Chapter 7: Femur And Pelvic Girdle

Front 1

The largest and strongest bone of the body is the_______

Back 1

femur

Front 2

A small depression located in the center of the femoral head is the __________

Back 2

Fovea Capitis

Front 3

The lesser trochanter is located on the _______ (medial or lateral) aspect of the proximal femur. It projects _____ (anteriorly or posteriorly) from the junction between the neck and shaft.

Back 3

Medial; posteriorly

Front 4

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 image receptor to achieve a true AP projection.

Back 4

15-20

Front 5

T or F: The terms pelvis and pelvic girdle are not synonymous.

Back 5

True

Front 6

List 4 bones that make up the pelvis

Back 6

1. right hip bone 2. left hip bone 3. Sacrum 4. Coccyx

Front 7

List the two bones that make up the pelvic girdle and their alternative names.

Back 7

Right and left hip bones; Ossa Coxae and/or innominate bones

Front 8

List the 3 divisions of the hip bone

Back 8

Ilium, Ischium, Pubis

Front 9

All 3 divisions of the hip bone eventually fuse at the ____ at the age of _______

Back 9

Acetabulum; 14 (mid teens)

Front 10

What are the two important radiographic landmarks found at the ilium?

Back 10

Iliac Crest and the ASIS

Front 11

Which bony landmark is found on the most inferior aspect of the posterior pelvis

Back 11

Ischial Tuberosity

Front 12

What is the name of the joint found between the superior rami of the pubic bones?

Back 12

Symphysis Pubis

Front 13

The ____ of the pelvis is the largest foramen in the skeletal system

Back 13

Orbturator foramen

Front 14

The upper margin of the greater trochanter is approximately ____ above the level of the superior border of the symphysis pubis, and the ischial tuberosity is about _____ below

Back 14

1inch (2.5cm); 1.5- 2 inches (4-5cm)

Front 15

An imaginary plane that divides the pelvic region into the greater and lesser pelvis is called the ________.

Back 15

Pelvic Brim

Front 16

List the alternate names for the greater and lesser pelvis.

Back 16

False Pelvis (greater); True Pelvis (Lesser Pelvis)

Front 17

List the major functions of the greater and lesser pelvis

Back 17

1. supports the lower abdominal organs and fetus

2. Forms the actual birth canal

Front 18

List the 3 aspects of the lesser pelvis, which also describe the birth route during the delivery process.

Back 18

1. Inlet (superior aperture)

2. Cavity

3. Outlet (inferior aperture)

Front 19

Match structure or characteristic to the correct hip bone

Possesses a larger tuberosity found at the most inferior aspect of the pelvis

Back 19

Ischium

Front 20

Match structure or characteristic to the correct hip bone

Lesser sciatic notch

Back 20

Ischium

Front 21

Match structure or characteristic to the correct hip bone

Ala

Back 21

Ilium

Front 22

Match structure or characteristic to the correct hip bone

Posterior superior iliac spine (PSIS)

Back 22

Ilium

Front 23

Match structure or characteristic to the correct hip bone

Possesses a slightly movable joint

Back 23

Pubis

Front 24

Match structure or characteristic to the correct hip bone

Anterior Superior Iliac Spine (ASIS)

Back 24

Ilium

Front 25

Match structure or characteristic to the correct hip bone

Forms the anterior, inferior aspect of the lower pelvic girdle

Back 25

Pubis

Front 26

Match structure or characteristic to the correct hip bone

Articulates with the sacrum to form the SI joints

Back 26

Ilium

Front 27

Does this characteristic apply to the male or female pelvis:

Wide more flared ilia

Back 27

Female

Front 28

Does this characteristic apply to the male or female pelvis:

Pubic arch angle of 110 degrees

Back 28

Female

Front 29

Does this characteristic apply to the male or female pelvis:

A Heart shaped inlet

Back 29

Male

Front 30

Does this characteristic apply to the male or female pelvis:

Narrow ilia that are less flared

Back 30

Male

Front 31

Does this characteristic apply to the male or female pelvis:

Pubic arch angle of 75 degrees

Back 31

Male

Front 32

Does this characteristic apply to the male or female pelvis:

Larger and more round shaped inlet

Back 32

Female

Front 33

What classification, mobility type, and movement type does the hip joint have?

Back 33

Synovial, diarthrodial, spheroidal

Front 34

What classification, mobility type, and movement type does the Sacroiliac joint have?

Back 34

Synovial, amphiarthrodial, limited

Front 35

What classification, mobility type, and movement type does the Symphysis pubis joint have?

Back 35

Cartilaginous, amphiarthrodial, limited

Front 36

What classification, mobility type, and movement type does the Acetabulum (union) joint have?

Back 36

Cartilaginous, amphiarthrodial, non-movable

Front 37

Label a-h and identify which bone it is a part of Ilium (IL), Ischium (IS), or Pubis (P)

Back 37

a.Crest, IL

b.ASIS, IL

c. Greater Trochanter

d. Body, IS

e. Superior Ramus, P

f. Ischial Tuberosity, IS

g. Inferior Ramus, P

h. Orbturator Foramen

Front 38

Label I-Q and identify which bone it is a part of Ilium (IL), Ischium (IS), or Pubis (P)

Back 38

I. Body, P

J.Body, IL

K. Wing (Ala), IL

L. Right Sacroiliac (SI) Joint

M.ischial Spne (IS)

N. Sacrum

O. Body, IL

P. PSIS, IL

Q.Posterior Inferior Iliac Spine, IL

Front 39

Label R-Z and identify which bone it is a part of Ilium (IL), Ischium (IS), or Pubis (P)

Back 39

R. Greater Sciatic Notch, IL

S. Ischial Spine, IS

T. Lesser sciatic notch, IS

U. Ischial Tuberosity, IS

V. Ramus, IS

W. Inferior Ramus, P

X. Acetabulum, IS, IL, P

Y. Anterior Inferior Iliac Spine, IL

Z. ASIS, IL

Front 40

Which two bony landmarks need to be palpated for hip localization?

Back 40

1. ASIS 2. Pubic Symphysis (or Greater Trochanter since it is at the level of pubic symphysis)

Front 41

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.

Back 41

ASIS; 1-2 inches (2.5-5 cm); pubic symphysis and/or greater trochanter,3-4 inches (8-10 cm)

Front 42

To achieve a true AP position of the proximal femur, the lower limb must be rotated ______ internally

Back 42

15-20 degrees

Front 43

Which structures on an AP pelvis or hip radiograph indicate whether the proximal head and neck are in position fora true ap projection?

Back 43

Lesser trochanter should not be visible, or should only be slightly visible, on the radiograph

Front 44

Which physical sign may indicate that a patient has a hip fracture?

Back 44

The patient's foot is rotated externally

Front 45

Which projection should be taken first and reviewed by a radiologist before attempting to rotate the hip into a lateral position (if trauma is suspected)

Back 45

AP pelvis

Front 46

Gonadal shielding should be used for all patients of reproductive age, unless_____

Back 46

It covers anatomic structures of primary interest

Front 47

Should gonadal shielding be used for a hip study on a young female?

If yes, describe how it should be placed on the patient.

Back 47

yes, use a shaped ovarian shield with the top of shield at level of ASIS and bottom at pubic symphysis

Front 48

Should gonadal shielding be used for a hip study on a young male?

If yes, describe how it should be placed on the patient.

Back 48

Yes, the top of the shield should be placed at the inferior margin of the pubic symphysis

Front 49

What is the advantage of using 90 kVp rather than a lower kV range for hip and pelvis studies on younger patients with an analog imaging system?

Back 49

It reduces patient dose

Front 50

What is the disadvantage of using 90 kVp rather than a lower kV range for hip and pelvis studies on younger patients with an analog imaging system?

Back 50

It reduces radiographic contrast

Front 51

Which one of the following conditions is a common indication for performing pelvic and hip examinations on a pediatric (newborn) patient?

a. osteoporosis

b. developmental dysplasia of hip (ddh)

c. ankylosing spondylitis

d. osteoarthritis

Back 51

b. developmental dysplasia of hip (ddh)

Front 52

T or F: Geriatric patients are often more prone to hip fractures because of their increased incidence of osteoporsis

Back 52

True

Front 53

Which of the following devices will improve overall visibility of the proximal hip demonstrated on an axiolateral (inferior superior) projection?

a. small focal spot

b 6:1 grid

c. compensating filter

d. shadow shield

Back 53

c. compensating filter

Front 54

T or F: Both joints must be included on an AP and lateral projecton of the femur even if a fracture of the proximal femur is evident

Back 54

True; if an ap and lateral femur study is ordered, both joints must be demonstrated

Front 55

Where is the central ray placed for an AP pelvis projection?

Back 55

Midway between ASIS and pubic symphysis

Front 56

The central ray for the AP pelvis projection is approximately __ inch(es) inferior to the level of the ASIS

Back 56

2 inches (5cm)

Front 57

Which specific positioning error is present when the left iliac wing is elongated on an AP pelvis radiograph?

Back 57

Rotation toward the left side

Front 58

Which specific positioning error is present when the left orburator foramen is more open than the right side on an AP pelvis radiograph?

Back 58

Right rotation

Front 59

Is the Axiolateral, inferosuperior (Danelius-Miller) Projection used for traumatic or non trauamtic injuries?

Back 59

Trauma

Front 60

Is the Unilateral frog leg (modified cleaves method) used for traumatic or non trauamtic injuries?

Back 60

Non-trauma

Front 61

Is the AP bilateral frog leg (modified cleaves method) used for traumatic or non trauamtic injuries?

Back 61

Non-trauma

Front 62

Is the modified axiolateral (Clements-Nakayama method) used for traumatic or non trauamtic injuries?

Back 62

Trauma

Front 63

Is the AP axial for pelvic "outlet" used for traumatic or non trauamtic injuries?

Back 63

Trauma

Front 64

Which of the following projections is recommended to demonstrate the superoposterior wall of the acetabulum?

A. AP Axial "inlet"

B. PA axial oblique

C. Axiolateral Inferosuperior

D. Modified axiolateral

Back 64

B. PA axial oblique

Front 65

How many degrees are the femurs abducted (from the vertical plane) for bilateral frog-leg projection?

Back 65

40-45 degrees

Front 66

Where is the central ray placed for a bilateral frog-leg (modified Cleaves method) projection?

Back 66

3inches (7.5) below level of ASIS (1inch (2.5cm) above pubic symphysis)

Front 67

Which size of analog cassette should be used for an adult bilateral frog-leg projection?

Back 67

14x17 crosswise

Front 68

Where is the central ray placed for an AP unilateral frog-leg projection?

Back 68

Midfemoral neck

Front 69

Which central ray angle is required for the "outlet" projection (Taylor Method) for a female patient?

a. 15 - 25 degrees caudad

b. 30-45 degrees cephalad

c. 20-35 degrees cephalad

d. none (cr is perpendicular)

Back 69

b. 30-45 degrees cephalad

Front 70

Which type of pathology is best demonstrated withe the Posterior Oblique (judet method)

A. Acetabular Fractures

B. Anterior pelvic bone fractures

C. Proximal Femur Fractures

D. Femoral neck fractures

Back 70

A. Acetabular Fractures

Front 71

How much obliquity of the body is required for the posterior oblique projection (judet method)?

a. None (CR is perpendicular)

b. 20 degrees

c. 30 degrees

d. 45 degrees

Back 71

d. 45 degrees

Front 72

What type of CR angle is used for a PA axial oblique (Teufel) projection?

a. 15 degrees cephalad

b. 15-20 degrees cephalad

c. 5 degrees caudad

d. 12 degrees cephalad

Back 72

d. 12 degrees cephalad

Front 73

How is the pelvis (body) positioned for a PA axial oblique (Teufel) projection?

A. PA with 45 degrees rotated away from affected side

B. Prone or erect PA - no rotation

C. PA 35 - 40 degrees toward affected side

D. AP with 40 degrees away from affected side

Back 73

C. PA 35 - 40 degrees toward affected side

Front 74

T or F: Any orthopedic device or appliance of the hip should be seen in its entirety on an AP hip radiograph

Back 74

True

Front 75

The axiolateral (inferosuperior) projection is designed for _____ (trauma or nontrauma) situations.

Back 75

Trauma

Front 76

How is the unaffected leg positioned for the axiolateral hip projection?

Back 76

it is flexed and elevated to prevent it from being superimposed over the affected hip

Front 77

Which one of the following factors does not apply to an axiolateral (inferosuperior) projection of the hip on a male patient?

a. IR parallel to femoral neck

b. 80-90kVp

c. Use of gonadal shielding

d. Use of stationary grid

Back 77

c. Use of gonadal shielding

Front 78

T or F: An AP pelvis projection using 90kV and 8mAs results in less patient dose that a projection using 80kVp and 12 mAs (for both males and females)

Back 78

True

Front 79

T or F: The unaffected foot during an axiolateral (inferosuperior) projection can be burned if allowed to rest on the collimator

Back 79

True

Front 80

The modified axiolateral requires the CR to be angled ____ degrees posteriorly from horizontal.

Back 80

15-20 degrees

Front 81

Which special projection of the hip demonstrates the anterior and posterior rims of the acetabulum and the ilioischialand iliopubic columns? (include the projection and the method name) Which CR angle (if any) is used for this projection?

Back 81

Posterior Oblique Projections of Acetabulum (Judet Method), 0 degrees (perpendicular)

Front 82

What is the name of a special projection of the pelvis used to assess trauma to pubic and ischial structures? (include the projection and the method name)

Back 82

AP Axial Outlet Projection (Taylor Method)

Front 83

What is the proper name for Axiolateral (inferosuperior) projection?

Back 83

Danelius-Miller Method

Front 84

What is the proper name for Modified Axiolateral projection?

Back 84

Clements-Nakayama Method

Front 85

What is the proper name for Bilateral or unilateral frog-leg projection?

Back 85

Modified Cleaves

Front 86

What is the proper name for PA axial oblique for acetabulum projection

Back 86

Teufel

Front 87

What is the proper name for AP axial for pelvic "outlet" bones projection?

Back 87

Taylor Method

Front 88

What is the proper name for Posterior Oblique for Acetabulum projection?

Back 88

Judet Method

Front 89

What is the optimal amount of hip abduction applied for the unilateral "frog-leg" projection to demonstrate the femoral neck without distortion?

a. 45 degrees from vertical

b. 90 degrees from vertical

c. 10 degrees from vertical

d. 20-30 degrees from vetrical

Back 89

d. 20-30 degrees from vetrical

Front 90

Situation: A radiograph of an AP pelvis projection reveals 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?

Back 90

Rotate the lower limbs 15-20 degrees internally to place the proximal femur in a true AP position. (W/ general chronic pain, the lower limbs usually can be rotated safely)

Front 91

Situation: A radiograph of an AP pelvis reveals that the right iliac wing is foreshortened as compared with the left side. Which specific positioning error has been made?

Back 91

The patient is rotated toward the left- LPO

Front 92

Situation: A radiograph of a unilateral frog-leg (modified Cleaves) projection produces distortion of the femoral neck. Based on the AP hip projection, the radiologist suspects a nondisplaced fracture of the femoral neck. What can the technologist do to better define this region?

Back 92

Repeat the exposure and only abduct the femur 20-30 degrees from vertical. (it will produce less distortion of the femoral neck)

Front 93

Situation: A radiograph of an axiolateral (inferosuperior) projection reveals 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 position be repeated. What can be done to avoid this problem on the repeat exposure?

Back 93

If possible, elevate the patient at least 2 inches by placing sheets or blankets beneath the pelvis

Front 94

Situation: A radiograph of an AP axial projection for anterior pelvic bones reveals that the pubic and ischial bones are not elongated sufficiently. The following analog factors were used for this study: 86kVp, 7mAs, bucky, 20-30 degrees CR cephalad angle, and 40-inch source image receptor distance (SID). The female patient was place in a supine position on the table. What must be changed to improve the quality of the image during the repeat exposure?

Back 94

A greater CR angle is required. Female patients require a CR angle of 30-45degrees

Front 95

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?

Back 95

The PA axial oblique (Teufel Method) or posterior oblique (Judet Method) can be taken to demonstrate aspects of the acetabulum more completely.

Front 96

A radiograph of an AP pelvis reveals that overall the image is underexposed (underpenetrated). The following analog factors were used: 80 kV, 40 in SID, Bucky, and AEC with the center chamber activated. Which one of these factors should be changed to produce increased image density?

Back 96

When using 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.

Front 97

A radiograph from a modified axiolateral projection reveals excessive grid lines on the image, which also appears underexposed. What can be done to avoid this problem during the repeat exposure?

Back 97

Ensure that the CR is centered to near the midline of the grid cassette and the face of the cassette is perpendicular to the CR

Front 98

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?

Back 98

Yes, any orthopedic appliance or prosthesis must be seen in its entirety in both projections

Front 99

A patient with hip pain from a fall enters the ER. The Physician orders a left hip study. When moved to the radiographic table, the patient complains loudly about pain in the left hip. Which positioning should be used for this patient?

Back 99

AP pelvis and axiolateral (inferosuperior)left hip. The AP pelvis radiograph should be taken initially w/o leg rotation; the radiograph muct be reviewed by the physician and checked for fractures or dislocations before attempting an internal rotation of the left leg for the axiolateral (inferosuperior) projection

Front 100

`A patient has just been moved to his hospital room after a bilateral hip replacement surgery. The surgeon has ordered a post-op hip routine for both hips. Which specific positioning routine should be used? (The patient can be brought to the radiology department.)

Back 100

AP pelvis and modified axiolateral- Clements-Nakayam Method

Front 101

A patient with a possible pelvic ring fracture from a trauma enters the ER. The AP pelvis projection, which was taken to determine whether the right acetabulum is 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?

Back 101

Posterior Oblique- Judet Method. CT is often judged to be superior in detecting pelvic ring fractures.

Front 102

A phsyician orders a study for inlet and outlet projections of the pelvis. Which projections could be performed to meet this request?

Back 102

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)

Front 103

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 of his AP pelvis projections?

Back 103

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

Front 104

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?

Back 104

AP pelvis and bilateral "frog-leg" (modified cleaves) projection.