Radiographic ppsitions of hip and sacroiliac joints

1. HIP AND SACROILIAC JOINTS
ØPresenter: Christapher John,II BMIT,No.6
ØModerator: Manzoor Ali
ØPresented on: 27/07/2022

2. Anatomy of hip;
• Hip joint is a ball and socket joint between Pelvis and femur
• Pelvis is a largest structure located in the lower part of body
• It has two parts: right and left
• Hipbone consist:
•Ilium
•Ischium
•Pubis

3. Anatomy of hip;

4. Anatomy of femur head;
• Femur is the longest bone
• Femur is the largest bone on thigh
• It consist of;
•Head
•Neck
•Greater trochanter
•Lesser trochanter

5. Anatomy of femur head;

6. Difference between male and female pelvis
• The adult male pelvis is narrow
• Heart-shaped pelvic inlet
• Pubic arch is less than 90 degrees.
• The adult female pelvis is usually broader.
• Round pelvic inlet
• Pubic arch is greater than 90 degrees.

7. HIP AND PROXIMAL FEMUR AP

8. Indications:
• Dislocation
• Severe fracture
• Implants
• Foreign bodies

9. Contra Indications:
• Pregnancy
• Restless patients

10. Patient position:
• Patient in supine position
• Rotate the feet and lower limbs about 15 to 20 degrees to place the
femoral necks externally
• Ensure that the pelvis is not rotated.

11. Patient position:
• Feet and lower limbs in natural, laterally rotated tabletop position,
causing poor profile of proximal femora

12. Patient position:
• Feet and lower limbs medially rotated 15 to 20 degrees, correctly
placed with upper femora in correct profile

13. Central ray:
• Perpendicular at Midline of patient about 2
inches
• Inferior to ASIS and 2 inches superior to
symphysis pubis

14. •Orientation =Portrait
•Cassette size = 24x30cm
•Factors =kVp- 70-80 mAs- 8-15
•SID =100cm
•Grid =Present
Technical details:

15. Image characteristics:
• The entirety of the hip and proximal femur are seen
• Greater trochanter should be seen in profile signifying
adequate internal rotation of the limb

16. UNILATERAL HIP AP

17. Indications:
• Implants
• Fracture
• Bone lesions
• Degeneratieve disease of hip

18. Contra Indications:
• Pregnancy
• Restless patients

19. Patient positioning:
• Supine position
• Rotate affected side limb internally
• Neck of femur parallel to tabletop
• Support with sandbags

20. Central ray:
• 2.5cm distal to line bisecting the
anterior superior iliac
spine(ASIS)and symphysis pubis

21. •Orientation =Portrait
•Cassette size = 24x30cm
•Factors =kVp- 70-80 mAs- 8-15
•SID =100cm
•Grid =Present
Technical details:

22. Essential image characteristics:
• Must include upper third of Femur
• Whole length of prosthesis,including cement must be visualized
• Used for checking internal fixation of following fracture

23. Radiographic Images:
Antero-posterior radiograph of single hip Antero-posterior radiograph of single hip showing
pin and plate

24. AXIOLATERAL
(Danelus miller method)
(Original cleaves method)

25. Indications:
• Pathologic condition and fractures
• The resulting image shows any orthopaedic appliances on its entirety
Danelus miller method:

26. Contra Indications:
• Pregnancy
• Restless patients

27. Patient position
• Patient supine position
• The pelvis is elevated, support the affected limb at hip level on
sandbags or firm pillows.
• Flex the knee and hip of the unaffected side to elevate the thigh in a
vertical position.
• Rest the unaffected leg
• Medially rotate the foot and lower limb of the affected side about 15
or 20 degrees.

28. Patient position:
Axiolateral hip: Danelius-Miller method Same projection, patient holding IR. Foot is
on a footrest

29. Central ray:
• 2.5 inches below the point of intersection
of the localization lines described
previously
Axiolateral hip: Danelius-Miller method.

30. •Orientation =Portrait
•Cassette size = 24x30cm
•Factors =kVp- 70-80 mAs- 8-15
•SID =100cm
•Grid =Present
Technical details:

31. COMPENSATING FILTER
• This projection is improved dramatically and can be performed with
one exposure with the use of a specially designed com- pensating
filter

32. Image characteristics:
• The resulting image shows the acetabulum, head, neck, and
trochanters of the femur

33. Radiographic images:
Axiolateral hip: Danelius-Miller
method.
Same projection with use of compensating
filter.

34. Original cleaves method
Indications
• Neck of femur fracture
• Pathologic condition

35. Contra Indications:
• Pregnancy
• Restless patients

36. Patient positioning:
• Flex patient’s elbow
• Rest the hands on chest
• Don’t rotate the pelvis
• Position can be achieved by placing the two ASIS
equidistant from the radiographic table
• Place compression band above hip joints for
stability

37. Central ray:
• Parallel with femoral shaft’s
• Angle between 25-45 degrees
(Depending how vertically the femora can be placed)

38. Image characteristics:
• Axiolateral projection of femoral head,neck and trochenteric area’s
Bilateral examination Unilateral hip examinations

39. •Orientation =Portrait
•Cassette size = 24x30cm
•Factors =kVp- 70-80 mAs- 8-15
•SID =100cm
•Grid =Present
Technical details:

40. SUPEROINFERIOR AXIAL INLET PROJECTION
(Bridgeman method)

41. Indications:
• This particular view is perpendicular to
the pelvic rim
• Assess the anterior-posterior
displacement of pubic rami fractures.
Pelvis inlet

42. Contra Indication:
• Pregnancy
• Restless patients

43. Patient position:
• Patient is supine
• Lower limbs are internally rotated 15-25°
from the hip(Nit done in suspected
fracture)
• Patient's hands are out of the imaging
field

44. Central ray:
• Midline at the level of the anterior superior iliac spine
• The central ray is angled 25-40° caudal to be perpendicular
to the plane of the pelvic inlet

45. •Orientation =Landscape
•Cassette size = 35x43cm
•Factors =kVp- 70-80 mAs- 20-30
•SID =100cm
•Grid =Present
Technical details:

46. Image characteristics:
• the entirety of the bony pelvic rim
• It should 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

47. Radiographic Images:
With pubis ramus fracture
Normal view With symphysis diastasis

48. MODIFIED AXIOLATERAL
(Clements Nakayama Modification)

49. Indications:
• When Danelius-Miller method cannot used
• Bilateral hip fracture
• Plastic surgery of hip joint
• Limitation of movement of unaffected leg

50. Contra Indication:
• Pregnancy
• Restless patients

51. Patient position:
• Patient in supine position
• Don’t rotate lower limb internally
• Slightly rotate limbs externally

52. Central ray:
• Directed 15 degrees posteriorly and aligned perpendicular to the
femoral neck and the grid IR

53. Image characteristics:
• Lateral hip image
• Shows the acetabulum and the
proximal femur including head,neck
and trochenters

54. •Cassette size =24x30/25x30cm
•Factors =kVp- 70-75 mAs- 20-25
Technical details:

55. Anatomy of sacroiliac joint
• The sacroiliac joint Or the SI joint Is the
joint between sacrum and ilium bones
of the pelvis
• They Are connected by strong
ligaments

56. SACROILIAC JOINTS(AP projection)

57. Indications:
• Show both iliac joints on one Image
• Done when patient unable to turn prone

58. Contra Indication:
• Pregnancy
• Restless patients

59. Patient position
• The patient lies supine on the table.
• The anterior superior iliac spine must be eqdistant from the table top.
• The knees should be flexed.

60. Central ray:
• Centre in the midline at a level midway between the antero superior
iliac spine and the superior border of the symphysis pubis
• The central ray is directed between 5 and 15 degrees cranialy.
Depending on the sex of the patient.
• The female requires greater caudal angulation of the beam.

61. Image characteristics:
• Sacroiliac joint
• Intervertebral space between L5 & S1
• Lumb0sacral junction & sacrum

62. •Cassette size =8-10cm/10-12cm
•Factors =kVp- 70-75 mAs-20-25
Technical details:

63. SACROILIAC JOINTS(posterior obliques)

64. Indications:
• Both sides are examined for comparison

65. Contra Indication:
• Pregnancy
• Restless patients

66. Patient position:
• Patient in prone position
• Body rotation of 25 to 30 degrees
• Patient rest on the forearm and flexed
knee of the elevated side.

67. Central ray:
• centered 1 Inch medial to the AS
IS cassette IR

68. Image characteristics:
• Sacroiliac joint space with minimal
overlapping of the ilium & sacrum.
• Joint centered on the radiograph.

69. •Cassette size =8x10cm/10x12cm
•Factors =kVp- 70-75 mAs- 20-25
Technical details:

70. Reference
• Merrill’s atlas of radiographic positioning and
procedures
• Bontrager’s textbook of radiographic
positioning
• Clark’s positioning in radiography
• https://radiopaedia.org

71. THANK YOU…!