pelvic cavity

13. The region between the inlet and the outlet of the true pelvis is called the ____________________________.

14. c. AP oblique projection (modified Cleaves method) for femoral necks

14. For which projection of the lower limbs or pelvis should the hips be flexed and the femora be abducted from the midline of the patient? a. AP projection of the hip b. AP projection of the pelvis c. AP oblique projection (modified Cleaves method) for femoral necks d. Axiolateral projection (Danelius-Miller method) of the hip

14. a. Perpendicularly

14. How should the central ray be directed for the Lauenstein method of a lateral hip projection? a. Perpendicularly b. Caudally 20 to 25 degrees c. Medially 20 to 25 degrees d. Cephalically 20 to 25 degrees

14. Female

14. Which gender (male or female) has a pelvis with a larger and more rounded outlet?

15. As much as possible to get the femora to a near- vertical position

15. How much should the hips and knees be flexed?

15. b. 1 inch (2.5 cm) above the pubic symphysis

15. Where on the midline of the patient should the cen- tral ray be directed for the AP oblique projection (modified Cleaves method)? a. To the level of the iliac crests b. 1 inch (2.5 cm) above the pubic symphysis c. To the level of the ASIS d. 2 inches (5 cm) above the ASIS

15. Female

15. Which gender (male or female) has a broader and shallower pelvis?

16. 45 degrees

16. After the patient's knees and hips are flexed, how many degrees from vertical should the thighs be abducted?

16. c. Lateral projection (Lauenstein method) of the hip

16. All of the following projections can be used to image a patient with a suspected intertrochanteric fracture, except for the: a. AP projection of the hip b. AP projection of the pelvis c. Lateral projection (Lauenstein method) of the hip d. Axiolateral projection (Danelius-Miller method) of the hip

16. A. Acetabulum B. Femoral head C. Femoral neck D. Lesser trochanter E. Ischial tuberosity

16. Identify each lettered structure shown in Fig. 7-12. A. _____________________________________________ B. _____________________________________________ C. _____________________________________________ D. _____________________________________________ E. _____________________________________________

18. First, draw a line from the ASIS to the superior bor- der of the pubic symphysis. Then draw another line from a point 1 inch (2.5 cm) inferior of the greater trochanter to the midpoint of the first line. The femo- ral neck runs parallel with this second line.

18. Describe an acceptable method for locating the femoral neck.

18. Femoral neck and intertrochanteric crest

18. Name the two areas of the proximal femur that are common sites for fractures in elderly patients.

9. The central ray should enter perpendicular to the IR at the pubic symphysis.

9. Where should the central ray enter the patient as positioned in Fig. 7-15, B?

18. Stop breathing (suspend respiration) during the exposure.

18. What breathing instructions should be given to the patient?

18. d. ASIS

18. Which structure should be centered to the midline of the table when the AP oblique projection (modified Cleaves method) is adapted to demonstrate only one hip? a. Femoral body b. Pubic symphysis c. Greater trochanter d. ASIS

19. Perpendicular to a point on the midline of the patient about 1 inch (2.5 cm) above the pubic symphysis

19. Describe how and where the central ray should be directed.

19. d. Axiolateral projection (Danelius-Miller method)

19. For which projection of an individual hip should the unaffected hip be flexed and the thigh be raised out of the way of the central ray? a. AP projection b. Lateral projection (Lauenstein method) c. AP oblique projection (modified Cleaves method) d. Axiolateral projection (Danelius-Miller method)

19. Anteriorly

19. In a typical adult, in which direction (anterior or posterior) does the femoral neck project away from the long axis of the femur?

19. To elevate the pelvis and provide better centering of the hip to the IR

19. Why should a firm pillow or folded blanket be placed under the pelvis?

2. The ischia are clipped or not included in the image.

2. Explain why Fig. 7-21 does not meet the evaluation criteria for this projection.

2. Up

2. The internal oblique position places the affected side ________________________________________________.

2. Taylor

2. To demonstrate the pubic and ischial rami without foreshortening, the ______________________ method should be used.

2. c. Two hip bones, sacrum, and coccyx only

2. Which bones form the pelvis? a. Two hip bones only b. Two hip bones and sacrum only c. Two hip bones, sacrum, and coccyx only d. Two hip bones, sacrum, coccyx, and femora

2.d. Pubis, ischium, and ilium

2. Which bones of the pelvis compose the acetabulum? a. Ilium and pubis only b. Ilium and ischium only c. Pubis and ischium only d. Pubis, ischium, and ilium

20. Flex the knee and hip of the unaffected side to elevate the thigh in a vertical position, then it can be rested on some support.

20. Describe how the unaffected lower limb should be positioned.

20. d. Axiolateral projection (Danelius-Miller method)

20. For which projection of the hip should the central ray be directed horizontally into the medial aspect of the affected thigh? a. AP projection b. Lateral projection (Lauenstein method) c. AP oblique projection (modified Cleaves method) d. Axiolateral projection (Danelius-Miller method)

20. One pubic symphysis, two hip joints (femoral head and acetabulum), and two SI joints

20. Identify the major articulations of the pelvis by name or abbreviation, and give the quantity for each.

22. Perpendicular to the long axis of the femoral neck, entering the patient on the medial aspect of the affected thigh near the groin, and centered to the IR

22. Describe how and where the central ray should be directed.

22. a. 45 degree RPO

22. Which of the following positions would be used to demonstrate the posterior rim of the left acetabulum? a. 45 degree RPO b. 45 degree LPO c. 45 degree RAO d. 45 degree LAO

23. True

23. True or false. The AP oblique projection should not be performed on a patient who is suspected to have a fractured femoral neck.

23. b. Anterior rim

23. What specific portion of the acetabulum is dem- onstrated by the AP oblique projection, external oblique position (Judet method)? a. Posterior rim b. Anterior rim c. Medial border d. Lateral border

24. True

24. True or false. In the seated position, the weight of the body rests on two ischial tuberosities.

24. False (The greater trochanter can be minimally seen on the medial edge of the femur.)

24. True or false. The greater trochanter should be seen in profile on the lateral side of the proximal femur.

24. b. Stop breathing for the exposure

24. What breathing instructions should be given to the patient? a. Breathe slowly and deeply b. Stop breathing for the exposure

24. b. AP axial "outlet" projection (Taylor method)

24. Which of the following would best demonstrate the pubic and ischial rami without foreshortening? a. AP axial "inlet" projection (Bridgeman method) b. AP axial "outlet" projection (Taylor method) c. AP oblique projection (Judet method) d. Axiolateral projection (Danelius-Miller method)

25. True

25. True or false. The highest point of the greater tro- chanter is in the same transverse plane as the mid- point of the hip joint

25. True

25. True or false. This projection can be modified to demonstrate only one hip area.

25. d. 30 to 45 degrees cephalad

25. What is the proper central ray orientation for the AP axial projection (Taylor method) for female patients? a. 20 to 35 degrees caudad b. 20 to 35 degrees cephalad c. 30 to 45 degrees caudad d. 30 to 45 degrees cephalad

3. Male patients: central ray angled 20 to 35 degrees cephalad; female patients: central ray angled 30 to 45 degrees cephalad

3. Explain how the central ray orientation for the AP axial "outlet" projection (Taylor method) differs between male and female patients.

3.a. Ilium

3. On which bone is the ala located? a. Ilium b. Pubis c. Femur d. Ischium

3. Down

3. The external oblique position places the affected side ________________________________________________.

3. To place the femoral necks parallel with the plane of the IR

3. What is the rationale for positioning of the lower limbs?

3. The central ray entered too low on the patient, and the IR was centered too low on the patient.

3. What positioning error likely produced this image?

4. The iliac crests are clipped, or not included in the image.

4. Explain why Fig. 7-22 does not meet the evaluation criteria for the AP projection of the pelvis. Fig. 7-22 AP pelvis with improper positioning.

4. c. The alae of the ilia are asymmetrical if the pelvis is rotated.

4. How is rotation of the pelvis detected in an AP pro- jection image? a. The lesser trochanters are well demonstrated if the pelvis is rotated. b. The femoral necks are seen in their entirety if the pelvis is rotated. c. The alae of the ilia are asymmetrical if the pelvis is rotated.

4.b. Ischial spine

4. Which of the following pelvic structures is not used as a positioning palpation point? a. Iliac crest b. Ischial spine c. Pubic symphysis d. ASIS

6. a. 2 inches (5 cm) distal to the superior border of the pubic symphysis

6. Where does the central ray enter the patient for the AP axial "outlet" projection (Taylor method)? a. 2 inches (5 cm) distal to the superior border of the pubic symphysis b. 2 inches (5 cm) proximal to the superior border of the pubic symphysis c. At the ASIS d. At the pubic symphysis

6. c. Ischium

6. Which bone/portion of the hip bone extends inferi- orly from the acetabulum and joins with the inferior ramus of the pubic bone? a. Ilium b. Pubis c. Ischium d. Acetabulum

5. Locate a point about 21⁄2 inches (6.4 cm) distal on a line drawn perpendicular to the midpoint of a line between the ASIS and the pubic symphysis.

5. Describe how to find the centering point where the central ray should enter the patient.

5. The central ray and IR were centered too high on the patient.

5. What positioning error likely produced the image labeled as Fig. 7-22?

5. The external oblique position of the Judet method demonstrates the ilioischial column (posterior) of the pelvis and the anterior rim of the acetabulum.

5. What specific portion of the acetabulum and pelvis is demonstrated by the external oblique position of the Judet method?

5. c. At the ASIS

5. Where does the central ray enter the patient for the superoinferior axial "inlet" projection (Bridgeman method)? a. 2 inches (5 cm) inferior to the pubic symphysis b. At the pubic symphysis c. At the ASIS d. At the iliac crests

5. c. Pubis

5. Which bone/portion of the hip bone consists of a body and two rami? a. Ala b. Ilium c. Pubis d. Ischium

5.c. Pubis and ischium only

5. Which portions of the hip bone join to form the obtu- rator foramen? a. Ilium and pubis only b. Ilium and ischium only c. Pubis and ischium only d. Pubis, ischium, and ilium

6. a. Iliac crest

6. What is the name of the border that extends on the hip bone from the posterior superior iliac spine to the ASIS? a. Iliac crest b. Greater sciatic notch c. Iliac auricular surface d. Brim of the lesser pelvis

7. A. Ischial spines B. Pubic rami (superimposed)

7. Identify each lettered structure shown in Fig. 7-18. A. _____________________________________________ B. _____________________________________________ Fig. 7-18 AP axial pelvic bones, Bridgeman method.

7. True

7. True or false. The entire pubis of the affected side should be demonstrated.

7. a. Ischial spine

7. What is the name of the process that separates the greater sciatic notch from the lesser sciatic notch on the hip bone? a. Ischial spine b. Ischial ramus c. Inferior ramus of the pubis d. Superior ramus of the pubis

7. Ilium

7. What part of the hip bone forms the broad, curved portion called the ala?

7. a. Central ray and IR centered too low

7. Which of the following likely caused the error demon- strated in Fig. 7-23? a. Central ray and IR centered too low b. Central ray and IR centered too high c. Incorrect AEC detector used d. Leg was not abducted enough

7. The proximal femora (greater and lesser trochanters and femoral neck)

7. Which structures in these two images appear different?

8. A. Ilium B. Acetabulum C. Superior pubic ramus D. Femoral head E. Pubic symphysis F. Obturator foramen G. Inferior pubic ramus H. Ischial ramus

8. Identify each lettered structure shown in Fig. 7-19. A. _____________________________________________ B. _____________________________________________ C. _____________________________________________ D. _____________________________________________ E. _____________________________________________ F. _____________________________________________ G. _____________________________________________ H. _____________________________________________

8. b. Ischial tuberosities

8. Which parts of the hip bones support the weight of the body when a person is in the sitting position? a. Ischial spines b. Ischial tuberosities c. Inferior rami of the pubes d. Posterior inferior iliac spines

1.a. Acetabulum

CHAPTER 7: SELF-TEST: OSTEOLOGY, ARTHROLOGY, AND POSITIONING OF THE PELVIS AND PROXIMAL FEMORA Answer the following questions by selecting the best choice. 1. Which structure of the pelvis articulates with the femur? a. Acetabulum b. Inferior aperture c. Auricular surface d. Obturator foramen

14. Bilateral frog-leg

Questions 14-25 pertain to the AP oblique projection (modified Cleaves method) of the femoral necks. Examine Fig. 7-8 as you answer the following questions. 14. What other name commonly refers to the AP oblique projection, modified Cleaves method?

10. d. About 2 inches (5 cm) inferior to ASIS and 2 inches (5 cm) superior to pubic symphysis

10. In average-sized patients, where should the IR be centered for the AP projection of the pelvis? a. To the level of the iliac crest b. To the level of the pubic symphysis c. 2 inches (5 cm) below the greater trochanter d. About 2 inches (5 cm) inferior to ASIS and 2 inches (5 cm) superior to pubic symphysis

12. b

12. Which positioning maneuver should be performed to place the femoral necks parallel with the IR for an AP projection of the pelvis? a. Rotate the lower limbs laterally 15 to 20 degrees. b. Rotate the lower limbs medially 15 to 20 degrees. c. Flex the hips 15 to 20 degrees and extend the lower limbs. d. Flex the hips and abduct the femora laterally 15 to 20 degrees.

13. The unaffected leg should be extended and supported at the level of the hip.

13. Describe how the unaffected lower limb should be positioned.

13. a. Perpendicularly

13. How should the central ray be directed for the AP oblique projection (modified Cleaves method) to demonstrate bilateral hips? a. Perpendicularly b. Cephalically 20 degrees c. Cephalically 40 degrees d. Parallel with the long axis of the femora

16. d. Greater trochanter and lesser trochanter

16. Which two large processes are located at the proximal end of the femur? a. Greater tubercle and lesser tubercle b. Greater tubercle and lesser trochanter c. Greater trochanter and lesser tubercle d. Greater trochanter and lesser trochanter

17. c. To position the femoral necks parallel with the IR

17. For the AP oblique projection (modified Cleaves method), what is the purpose of abducting the fem- ora the required number of degrees? a. To position the pelvis in the true lateral position b. To prevent superimposing the acetabulum with the pelvis c. To position the femoral necks parallel with the IR d. To prevent superimposing the femoral head with the acetabulum

17. To place the long axis of the femoral necks parallel with the plane of the IR

17. What is the purpose of abducting the thighs as required?

9. a. It forms part of the acetabulum.

9. Where in the pelvis is the body of the pubis located? a. It forms part of the acetabulum. b. It forms part of the pubic symphysis. c. It is between the inferior and superior rami of the pubis. d. It is between the ischial ramus and the inferior ramus of the pubis.

2. Extend and rotate the lower limbs medially 15 to 20 degrees

Questions 2-13 refer to the AP projection of the pelvis and proximal femora. 2. Describe how the patient's lower limbs should be positioned.

6. a. Hip joint centered to the image b. Hip joint, acetabulum, and femoral head demonstrated

Fig. 7-23 is a lateral projection of the hip (Lauenstein method) with a positioning error. Examine the image and answer the following questions. Fig. 7-23 Lateral hip with improper positioning. 6. Which of the following evaluation criteria are not met in this image? a. Hip joint centered to the image b. Hip joint, acetabulum, and femoral head demonstrated c. Femoral neck overlapped by the greater trochanter d. Evidence of proper collimation