RADTK 120 PELVIC GIRDLE
The medial surface of the ilium contains what?
iliac fossa
What three bones join together to form the acetabulum?
ilium, pubis, and ischium
The region between the inlet and the outlet is called:
the pelvic cavity
What are the central ray angle and direction for the superoinferior axial projection (Bridgeman method)? Answers: 40 degrees caudad 20 to 35 degrees caudad for males 20 to 35 degrees cephalad for males 40 degrees cephalad
40 degrees caudad
What are the essential projections for the hip?
AP Lateral (mediolateral) (Lauenstein; Hickey) Axiolateral (Danelius-Miller)
Which of the following projections demonstrates the anterior pelvic bones with less foreshortening than other projections? Answers: PA AP axial (Taylor method) Superoinferior axial (Bridgeman method) Modified axiolateral (original Cleaves method)
AP axial (Taylor method)
Which of the following projections is used to demonstrate bilateral projections of the femoral necks? Answers: Axiolateral (Danelius-Miller method) AP oblique (modified Cleaves method) AP oblique (Judet method) Lateral (Hickey method)
AP oblique (modified Cleaves method)
The first step in localizing the femoral head is to draw an imaginary line connecting the: Answers: ASIS and superior margin of hte pubic symphysis Anterior superior iliac spine (ASIS) and greater trochater iliac crest and superior margin of the pubic symphysis iliac crest and greater trochanter
ASIS and superior margin of the pubic symphysis
How is the central ray directed for the axiolateral projection of the hip (Danelius-Miller method)? Answers: Vertically and 20 to 25 degrees cephalad Horizontally and 20 to 25 medially Horizontally and perpendicular to the femoral neck Vertically and perpendicular to the femoral neck
Horizontally and perpendicular to the femoral neck
Which projection is used to demonstrate the hip joint and the relationship of the femoral head to the acetabulum? Answers: AP oblique projection of the acetabulum (Judet method), internal oblique position AP oblique projection of the acetabulum (Judet method), external oblique position AP projection of the pelvis Lateral projection of the hip (Lauenstein and Hickey methods)
Lateral projection of the hip (Lauenstein and Hickey methods)
Which pathologic condition of the pelvis and upper femora is characterized by flattening of the femoral head and is caused by vascualr interruption? Answers: Legg-Calve-Perthes disease Ankyosing spondylitis Congenital hip dysplasia Paget's disease
Legg-Calve-Perthes disease
Osteoporosis
Loss of bone density
Chondrosarcoma
Malignant tumor arising from cartilage cells
How are the lower limbs positioned for the AP projection of the pelvis? Answers: Medially rotated 15 to 20 degrees Laterally rotated 15 to 20 degrees Abducted as much as possible Adducted as much as possible
Medially rotated 15 to 20 degrees
What is the shape of the pelvis inlet (superior aperture) in a female? Answers: Oval Round Narror Shallow
Oval
All of the following projections are used to demonstrate the anterior pelvic bones, except the: Answers: PA axial oblique (Teufel method) PA AP axial (Taylor method) Superoinferior axial (Bridgeman method)
PA axial oblique (Teufel method)
The fovea capitis is demonstrated on the: Answers: Superoinferior axial projection (Bridgeman method) PA axial oblique projection (Teufel method) PA oblique ilium projection AP oblique ilium projection
PA axial oblique projection (Teufel method)
AP hip:
Patient Position: supine Part Position: no rotation of pelvis. (ASIS to table top distance equal to both sides). Medially rotate lower limb and foot about 15 to 20 degrees. (places femoral neck parallel to IR). CR is perpendicular to femoral neck. Use localization technique described previously. Adjustment may be necessary ir orthopedic device is present. Colimated field is the size of the IR. Shield gonads. Suspend respiration.
Lateral hip (Hickey)
Patient position: rotate slightly toward affected side to an oblique position. Part position: center affected hip to midline of grid. Flex affected kness and draw thigh to almost right anlge to hip. Body of femur parallel to table. Support opposite hip and knee. CR is angled 20 degrees cephalic, and enters at the hip joint. Center the IR to the CR.
Axiolateral Hip (Danelius-Miller)
Patient position: supine Part position: elevate pelvis for thin patients. Flex knee and hip of unaffected limb to place thigh vertical. Rest unaffected leg and foot on a support. No rotation of pelvis. Rotate affected limb 15 to 20 degrees medially. IR: vertical with upper border in crease above iliac crest. Angle lower bordere away from body until parallel with femoral neck. Support IR in position. CR: is horizontal and perendicular to long axis of femoral neck.
The pelvis serves as what for the trunk and girdle for attachment of the lower limb?
a base
auricular surface:
a large rough surface for articulation with the sacrum.
The angulation of the neck of the femur varies considerable with what?
age, sex, and stature
The pelvis is divided into two portions by what?
an oblique plane that extends form the upper anterior margin of the sacrum to the upper margin of the pubic symphysis
The anterior and posterior borders of the ala present what four prominent projections?
anterior superior iliac crest anterior inferior iliac crest posterior superior iliac crest posterior inferior iliac crest
The ala has what three borders?
anterior, posterior and superior
In the average adult, the neck projects anteriorly from the body at an angle of what? and superiorly at an angle of what?
approximately 15 to 30 degrees approximately 120 to 130 degrees
The ilium consists of what?
body and ala
The ischium consists of what?
body, and ischial ramus
The pubis consists of what?
body, superior ramus, and inferior ramus
Osteosarcoma
bone cancer
The boundary line of this plane is called:
brim of the pelvis
Hip joint:
can be located palpating the ASIS and the superior margin of the pubis symphysis. The midpoint of a line drawn between these two points is directly above the center of the dome of the acetabular cavity.
Pubic symphysis:
can be palpated on the midsagital plane and on the same horizontal plane as the greater trochanters. By placing the fingertips at the location and performing a breif downward palpation with the hand flat, palm down, and fingers together, the radiographer can locate the superior margin of the pubis symphysis. To avoid possible embarrassment or misunderstanding, the radiographer should advise the patient in advance that this an other palpations ofthe pelvic landmarks are part of normal procedure and necessary for an accurate examination. Normally after that discussion that patient is more than willing to let you do what you need to do to get the accurate image.
The ilium, pubis, and ishium are seperated by ___________ in children, then fuse into bone in adults.
cartilage
Pubic symphysis:
cartilagnious, symphysis, slightly movable
Acetabulum:
cup-shaped socket that recieves the head of the femur
Dislocation
displacement of a bone from the joint space
Fracture
disruption in the continuity of bone
Which of the following are procedural steps required for the AP oblique projection of the acetabulum (Judet method), internal oblique position? Answers: Placing the top of the image receptor at the iliac crest Medially rotating the affected limb 15 to 20 degrees medially Directing the central ray perpendicular to the femoral neck Elevating the affected hip 45 degrees
elevating the affected hip 45 degrees
Gonadal shielding is required for all images of the pelvis and upper femora. Answers: False True
false
Where are common sites for fractures on the humerus in elderly patients?
femoral neck and the intertrachanteric crest
Legg-Calve-Perthes disease
flattening of the femoral head due to vascular interruption
Osteoarthritis or degenerative joint disease
form of arthritis marked by progressise cartilage deterioration in synovial joints and vertebrae
Osteoarthritis or degenerative joint disease
form of arthritis marked by progressive cartilage deterioration in snyovial joints and verebrae
Body of the pubis:
forms approximately 1/5 of the acetabulum anteriorly
The body of the ischium:
forms approximately 2/5 of the acetabulum posteriorly
Body of the ilium:
forms approximately two fifths of the acetabulum superiorly
A small depression at th center of the head of the femur is called:
fovea capitis, which attaches to the ligamentum capitus femoris
The iliopubic column and ilioischial column are used to identify what?
fracures around the acetabulum
The inferior aperture, or outlet, of the true pelvis is measured how?
from the tip of the coccyx to the inferior margin of the pubis symphysis in the anteroposterior direction and between the ischial tuberosities in the horizontal direction
The proximal end of the humerus consists of what?
head, neck, greater trochanter, and lesser trochater
What bony landmark can be used for the radiograph of the pelvis and hip?
iliac crest ASIS pubic symphysis greater trochanter of the femur ischial tuberosity tip of coccyx
The hip bone is divided further into what two distinct areas?
iliopubic column and ilioischial column
The hip bone consists of what?
ilium, pubis, and ischium
The three portions of the hip bone are the: Answers: - Ilium, ischium, and pubis - Ileum, ischium, pubis - Ala, sacrum, and coccyx - Innominate, os coxae, and sacrum
illium, ishium, and pubis
Osteopetrosis
increased density at atypically soft bone
Osteopetrosis
increased density of atypically soft bone
The lower prong of the pubis is termed:
inferior ramus
Which position of the AP oblique projection of the acetabulum (Judet method) requires the affected hip to be elevated 45 degrees? Answers: Internal oblique External oblique Neither position Both positions
internal oblique
The prominent ridge extending between the trochanters at the base of the neck on the posterior surface of the body is called:
intertrochanteric crest
Anterior superior iliac crest (ASIS):
is an important and frequently used radiographic positioning reference point
The angle below the pubic symphysis: Answers: Is larger in males Is larger in females Is approximately the same in both genders Varies with age
is larger in females
Female pelvis:
is lighter in structure than the male pelvis. It is wider and shallower, and the inlet is larger and more oval shaped. The sacrum is wider, it curves more sharply posteriorly, and the sacral promontory is flatter. Shaped for child bearing.
At the superoposterior border of the body of the ischium is a prominent projection called:
ischial spine
The body of the ischium projects posteriorly and inferiorly from the acetabulum to form an expanded portion called:
ischial tuberosity
Which of the following criteria is used to evaluate the axiolateral projection (Danelius-Miller method) of the hip? Answers: Ischial tuberosity demonstrated below the femoral head Lesser trochanter visible on the medial side of the femur Femoral neck overlapped by the greater trochanter Hip joint demonstrated open
ishial tuberosity demonstrated below the femoral head
All of the following projections require the central ray to be directed perpendicular to the image receptor, except: Answers: Axiolateral of the hip (Danelius-Miller method) Lateral of the hip (Hickey method) AP oblique of the acetabulum (Judet method) AP pelvis
lateral of the hip (Hickey method)
What indention is located right below the ishial spine?
lesser sciatic notch
All of the following criteria are used to evaluate the AP projection of the pelvis EXCEPT: Answers: Lesser trochanters in profile on the medial side of the femora Ischial spines equally demonstrated Ilia equidistant to the edge of the radiograph Greater trochanters in profile
lesser trochanters in profie on the medial side of the femora
iliac crest:
located on the posterior aspect of the ilium, may be more difficult to locate in heavily muscled patients. To avoid positiong errors, this structure may be more easily palpated during patient expiration becuase the abdominal muscles will be relaxed
Osteoporosis
loss of bone density
The less prominent risge connecting the trochanters anteriorly is called:
the intertrochanteric line
Femur:
the longest, strongest, and heaviest bone in the body.
The rami of the pubis and ischium enclose what?
the obturator foramen
The brim forms what?
the superior aperture or inlet of the true pelvis
The region below the brim is called:
the true or lesser pelvis
When the body is in a seated-upright position, its weight rests on what?
the two ischial tuberosities
Paget disease
thick, soft bone that marked by bowing and fractures
Metastasis
transfer of a cancerous lesion from one area to another
The pelvic girdle is composed of what?
two hip bones
The pelvis consists of what four bones?
two hip bones, sacrum, and coccyx
The longitudinal plane of the femur is angles about 10 degrees from what?
vertical
Greater trochanter:
which can be palpated immediatley below the deptression in the soft tissues of the lateral surface of the hip, is in approximately the same horizontal plane as the midpint of the hip joint and the coccyx. The most prominent point of the greater trochanter is in te smae horizontal plane as the pubic symphysis. Most prominent laterally and more easily palpated when the lower leg is medially rotated.
AP oblique projection of the femoral necks (Modified Cleaves)
- (this method is contraindicated if fracture or patholog is suspected) Patient position: supine Part position for bilateral: no rotation of pelvis. ASIS equal distance from table top. Flex hip and knees. Draw feet up as much as possible. Abduct thighs equally and maximally. Place soles of feet together for support. Center is IR 1 inch above pubis symphysis. CR is perpendicular to MSP at level 1 inch above pubic symphysis. Collimated field is the size of the IR. Shield gonads. Suspend respiration. Part position for unilateral: center ASIS or affected side to midline of grid. Flex affected hip and knee. Draw foot up to opposite knee as much as possible. Abduct thigh about 45 degrees laterally. CR is perpendicular to femoral neck. - shows an AP oblique projection of the femoral heads, necks, and trochateric areas onto one radiograph for comparison.
Evaluation criteria of AP pelvis and upper femora:
- entire pelvis and proximal femora - lesser trochanters, if seen, demonstrated on medial border of femora - femoral necks without superimposition - greater trochanters in profile - both ilia equidistant to edge of image - both greater trochanters equidistant to edge of image - lower vertebral column in center of image - symmetric obturator foramina - ishial spines equally demonstrated - symmetric ilia alae - sacrum and coccyx aligned with pubic symphysis
Evaluation criteria of AP hip:
- femoral head penetrated and seen through acetabulum - parts of illium and pubic bones included - any orthopedic device in its entirety - hip joint - greater trochanter in profile - entire lone axis of femoral neck without foreshortening - proximal one third of femur - lesser trochanter, if seen, is minimally demonstrated on medial side of femur
Evaulation criteria of axiolateral hip (Danelius-Miller):
- femoral neck wihtout overlap from greater trochanter - small amount of lesser trochanter on posterior surface - small amount of greater trochanter on anterior and posterior surface of proximal femur. - soft tissue shadow of unaffected thigh not seen on anatomy of interest - hip joint with acetabulum - any orthopedic appliance in its entirety - ishial tuberosity below femoral head
Evaluation criteria of lateral hip (Hickey):
- hip joint in center - hip joint, acetabulum, and femoral clearly demonstrated - femoral neck free of superimposition
Evaluation criteria of lateral hip (Lauenstein):
- hip joint in center - hip joint, acetabulum, and femoral head clearly demonstrated - femoral neck overlapped by greater trochanter
Evaluation criteria of AP oblique femoral necks (Modified Cleaves):
- no rotation (symmetric structures) - acetabulum, femoral head and neck clearly demonstrated. - lesser trochanter on medial side of femur - greater trochanter does not superimposed femoral neck - femoral axes at equal angles from hips
Lateral hip (Lauenstein)
-This method is contraindicated if fracture or pathology is suspected. Patient position: rotate slightly toward affected side to an oblique position. Part position: center affected hip to midline of grid. Flex affected knee and draw thigh to almost right angle to hip. Body of femur parallel to table. Support opposite hip and knee. CR is perpendicular through hip. Enters midway between ASIS and pubic symphysis. Colimated field is the size of the IR.
What anatomy is demonstrated on the AP oblique projection of the acetabulum (Judet method) in external oblique position? (1) Ilioischial column (2) Anterior rim of the acetabulum (3) Iliopubic column Answers: 1 and 2 only 1 and 3 only 2 and 3 only 1, 2, and 3
1 and 2 only
What is the central ray angle orientation for the PA axial oblique projection (Teufel method)? Answers: 12 degrees cephalad 12 degrees caudad 20 to 45 degrees caudad, depending on gender 20 to 45 degrees cephalad, depending on gender
12 degrees cephalad
What patient position is required to demonstrate the left ilium in an AP oblique projection? Answers: 40-degree LPO 40-degree RPO 38-degree LAO 38-degree RAO
40 degree RPO
All of the following directions apply to the AP projection of the hip except: Answers: The central ray is directed vertically and perpendicular to the image receptor The central ray is directed approximately 2½ inches (6.4 cm) distal on a line drawn perpendicular to the midpoint of a line between the anterior superior iliac spine and the pubic symphysis The lower limb is flexed at the knee and the thigh abducted as much as possible The lower limb is medially rotated 15 to 20 degrees
The lower limg is flexed at the knee and the thigh abducted as much as possible
The medial aspects of each ilium artiuclate with: Answers: The sacrum The coccyx Each other The femoral heads
The sacrum
Pagets disease
Thich, soft bone marked by bowing and fractures
What anatomic structure is located at the center of the first imaginary line drawn in the hip localization method? Answers: Femoral head Femoral neck Greater trochanter Top of the acetabular dome
Top of the acetabular dome
Congenital hip dysplasia
malformation of the acetabulum causing displacement of the femoral head
Congenital hip pysplasia
malformation of the acetabulum causing displacement of the femoral head
multiple myeloma
malignant neoplasm of plasma cells invovling the bone marrow and causing destruction of the bone
Chrondrosarcoma
malignant tumor arising from cartilage cells
Which special projection is useful in providing a lateral image of the hip joint in trauma cases where the unaffected limb has limited mobility? Answers: PA axial oblique (Teufel method) AP axial (Taylor method) Modified axiolateral projection (Clements-Nakayama method) Superoinferior axial (Bridgeman method)
modified axiolateral projection (Clements-Nakayama method)
tumor
new tissue growth where cells proliferation is uncontrolled
The arcuate line passes how?
obliquely, inferiorly, nad medially to its junction with the pubis
The hip bone is often referred to as what?
os coxae or innominate bone
AP pelvis and upper femora:
patient postion: supine part position: MSP of body centered to midline. Equal ASIS to table distance on both sides. Medially rotate feet and lower limbs 15 to 20 degrees. This places the femoral necks parallel with the IR. DO NOT rotate if trauma or other pathology suspected. Upper border of the IR 1 inch to 1.5 inches above crests. CR is perpendicular. Colimated field is the size of the IR. Shield gonads. Suspend respiration. - shows AP projection ofthe pelvis and of the head, neck, trochanters, and promiximal one third or one fourth of the shaft of the femora.
Where is the spine of the ischium located? Answers: - Anterior and superior on the hip bone - Anterior and inferior on the hip bone - Posterior and inferior on the hip bone - Posterior and superior on the hip bone
posterior and inferior on the hip bone
The ishial ramus:
projects anteriorly and medially from the tuberosity to its junction with the inferior ramus of the pubis
The superior ramus:
projects inferiorly and medially from the acetabulum to the midline of the body
The neck of the humerus:
projects medially, superiorly, and anteriorly from the body
Ala of the ilium:
projects superiorly from the body o from prominence of the hip.
Slipped epiphysis
proximal portion of femur dislocation from distal portion of the proximal epipysis
Ankylosing spondylitis
rheumatoid arthritis variant involving the SI joints and spine
The ilium curves inward below the auricular surface to form what?
the greater sciatic notch
The superior margin extending from the ASIS to the posterior superior iliac spine is called:
the iliac crest
Hip joint:
synovial, ball and socket, freely movable
Sacroiliac Joint:
synovial, irregular gliding, slightly movable
The inferior and posterior portions of the wing portion of the ilium present what?
the auricular surface
The trochanters are situated at the junction of:
the body and the base of the superolateral part of the femoral body, and the lesser trochanter is at the posteromedial part
The region above the brim is called:
the false of greater pelvis