This document provides an overview of various pelvis x-ray projections, including their purposes, patient positioning, technical factors, and image evaluation criteria. It describes the anteroposterior (AP), inlet, outlet, Judet, and flamingo projections. The AP view examines the pelvic ring and bones. The inlet is perpendicular to the pelvic rim. The outlet assesses cephalad/caudal translation following trauma. The Judet views the acetabulum. And the flamingo series evaluates pubic symphysis instability with the patient in neutral, left foot raised, and right foot raised positions. Proper collimation, centering, orientation and other technical parameters are outlined for each view.

1. WELCOME TO ALL…..

2. PELVIS XRAY PROJECTIONS
MISS.JENIFER C,
DRDT 1ST YEAR,
KILPAUK MEDICAL COLLEGE,
CHENNAI-10

3. PELVIS ANATOMY
 The pelvis is either the lower part of the trunk of the human body between
the abdomen and the thighs.
 It includes several structures : the bony pelvis, the pelvic cavity, the pelvic
floor, and the perineum.
 The pelvic spine consists of the sacrum and coccyx.
 At birth, each pelvic half consists of 3 separate primary bones:
 The Ilium
 The Ischium
 The Pubis
 These bones are joined by hyaline cartilage

4. TYPES OF HUMAN PELVIS
MALE PELVIS
• Pelvic inlet Heartshaped , narrow
• Obturator foramen Round
• Pubic angle Narrow (< 70°)
FEMALE PELVIS
• Pelvic inlet Oval and rounded; wide
• Obturator foramen Oval
• Pubic angle Wide (> 80°)

5. MALE FEMALE

6. PATIENT PREPARATION
Remove all radio
opaque material

7. BASIC PROJECTIONS OF PELVIS
1) ANTERO-POSTERIOR PROJECTION
2) INLET PROJECTION
3) OUTLET PROJECTION
4) JUDET PROJECTION
5) FLAMINGO PROJECTION

8. The AP pelvis view is part of a pelvic series examining the
iliac crest, sacrum, proximal femur, pubis, ischium and the
great pelvic ring. It is of considerable importance in the
management of severely injured patients presenting to
emergency departments.
Patient position
 patient is supine
 lower limbs are internally rotated 15-25° from the hip
(do not attempt this if a fracture is suspected)
PELVIS ANTEROPOSTERIOR PROJECTION

9. PELVIS ANTEROPOSTERIOR PROJECTION

10. Technical factors
AP projection
Centring point
The midpoint of the anterior superior iliac spine and the pubic symphysis
Collimation
Laterally to the skin margins
Superior to above the iliac crests
Inferior to the proximal third of the femur
Orientation
Landscape
Detector size
35 cm x 43 cm
Exposure
70-80 kVp
20-30 mAs
SID
100 cm
Grid
Yes

11. Image Technical Evaluation
 Entirety of the bony pelvis is imaged from superior of
the iliac crest to the proximal shaft of the femur.
 Obturator foramina appear equal.
 Iliac wings have an equal concavity.
 Greater trochanters of the proximal femur are in profile.

12. The AP outlet view is part of a pelvic series examining the iliac crest,
sacrum, proximal femur, pubis, ischium and the great pelvic ring. It is
of considerable importance in the management of severely injured
patients presenting to emergency departments. This particular view
allows for assessment of the cephalic/caudal translation and superior
migration of the hemipelvis following trauma.
Patient position
 Patient is supine
 Lower limbs are internally rotated 15-25° from the hip (do not
attempt this if a fracture is suspected)
 Patient hands are out of the way of the imaging field
ANTERO POSTERIOR OUTLET PROJECTION

13. ANTERO POSTERIOR OUTLET PROJECTION

14. Technical factors
AP axial projection
Centring point
5 cm distal to the superior pubic symphysis border
The central ray is angled 20-35° cephalic for males and 30-45° for females.
Ensure primary beam is aligned with the image receptor
Collimation
Laterally to the skin margins
Superior to above the iliac crests
Inferior to the proximal femur
Orientation
landscape
Detector Size
35 cm x 43 cm
Exposure
70-80 kVp
20-30 mAs
SID
100 cm
Grid
yes

15. Image technical evaluation
 The entirety of the bony pelvis is imaged from superior
of the iliac crest to the proximal shaft of the femur.
 The pubic symphysis should be central to the image with
little to no patient rotation.
 There is a clear demonstration of both the anterior and
inferior pubic ramus with little to no foreshortening

16. The AP inlet view is part of a pelvic series examining the iliac
crest, sacrum, proximal femur, pubis, ischium and the great pelvic ring.
It is of considerable importance in the management of severely injured
patients presenting to emergency departments 1. This particular view is
perpendicular to the pelvic rim, allowing for assessment of any
suspected narrowing or widening of that rim. Additionally it is used to
assess anterior-posterior displacement of pubic rami fractures.
Patient position
 patient is supine
 lower limbs are internally rotated 15-25° from the hip (do not
attempt this if a fracture is suspected)
 patient's hands are out of the way of the imaging field
ANTERO POSTERIOR INLET PROJECTION

17. ANTERO POSTERIOR INLET
PROJECTION

18. Technical factors
AP superoinferior projection
Centering point
Midline at the level of the anterior superior iliac spine
The central ray is angled 25-40° caudal to be perpendicular to the plane
Ensure central ray is aligned with the image receptor
Collimation
Laterally to the skin margins
Superior to above the iliac crests
Inferior to the proximal femur
Orientation
Landscape
Detector size
35 cm x 43 cm
Exposure
70-80 kVp
20-30 mAs
SID
100 cm
Grid
Yes

19. Image technical evaluation
 The entirety of the bony pelvic rim is central to the image
without superimposition
 The iliac wings are evident on the superior portion of the
image, the inferior and superior pubic rami are
superimposed on the inferior portion.

20. The oblique pelvis otherwise known as the Judet view is an additional
projection to the pelvic series when there is suspicion of an acetabular
fracture.
The Judet view is comprised of two projections, first the iliac oblique
for assessment of the posterior column and anterior wall of the
acetabulum; secondly, the obturator oblique view demonstrating
the anterior column of the pelvis along with the posterior wall of
the acetabulum.
PELVIS JUDET PROJECTION

21. Patient position
1. Iliac oblique
 patient is supine
 the unaffected side is rotated roughly 45°anterior, generally
aided with a 45° sponge
 it is advisable the patient is central on the table and at no risk
of over rolling
2. Obturator oblique
 patient is supine
 the affected side is rotated roughly 45° anterior, generally
aided with a 45° sponge
 ensure the patient is central on the table and at no risk of over
rolling

23. Technical factors
Centring point
Iliac oblique
5 cm distal and 5 cm medial of the ASIS closest to the image receptor
Obturator oblique
5 cm distal and 5 cm medial of the ASIS that is rolled up anterior to the image receptor
Collimation
Superior to the level of the ASIS
Inferior to the proximal femur
Laterally to the skin margins
Medially to the pubic symphysis
Orientation
Portrait
Detector size
24 cm x 30 cm
Exposure
70-80 kVp
10-20 mAs
SID
100 cm
Grid
Yes

24. Image technical evaluation
 The iliac oblique projection should demonstrate the
anterior rim of the acetabulum as well as the posterior
ilioischial column. The iliac wing, as it is 'flatten' out on
the image should be well demonstrated.
 The obturator oblique projection should confidently show
the posterior rim as well as the anterior ilioischial line, as
per the name the obturator foramen is well demonstrated.

25. The flamingo view series of the pelvis is a specialized
orthopedics series consisting of three separate pelvis
projections. It is used for assessing instability of the pubic
symphysis, often in the context of previous pelvic trauma.
This projection should only be performed under specialist
supervision or referral.
Patient position
The series is comprised of three separate projections
traditionally performed AP erect, however patients with
balance issues can benefit from a PA projection.
PELVIS FLAMINGO PROJECTION

26. Neutral
 patient is erect with both feet evenly planted on the ground
 standing AP (or PA) with the posterior aspect of the pelvis resting against the
upright detector
 patient's hands are out of the way of the imaging field
Left foot raised
 patient is erect with left foot off the floor for the projection, patient is reminded
to place weight on right foot
 standing AP (or PA) with the posterior aspect of the pelvis resting against the
upright detector
 patient's hands are out of the way of the imaging field
Right Foot Raised
 patient is erect with right foot off the floor for the projection, patient is
reminded to place weight on left foot
 standing AP (or PA) with the posterior aspect of the pelvis resting against the
upright detector
 patient's hands are out of the way of the imaging field

27. PELVIS FLAMINGO PROJECTION

28. Technical factors
AP/PA erect dynamic projection
Centering point
The midpoint of the anterior superior iliac spine and the pubic symphysis
Collimation
Laterally to the skin margins
Superior to include the anterior superior iliac spine
Inferior to the proximal third of the femur
Orientation
Landscape
Detector size
35 cm x 43 cm
Exposure
70-80 kVp
20-30 mAs
SID
100-150 cm
Grid
Yes

29. Image technical evaluation
 Clear annotations indicating what image the projection
is in the series
 Entirety of the superior and inferior pubic rami visulised
 Proximal femur visible

30. CONCLUSION
YOU CANNOT SEE THE RADIATION….
YOU CANNOT SMELL THE RADIATION…
YOU CANNOT FEEL THE RADIATION…..

31. THANK YOU….