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Chapter 7 Bontrager

Terms in this set (120)

The largest and strongest bone of the body is the
femur
A small depression located in the center of the femoral head is the
fovea capitis
The lesser trochanter is located on the __________ (medial or lateral) aspect of the proximal femur.
medial
The lesser trochanter projects ___________ (anteriorly or posteriorly) from the junction between the neck and shaft.
posteriorly
Because of the alignment between the femoral head and pelvis, the lower limb must be rotated __________ degrees internally to place the femoral neck parallel to the plane of the IR to achieve a true AP projection
15 to 20
T/F: the terms pelvis and pelvic girdle are not synonymous.
true
List the four bones that make up the pelvis.
right and left hip bones, sacrum, and coccyx
List the two bones that make up the pelvic girdle.
right and left hip bones
List two additional terms used for the right and left hip bones.
ossa coxae and innominate bones.
List the three divisions of the hip bone.
ilium, ischium, pubis
All three divisions of the hip bone eventually fuse at the ________ at the age of _______.
acetabulum; midteens
What are the two important radiographic landmarks found on the ilium?
crest of the ilium (iliac crest) and anterior superior iliac spine (ASIS)
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 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 __________ inches above the level of the superior border of the symphysis pubis, and the ischial tuberosity is about ________ inches below.
1 inch (2.5 cm); 1 1/2 to 2 inches (4 to 5 cm)
An imaginary plane that divides the pelvic region into the greater and lesser pelvis is called the
pelvic brim
List the alternate terms for the greater and lesser pelvis.
false pelvis and true pelvis
List the major function of the greater pelvis and the lesser pelvis.
supports the lower abdominal organs and fetus, forms the actual birth canal.
List the three aspects of the lesser pelvis, which also describes the birth route during the delivery process.
inlet, cavity, outlet
Match the following structures or characteristics to the correct hip bone: lesser sciatic notch.
ischium
Match the following structures or characteristics to the correct hip bone: ala.
ilium
Match the following structures or characteristics to the correct hip bone: posterior superior iliac spine (PSIS).
ilium
Match the following structures or characteristics to the correct hip bone: possesses a slightly movable joint.
pubis
Match the following structures or characteristics to the correct hip bone: anterior superior iliac spine (ASIS).
ilium
Match the following structures or characteristics to the correct hip bone: forms the anterior, inferior aspect of the lower pelvic girdle.
pubis
Match the following structures or characteristics to the correct hip bone: articulates with the sacrum to form the sacroiliac (SI) joints.
ilium
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
What imaging modality has replaced the procedure cephalopelvimetry?
sonography (ultrasound)
Male or Female: wide, more flared ilia.
female
Male or Female: pubic arch angle of 110 degrees.
female
Male or Female: a heart-shaped pelvic inlet.
male
Male or Female: narrow ilia that are less flared.
male
Male or Female: pubic arch angle of 75 degrees.
male
Male or Female: ischial spines protruding less into pelvic inlet.
female
List the joint classification, mobility type, and movement type: hip joint.
classification: synovial
mobility type: diarthrodial
movement type: ball and socket
List the joint classification, mobility type, and movement type: sacroiliac.
classification: synovial
mobility type: amphiarthorodial
movement type: limited
List the joint classification, mobility type, and movement type: symphysis pubis.
classification: cartilaginous
mobility type: amphiarthrodial
movement type: limited
List the joint classification, mobility type, and movement type: acetabulum (union).
classification: cartilaginous
mobility type: synarthrodial
movement type: nonmovable
Which two bony landmarks need to be palpated for hip localization?
ASIS and symphysis pubis (or greater trochanter if palpation of this landmark is not permitted by institution)
From the midpoint of the imaginary line created by the two landmarks (ASIS and symphysis pubis), where would the femoral neck to be located?
approximately 2.5 inches (6 to 7 cm) below the midpoint of the line.
A second method for locating the femoral head is to palpate the ____________ and go ____________ inches (________ cm) medial at the level of the ___________, which is ___________ inches (__________ cm) distal to the original palpation point.
ASIS; 1 to 2 inches (3 to 5 cm); symphysis pubis and/or greater trochanter; 3 to 4 inches (8 to 10 cm)
To achieve a true AP position of the proximal femur, the lower limb must be rotated ___ internally.
15 to 20 degrees
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 slightly visible, on the radiograph
Which physical sign may indicate that a patient has a hip fracture?
The patient's foot is rotated externally.
Which projection should be taken first an 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? If yes, describe how it should be placed on a patient.
yes, use a shaped ovarian shield with top of the 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 pubic symphysis.
What is the advantage of using 90 kVp rather than a lower kVp range for hip and pelvic studies on younger patients?
it reduces patient dose
What is the disadvantage of using 90 kVp for hip and pelvis studies for geriatric patients with some bone mass loss?
it reduces radiographic contrast
Which of the following conditions is a common clinical indication for performing pelvic and hip examinations on a pediatric (newborn) patient?
development dysplasia of hip (DDH)
T/F: geriatric patients are often more prone to hip fractures because of their increased incidence of osteoporosis.
true
T/F: the soft tissue of bariatric patient is indicative of the actual size of the bony pelvis.
false (the size of the bony pelvis is not proportional to the girth and dimensions of the soft tissue that surrounds it)
Which of the following imaging modalities can be used on a newborn to assess hip joint stability during movement of the lower limbs?
sonography
Which of the following image modalities is most sensitive in diagnosing early signs of metastatic carcinoma of the pelvis?
nuclear medicine
A degenerative joint disease.
osteoarthritis
Most common fracture in older patients because of the high incidence of osteoporosis or avascular necrosis.
proximal hip fracture
A malignant tumor of the cartilage of hip.
chondrosarcoma
A disease producing extensive calcification of the longitudinal ligament of the spinal column.
ankylosing spondylitis
A fracture resulting from a severe blow to one side of the pelvis.
pelvic ring fracture
Malignancy spread to bone via the circulatory and lymphatic systems or direct invasion
metastatic carcinoma
now referred to as developmental dysplasia of the hip.
congenital dislocation
Which of the following devices 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?
CT
T/F: 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 one each projection.
Where is the central ray placed on an AP pelvis projection?
midway between ASIS and symphysis pubis
The central ray for the AP pelvic projection is approximately ______ inches (______ cm) inferior to the level of the ASIS.
2 inches (5 cm)
Which specific positioning error is present when the left iliac wing is elongated on an AP pelvis radiograph?
rotation toward 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?
rotation toward right side
Indicate whether each of the following projections is used for patients with traumatic or nontraumatic injuries: axiolateral, inferosuperior (danelius-miller) projection.
traumatic injuries
Indicate whether each of the following projections is used for patients with traumatic or nontraumatic injuries: unilateral frog-leg (modified cleaves method).
nontraumatic injuries
Indicate whether each of the following projections is used for patients with traumatic or nontraumatic injuries: AP bilateral frog-leg (modified cleaves method).
nontraumatic injuries
Indicate whether each of the following projections is used for patients with traumatic or nontraumatic injuries: modified axiolateral (clements-nakayama method)
traumatic injuries
Indicate whether each of the following projections is used for patients with traumatic or nontraumatic injuries: AP axial for pelvic outlet (taylor method)
traumatic injuries
Which of the following projections is recommended to demonstrate the superoposterior wall of the acetabulum?
PA axial oblique
When gonadal shielding is not used, ________ (males or females) receive a greater gonadal dose with an AP pelvis projection.
females (because of location of CR and reproductive organs)
How many degrees are the femurs abducted (from the vertical plane) for the bilateral frog-leg projection?
40 to 45 degrees
Where is the central ray placed for a bilateral frog-leg (modified cleaves method) projection?
3 inches (7.5 cm) below level of ASIS (2 inch [2.5 cm] above symphysis pubis)
Which size of image receptor should be used for an adult bilateral frog-leg projection?
14 x 17 inches (35 x 43 cm) landscape
Where is the central ray placed for an AP unilateral modified cleaves method projection?
midfemoral neck
Which central ray angel is required for the AP axial for pelvic outlet (taylor method) projection for a female patient?
30 to 35 degrees cephalad
Which type of pathology is best demonstrated with the posterior oblique (judet method)?
acetabuluar fractures
How much obliquity of the body is required for posterior oblique projection (judet method)?
45 degrees
What type of CR angle is used for a PA axial oblique (teufel) projection?
12 degrees cephalad
How is the pelvis (body) positioned for a PA axial oblique (teufel) projection?
PA 35 to 40 degrees toward affected side
T/F: 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 non traumatic) 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 of the following factors does not apply to an axiolateral (inferosuperior) projection of the hip on a male patient?
use of gonadal shielding
T/F: an AP pelvis projection using 90 kVp and 8 mAs results in less patient dose than an projection using 80 kVp and 12 mAs (for both males and females)>
true
T/F: the unaffected foot during an axiolateral (inferosuperior) projection can be burned if allowed to rest on the collimator.
true
The modified axiolateral (clements-nakayama) projection requires the CR to be angled ________ degrees posteriorly from horizontal.
15 to 20
Which special projection of the hip demonstrates the anterior and posterior rims of the acetabulum and the ilioschial and iliopubic columns? (include the projection name and method name).
posterior oblique projections of acetabulum (judet method) 0 degrees perpendicular
What is the name of a special projection of the pelvis used to assess trauma to pubic and ischial structures? (include the projection name and the method name).
AP axial outlet projection (taylor method)
What is the method name for axiolateral (inferosuperior) projection?
danelius-miller method
What is the method name for modified axiolateral projection?
clements-nakayama
What is the method name for AP bilateral or unilateral frog-leg projection?
modified cleaves method
What is the method name for posterior axial oblique projection for acetabulum?
teufel method
What is the method name for AP axial projection for pelvic outlet bones?
taylor method
What is the method name for posterior oblique projection for acetabulum?
judet method
What is the optimal amount of hip abduction applied for the unilateral modified cleaves method projection to demonstrate the femoral neck without distortion?
20 to 30 degrees from vertical
T/F: the lauenstein/hickey method for the unilateral "frog-leg" projection will produce distortion of the femoral neck.
true
How much is the IR tilted for the modified axiolateral projection of the hip?
15 degrees from the vertical
T/F: gonadal shielding can be used for males for the axiolateral (inferosuperior) projection of the hip.
false
Situation: A radiograph of an AP pelvis projection shows that the lesser trochanters are readily demonstrated on the medial side of the proximal femurs. The patient is ambulatory but has a history of early osteoarthritis in both hips. Which positioning modification needs to be made to prevent this positioning error?
rotate the lower limbs 15 to 20 degrees internally to place the proximal femurs in a true AP position (with general chronic pain, the lower limbs usually can be rotated safely).
Situation: A radiograph of an AP pelvis shows that the right iliac wing is foreshortened as compared with the left side. Which specific positioning error was made?
the patient is rotated toward the left - left posterior oblique (LPO)
Situation: A radiograph of a unilateral frog-leg (modified cleaves) projection produces a distortion of the femoral neck. Based on the AP hip projection, the radiologist suspects a nondisplaced fracture of the femoral beck. What can the technologist do to define this region better?
repeat the exposure and only abduct the femur 20 to 20 degrees from vertical (it will produce less distortion of the femoral neck)
Situation: A radiograph of an axiolateral (inferosuperior) projection shows that the posterior aspect of the acetabulum and femoral head were cut off of the bottom of the image. The emergency room physician requests that the projection can repeated. What can be done to avoid this problem on the repeat on the repeat exposure?
if possible, elevate the patient at least 2 inches (or 5 cm) by placing sheets or blankets beneath the pelvis
Situation: A radiograph of an AP axial projection for anterior pelvic bones shows that the pubic and ischial bones are not elongated sufficiently. The following exposure factors were used for this study: 86 kVp, 7 mAs. bucky, 20 to 30 degrees central ray cephalad angle, and 40-inch (100-cm) SID. The female patient was placed in a supine position on the table. What must be changed to improve the quality of the image during the repeat exposure?
a greater central ray angle is required and female patients require a central ray angle of 30 to 45 degrees
Situation: A patient enters the ER with a pelvis injury resulting from a motor vehicle accident. The initial AP pelvis projection demonstrates a possible defect or fracture of the left acetabulum. No other fractures are detected and the patient is able to move comfortably. What additional projections can be taken to demonstrate a possible acetabular fracture?
the PA axial oblique (teufel method) or posterior oblique (judet method) can be taken to demonstrate aspects of the acetabulum more completely
Situation: A radiograph of an AP pelvis shows overall the image is underexposed (underpenetrated). The following exposure factors were used: 80 kVp, 40-inch (100-cm) SID, bucky, and automatic exposure control with the center chamber activated. Which os these factures should be changed to produce increased image density?
when using automatic exposure control (AEC) for an AP pelvis projection, the left and right ionization chambers must be activated. The center chamber is over the less dense pelvic cavity, which may lead to an underexposed image.
Situation: A radiograph from a modified axiolateral projection of the hip shows excessive grid lines on the image, which also appears underexposed. What can be done to avoid this problem during the repeat exposure?
ensure that the central ray centered to near the midline of the grid cassette and the face of the image receptor is perpendicular to the central ray
Situation: A portable AP and lateral hip study is ordered for a patient who is in recovery following hip replacement surgery. The radiograph of the AP hip reveals that the upper portion of the acetabular prosthesis is slightly cut off but is included on the lateral projection. Should the technologist repeat the AP projection? Why or why not?
yes any orthopedic appliance or prosthesis must be seen in its entirety in both projections
Situation: A patient with hip pain from a fall enters the emergency room. The physician orders a left hip study. When moved to the radiographic table, the patient complains loudly about the pain in the left hip. Which positioning routine should be used for this patient?
AP pelvic and axiolateral (inferosuperior) left hip. The AP pelvis radiograph should be taken initially without leg rotation; the radiograph must be reviewed by the physician and checked for fractures or dislocations before attempting an internal rotation of the left leg for the axiolateral
Situation: A patient has just been moved to his hospital room after a bilateral hip replacement surgery. The surgeon has ordered a postoperative hip routine for both hips. Which specific positioning routine should be used? (The patient can be brought to the radiology department).
AP pelvis and modified axiolateral (clements-nakayama method)
Situation: A patient with a possible pelvic ring fracture from a trauma enters the emergency room. The AP pelvis projection, which was taken to determine whether the right acetabulum was fractured, is inconclusive. Which other radiographic projection can be taken to better visualize the acetabulum? What other imaging modality can be used to determine the presence of a pelvic ring fracture?
posterior oblique - judet method, CT is often judged superior in detecting pelvic ring fractures
Situation: A physician orders a study for inlet and outlet projections of the pelvis. Which projections could be performed to meet this request?
AP axial for pelvic "outlet" (taylor method) and ap axial for pelvic "inlet" projections and possibly the posterior oblique (judet method) projections to provide another perspective of the inlet and outlet regions of the pelvis (if unsure of the request routine, contact the physician for clarification)
Situation: A technologist notices that his AP pelvis projections often demonstrate a moderate degree of rotation. What positioning technique can the technologist perform to eliminate (or at least minimize) rotation on his AP pelvis projections?
palpate both ASIS and ensure they are equal distance from the tabletop. to verify no rotation is still present, ensure that the iliac wings are symmetric, as seen on the radiograph.
Situation: A very young child comes to the radiology department with a clinical history of DDH. What is the most common positioning routine for this condition?
AP pelvis and bilateral modified cleaves method (frog-leg)
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