S2. Procedures Final

• Prominent structures of the proximal femur

  • Femoral head & neck
  • Intertrochanteric line
  • Lesser & Greater trochanter
  • Intertrochanteric crest
  • Fovea capitus
• Prominent structures of the distal femur

  • Medial & Lateral epicondyle
  • Medial & Lateral condyle
  • Intercondylar fossa
  • Intercondylar sulcus (patellar surface)
  • Adductor tubercle
  • Popliteal surface
• How to align the IR for proximal femur projections

  Top of the IR at level of the ASIS, long axis of IR centered w/ long axis of femur
• How to align the IR for distal femur projections

  Bottom of the IR 1-2" below knee joint, long axis of the IR centered w/ long axis of femur
• Parts of the pelvis

  • Pubis
  • Ischium
  • Ilium
• Acetabulum


  The structure of the pelvis that receives the femoral head
• Femoral neck projection

  • Anteriorly 15-20 degrees
  • Superiorly 120-130 degrees
• Hip joint

  Synovial, ball-and-socket
• Pubic symphysis

  Cartilaginous, slightly movable
• Characteristic differences between male and female pelvis

  • Female: Lighter in structure, Wider and shallower, Larger inlet w/ more oval shape, Wider angle of pubic arch (>900), Less protrusion of the ischial spines into pelvic inlet
  • Male: Heavier in structure, Narrow and deep, Smaller inlet w/ rounder shape, Outlet is narrow and more protrusion of ischial spines
• Palpable bony landmarks in the pelvis and hip region

  • Iliac crest
  • ASIS
  • Pubic symphysis
  • Ischial tuberosities
• Landmarks used for hip joint localization

  • ASIS
  • Pubic symphysis
• How to properly internally rotate lower limbs for AP pelvis

  Heels 8-10" apart
• Where the CR is directed for an AP projection of the pelvis

  1. 2" inferior to ASIS

  2. 2" superior to pubic symphysis

  3. Midway between ASIS and pubic symphysis
• How the IR is positioned for an AP projection of the pelvis

  Perpendicular to the femoral neck using the localizing technique
• How rotation is assessed on an AP projection of the pelvis

  1. Symmetry of iliac wings: side or rotation indicated by wing elongation (right wing elongated = right rotation) (left wing foreshortened = right rotation)

  2. Symmetry of obturator foramina: side of rotation indicated by closed obturator foramen (right closed = right rotation) (left open = right rotation)
• How the IR is aligned for an axiolateral projection of the hip

  Angled away from the body until parallel to femoral neck
• How the CR is aligned for an axiolateral projection of the hip

  Angled mediolaterally perpendicular to the femoral neck
• How the lower limbs are positioned for an axiolateral projection of the hip

  Supine (unless contraindicated) medially rotate affected side 15-20, flex knee of unaffected side to elevate thigh in vertical position
• What is the proper name of Axiolateral projection of the hip

  Danelius-Miller method
• Where contrast is injected during arthrography

  Joint capsule (capsular space)
• Joints that can be imaged using arthrography

  • Any synovial joint – most commonly shoulder (also knee; hip in pediatrics)
• Type of contrast used during arthrography

  Water-soluble, and/or air
• Avascular necrosis


  Death of bone tissue due to lack of blood supply, most common in adults between 30-60 years and often affects the hip/femoral head
• Most common fracture site of the hip in elderly patients

  Femoral neck & Intertrochanteric crest
• Functions of the vertebral column

  • Encloses and protects spinal cord
  • Supports trunk and skull
  • Provides muscle attachments
• Curvature of the cervical spine

  Lordotic (convex anteriorly)
• Composition of the vertebral disk

  • Fibrocartilage
  • Annulus fibrosus – outer
  • Nucleus pulposus – central, soft mass
• Unique features of cervical vertebrae

  • Transverse foramina located on transverse processes & bifid spinous processes
• Part of C1 that receives the condyles of the occipital bone

  Superior articular processes
• How rotation is assessed on an AP projection of the cervical spine

  Spinous process
• Structures visualized in AP axial oblique projections of the cervical spine

  • Lower 5 cervical bodies, upper 2 or 3 thoracic bodies, interpediculate spaces, superimposed transverse and articular processes, intervertebral disk space
• Evaluation criteria for a lateral projection of the C-spine

  • All 7 cervical vertebrae and at least 1/3 of the T1, C4 center, neck extended so that mandibular rami are not overlapping the atlas or axis
• How the head is positioned for an AP open mouth odontoid projection

  Adjust the head so that a line from the lower edge of the upper incisors to the tip of the mastoid process (occlusal plane) is perpendicular to the IR.
• What positioning error occurred if the upper incisors are projected over the dens
• How rotation is assessed in an AP open mouth odontoid projection

  Mandibular rami equidistant from dens, demonstrating proper head rotation.
• Where the dens is visualized using the Fuchs method

  Within the foramen magnum
• Where the CR is directed for a lateral projection of the soft tissue neck to visualize the upper airway

  MCP at the level of the laryngeal prominence
• How the exposure is made when imaging the soft tissue neck

  On inspiration
• Structures shown in a lateral radiograph of the soft tissue neck

  • Air-filled upper airway, trachea, superior mediastinum