Deck 7: Image Analysis of the Hip and Pelvis

Question 1

A left AP hip projection of a patient who was rotated toward the right side demonstrates
1)a narrowed left obturator foramen.
2)the sacrum and coccyx rotated toward the left hip.
3)a narrowed left iliac wing.
4)the lesser trochanter in profile.

A) 1 only
B) 2 and 3 only
C) 1, 2, and 3 only
D) 2, 3, and 4 only

Answer 1

2 and 3 only

Question 2

For an AP pelvis projection (modified Cleaves method), the
1)legs are abducted until the femurs are at a 60- to 70-degree angle with the imaging top.
2)ASISs are positioned at equal distances from the imaging table.
3)knees and hips are flexed until the femurs are aligned at a 60- to 70-degree angle with the imaging table.
4)central ray is centered to the iliac crest.

A) 1 and 2 only
B) 2 and 3 only
C) 1, 2, and 3 only
D) 1, 3, and 4 only

Answer 2

2 and 3 only

Question 3

An axiolateral (inferosuperior) hip projection obtained with the patient's affected leg in external rotation demonstrates
1)the greater trochanter in profile anteriorly.
2)the greater trochanter at a transverse halfway between the lesser trochanter and the femoral head.
3)the greater trochanter in profile posteriorly.
4)soft tissue from the unaffected leg superimposed over the affected leg's acetabulum and femoral head.

A) 1 only
B) 2 and 3 only
C) 3 only
D) 3 and 4 only

Answer 3

3 only

Question 4

An AP hip projection obtained with the patient's leg in external rotation demonstrates
1)the lesser trochanter in profile.
2)a foreshortened femoral neck.
3)the greater trochanter in profile.
4)the femoral neck without foreshortening.

A) 1 and 2 only
B) 1 and 4 only
C) 2 and 3 only
D) 3 and 4 only

Question 5

For an AP axial sacroiliac joint projection, the
1)patient is supine with the legs flexed until the feet are flat on the imaging table.
2)central ray is angled 35 degrees cephalically for male patients.
3)central ray is centered to the midsagittal plane at a level 1.5 inches superior to the symphysis pubis.
4)male patients require 5 degrees less central ray angulation than female patients.

A) 1 and 3 only
B) 1 and 2 only
C) 3 and 4 only
D) 2, 3, and 4 only

Question 6

When obtaining an axiolateral (inferosuperior) projection of the hip on patients with ample lateral soft-tissue thickness, the

A) IR is positioned superior to the iliac crest.
B) central ray is centered inferior to the femoral head.
C) IR is positioned inferior to the iliac crest.
D) IR is positioned at the iliac crest.

Question 7

For the axiolateral (inferosuperior) projection of the hip,
1)the unaffected hip should be in maximum flexion and abduction.
2)the central ray should be positioned parallel with the femoral neck.
3)a grid and tight collimation are needed to increase detail visibility.
4)the affected leg should always be internally rotated.

A) 1 and 3 only
B) 2 only
C) 1, 3, and 4 only
D) 1, 2, 3, and 4

Question 8

Hip and knee flexion for an AP pelvis projection (modified Cleaves method)
1)positions the greater trochanter in profile.
2)positions the lesser trochanter in profile.
3)rotates the greater trochanter beneath the femoral neck.
4)determines the degree of femoral neck foreshortening.

A) 1 and 3 only
B) 2 and 4 only
C) 2 and 3 only
D) 1 and 4 only

Question 9

For an AP projection of the hip with accurate positioning,
1)the ASISs are positioned at equal distances from the IR.
2)the patient's legs are externally rotated until the epicondyles are at a 45-degree angle with the imaging table.
3)gonadal shielding should not be used.
4)the central ray is centered 1.5 inches (4 cm) distal to the midpoint between the ASIS and symphysis pubis to center the hip joint in the field.

A) 1 and 4 only
B) 2 and 3 only
C) 1, 3, and 4 only

Question 10

An AP hip projection (modified Cleaves method) obtained with the knee and hip flexed more than 60 to 70 degrees with the imaging table demonstrates
1)an obscured lesser trochanter.
2)the greater trochanter laterally.
3)the greater trochanter superimposed over the femoral head.
4)the greater trochanter medially.

A) 1 and 4 only
B) 1 and 2 only
C) 2 only
D) 3 only

Question 11

For an AP hip projection (modified Cleaves method), the
1)lesser trochanter is demonstrated in profile.
2)greater trochanter appears at a level halfway between the lesser trochanter and femoral head.
3)ischial spine is demonstrated with pelvic brim superimposition.
4)greater trochanter is demonstrated medially.

A) 1 and 2 only
B) 2 and 3 only
C) 1, 2, and 3 only
D) 1, 2, 3, and 4

Question 12

As one increases the degree of femoral abduction for an AP hip projection (modified Cleaves method), the
1)greater trochanter moves closer to the femoral head.
2)lesser trochanter is placed in profile.
3)femoral neck demonstrates increased foreshortening.
4)obturator foramen appears wider.

A) 1 and 2 only
B) 1 and 3 only
C) 2 and 3 only
D) 1, 3, and 4 only

Question 13

An AP pelvis projection obtained with the patient rotated toward the left hip demonstrates
1)the symphysis pubis rotated toward the left hip.
2)a narrower right iliac wing.
3)a narrower left obturator foramen.
4)the sacrum and coccyx rotated toward the right hip.

A) 1 and 4 only
B) 2 and 3 only
C) 3 and 4 only
D) 1, 2, 3, and 4

Question 14

An AP hip projection (modified Cleaves method) obtained with the leg abducted almost to the imaging table demonstrates the greater trochanter
1)at a transverse level halfway between the lesser trochanter and femoral head.
2)laterally.
3)superimposed by the femoral neck.
4)medially.

A) 1 and 2 only
B) 3 only
C) 3 and 4 only
D) 4 only

Question 15

For an AP left hip projection (modified Cleaves method), the patient was positioned with the left ASIS placed closer to the imaging table than the right ASIS. On such a projection, the left hip demonstrates
1)a narrowed obturator foramen.
2)a widened iliac wing.
3)the iliac spine without pelvic brim superimposition.
4)the sacrum and coccyx without symphysis pubis alignment.

A) 1 and 2 only
B) 2, 3, and 4 only
C) 1, 3, and 4 only
D) 1, 2, 3, and 4

Question 16

Which of the following is true with regard to the female pelvis?
1)The ala is narrower than on a male pelvis.
2)The overall shape is wider than on a male pelvis.
3)The obturator foramen is smaller than on a male pelvis.
4)The pelvis inlet is heart shaped.

A) 1 and 4 only
B) 2 and 3 only
C) 2 only
D) 3 and 4 only

Question 17

An optimal AP pelvis projection demonstrates
1)the sacrum and coccyx aligned with the symphysis pubis.
2)the ischial spines aligned with the pelvic brim.
3)a narrow right iliac wing and a wider left iliac wing.
4)a symmetrically appearing obturator foramen.

A) 1 only
B) 1 and 4 only
C) 1, 2, and 4 only
D) 3 and 4 only

Question 18

Internally rotating the affected leg for an axiolateral (inferosuperior) projection of the hip
1)positions the greater trochanter behind the femoral neck and shaft.
2)positions the lesser trochanter in profile.
3)positions the greater trochanter in profile.
4)reduces the posterior decline of the femoral neck.

A) 1 and 2 only
B) 3 and 4 only
C) 1, 3, and 4 only
D) 1, 2, and 4 only

Question 19

An AP hip projection with accurate positioning demonstrates the
1)lesser trochanter in profile.
2)greater trochanter in profile.
3)femoral neck without foreshortening.
4)sacrum rotated toward the affected hip.

A) 1 only
B) 2 and 3 only
C) 1, 2, and 3 only
D) 2, 3, and 4 only

Question 20

An AP axial sacral iliac joint projection with accurate positioning demonstrates the
1)median sacral crest and symphysis pubis in alignment.
2)sacroiliac joints without foreshortening.
3)symphysis pubis superimposed over the inferior sacral segments.
4)second sacral segment at the center of the image.

A) 1 and 2 only
B) 3 and 4 only
C) 1, 2, and 4
D) 1, 2, 3, and 4

Question 21

An AP oblique sacroiliac joint projection (RPO position) with poor positioning demonstrates a closed sacroiliac joint, the superior and inferior sacral alae without superimposition, and the lateral sacral ala superimposed over the iliac tuberosity. How was the positioning setup mispositioned for such a projection to be obtained?

A) The pelvis was insufficiently rotated.
B) The pelvis was overrotated.
C) The central ray was not angled.
D) The central ray was centered too medially.

Question 22

Which of the following statements is not true about an AP pelvis projection obtained with the patient rotated toward the right hip?

A) The right ilium is wider than the left ilium.
B) The left obturator foramen will be narrower than the right foramen.
C) The sacrum and coccyx are visualized closer to the left hip than the right hip.
D) The right ischial spine will be demonstrated without pelvic brim superimposition.

Question 23

An AP projection of the sacroiliac joints taken with insufficient central ray angulation will

A) demonstrate the inferior sacrum without symphysis pubis superimposition.
B) demonstrate sacral elongation.
C) demonstrate the inferior sacrum with symphysis pubis superimposition.
D) occur if a 35-degree cephalic angle is used on a female patient.

Question 24

For an AP oblique sacroiliac joint projection (LPO position), the
1)patient's midsagittal plane is placed at a 25- to 30-degree angle with the imaging table.
2)sacroiliac joint of interest is positioned farther from the IR.
3)right marker should be used.
4)central ray is centered 1 inch (2.5 cm) medial to the elevated ASIS.

A) 1 only
B) 2 and 4 only
C) 2, 3, and 4 only
D) 1, 2, 3, and 4

Question 25

The central ray angulation used for AP axial sacroiliac joint projections

A) produces an image without sacroiliac joint foreshortening.
B) ranges from 25 to 30 degrees cephalically.
C) needs to be greater in male than in female patients.
D) needs to be decreased as the lumbosacral curvature increases.

Question 26

A less than optimal AP hip projection demonstrating the lesser trochanter in profile

A) was obtained with the leg in internal rotation.
B) will also demonstrate the greater trochanter at the same level as the femoral head.
C) will also demonstrate the greater trochanter in profile.
D) will also demonstrate a foreshortened femoral neck.

Question 27

How is the patient positioned for an AP projection (modified Cleaves method) of the pelvis to demonstrate the femoral neck without foreshortening?

A) Abduct the femurs to a 45-degree angle with the IR.
B) Abduct the femurs until they are placed as close to the imaging table as possible.
C) Abduct the femurs to 20 to 30 degrees from vertical.
D) This cannot be accomplished in this projection.

Question 28

A less than optimal AP hip projection (modified Cleaves method) demonstrating the greater trochanter positioned laterally

A) will also demonstrate the greater trochanter at the same transverse level as the femoral head.
B) will also demonstrate the lesser trochanter in profile medially.
C) was obtained because the knee and hip were not flexed enough.
D) was obtained because the knee and hip were flexed more than the required amount.

Question 29

An optimal AP pelvis projection (modified Cleaves method) should demonstrate all of the following except the

A) lesser trochanters in profile medially.
B) proximal aspects of the greater and lesser trochanters at approximately the same transverse level.
C) inferior sacrum at the center of the exposure field.
D) ischial spines aligned with the pelvic brim.

Question 30

A less than optimal axiolateral (inferosuperior) hip projection demonstrating the greater trochanter at a transverse level proximal to the lesser trochanter

A) could result if the central ray were centered too proximally.
B) was obtained using too small of a central ray to femur angle.
C) will also demonstrate the femoral neck without foreshortening.
D) was obtained using a central ray to femur angle that was too large.

Question 31

A less than optimal AP oblique sacroiliac joint projection demonstrating the ilium superimposing the inferior sacral ala and lateral sacrum will

A) also demonstrate the lateral sacral ala superimposing the iliac tuberosity.
B) demonstrate an open sacroiliac joint.
C) also demonstrate the superior and inferior sacral alae without iliac superimposition.
D) require decreased pelvic obliquity to obtain optimal positioning.

Question 32

Which of the following is not true about AP hip projection (modified Cleaves method)?

A) The femoral neck is superimposed over the lesser trochanter when the knee and hip are flexed to a 60- to 70-degree angle with the imaging table.
B) The femoral neck demonstrates increased foreshortening with increased femur abduction.
C) With increased femoral abduction the greater trochanter moves more proximal.
D) The lesser trochanter is placed in profile medially when the knee and hip are flexed to a 60- to 70-degree angle with the imaging table.

Question 33

An optimal axiolateral (inferosuperior) hip projection demonstrates all of the following except the

A) lesser trochanter in profile posteriorly.
B) femoral neck with partial foreshortening.
C) greater trochanter superimposed by the femoral shaft.
D) lesser and greater trochanters at approximately the same transverse level.