Question 1

A patient enters the ED with a possible separation of the symphysis pubis caused by trauma.The AP pelvis projection is inconclusive for determining the extent of the injury.What other projection can be taken to evaluate this region without excessive movement of the patient?

Accepted Answer

The AP axial (Taylor) outlet projection is used to evaluate the pubic and ischial bones, including the symphysis pubis, and can provide a clearer view of the separation without requiring excessive movement of the patient.

Question 2

A PA axial oblique projection (Teufel method) is performed on a patient.The resultant radiograph demonstrates distortion of the acetabulum.The following positioning factors were used: 40° anterior oblique, 12° cephalad CR angle, and CR centered to the upside hip (acetabulum).What needs to be modified during the repeat exposure?

Accepted Answer

The CR should be centered to the downside hip (acetabulum) for the PA axial oblique projection (Teufel method) to avoid distortion.

Question 3

A patient enters the ER with possible bilateral fractured hips.Which of the following routines should be performed?

Accepted Answer

The best routine to evaluate for possible bilateral fractured hips is an AP pelvis and modified axiolateral (Clements-Nakayama method) projections for both hips. This routine allows for visualization of the entire hip joint, including the femoral head and neck, acetabulum, and proximal femur, from both the anterior and lateral perspectives. This can help detect any possible fractures or traumatic injuries.

Question 4

A radiograph of an axiolateral (inferosuperior) projection of the hip reveals a soft tissue artifact seen across the affected hip.This artifact prevents a clear view of the femoral head and neck.What must the technologist do to eliminate this artifact or its effect during the repeat exposure?

Accepted Answer

Elevating and flexing the unaffected leg more can help clear the soft tissue from the path of the x-ray beam, providing a clearer view of the affected hip.

Question 5

A patient comes to the ER with a possible pelvic ring fracture.The initial AP pelvis projection is inconclusive.What other projection(s) can be taken to assist with the diagnosis?

Accepted Answer

The AP axial inlet projection provides a view of the pelvic ring and can help in assessing the extent and nature of a pelvic ring fracture.

Question 6

A radiograph of a unilateral frog-leg (modified Cleaves method) projection reveals that the femoral neck is foreshortened and distorted.The radiologist is concerned about pathology involving the neck.What can the technologist do to improve the visibility of the femoral neck without foreshortening during the repeat exposure?

Accepted Answer

Decreasing the abduction of the femur to 20° to 30° from vertical helps in reducing the foreshortening of the femoral neck, thus improving the visibility of the area of interest without distortion. This adjustment aligns the femoral neck more parallel to the direction of the X-ray beam, resulting in a more accurate representation of the femoral neck on the radiograph.

Question 7

A patient enters the emergency department (ED) having sustained trauma to the pelvis.The patient's main complaint is about her left hip.Which of the following projections should be taken first to rule out fracture or dislocation?

Accepted Answer

The AP pelvis projection is the best first choice to rule out any pelvic fractures or dislocations as it provides a comprehensive view of the entire pelvis. In addition, it can also capture the left hip joint in its entirety, allowing for any abnormalities or injuries to be identified. Once any significant pelvic injury has been ruled out, further imaging such as the AP projection of the left hip or the axiolateral projection can be performed if necessary. The lateral frog-leg projection may not be the best initial choice as it only captures a specific view of the left hip joint and may not provide enough information about the rest of the pelvis.

Question 8

A radiograph of an axiolateral (inferosuperior) projection reveals that there is an excessive amount of grid lines present.A 6:1 linear grid was used.Which of the following points will correct this problem on the repeat exposure?

Accepted Answer

Grid lines can occur due to improper alignment of the grid with the CR and image receptor. Keeping the image receptor and grid parallel to the femoral neck and perpendicular to the CR will correct this problem. Using a screen rather than a grid or decreasing the SID will not correct the issue with grid lines. Keeping the image receptor and grid perpendicular to the femoral neck can also cause grid lines.

Question 9

A radiograph of an AP pelvis reveals that the left obturator foramen is more open or elongated as compared with the right.What is the specific positioning error present on this radiograph?

Accepted Answer

The left obturator foramen appears more open or elongated, indicating that the right side is closer to the image receptor, suggesting right rotation.

Question 10

During a repeat study of the AP axial (Taylor) outlet projection, both obturator foramina are symmetric but foreshortened.Which of the following positioning modifications must be performed to correct this error?

Accepted Answer

To correct foreshortened obturator foramina in an AP axial (Taylor) outlet projection, increasing the cephalic CR (central ray) angulation is necessary. This adjustment helps to elongate the appearance of the obturator foramina on the radiographic image.

Question 11

A radiograph of an AP pelvis reveals that the right iliac wing is foreshortened as compared with the left side.What specific positioning problem is present on this radiograph?

Accepted Answer

Left rotation of the patient during an AP pelvis radiograph results in the right iliac wing appearing foreshortened compared to the left side, indicating that the patient's pelvis was rotated towards the left.

Question 12

A patient enters the ER with a possible pelvic ring fracture due to an MVA.The initial pelvis projections do not reveal any fracture or dislocation, but the ER physician is concerned about a possible right acetabular fracture.Which of the following projections will best demonstrate the right acetabulum?

Accepted Answer

The Posterior oblique pelvis projection (Judet method) is specifically designed to best demonstrate the acetabulum. It provides a clear view of the anterior and posterior rims, the acetabular fossa, and the ilioischial column, which are critical for diagnosing acetabular fractures.

Question 13

A patient comes to radiology with a request for a right hip study.He is from an extended care facility and is confused about the cause of the injury.The technologist takes an AP pelvis, and when the lateral frog-leg projection is attempted, the patient complains loudly about the pain in his affected hip.What should the technologist do to complete the study?

Accepted Answer

The axiolateral (inferosuperior) projection is an alternative projection that can be used when the patient is unable to tolerate the lateral frog-leg position. This projection can provide a similar view of the hip joint and is less painful for the patient. The other options (A, B, D) are not ideal choices in this situation as they may cause increased pain or a suboptimal image.

Question 14

Which of the following lateral hip projections cannot be performed on a trauma patient with a possible hip fracture?

Accepted Answer

The Modified Cleaves method requires the patient to be positioned in a cross-legged position which may be too painful or impossible for a patient with a hip fracture. The other options do not require this position and can be performed on a trauma patient with a possible hip fracture.

Question 15

What type of CR angle is required for the AP axial, inlet projection?

Accepted Answer

The answer of What type of CR angle is required...

Question 16

A radiograph of an AP pelvis demonstrates that the right obturator foramen is foreshortened but the left foramen is open.Which one of the following positioning errors is present on this radiograph?

Accepted Answer

The right obturator foramen appears foreshortened because the pelvis is rotated towards the right side, causing the right side to be closer to the image receptor.

Question 17

The proper name of the method used for the unilateral frog-leg projection is the _____ method.

Accepted Answer

The unilateral frog-leg projection, which is a radiographic technique used to view the hip in profile, is properly referred to as the modified Cleaves method.

Question 18

A radiograph of an AP axial (Taylor) "outlet" projection reveals that the obturator foramina are not symmetric.What type of positioning error is present on this radiograph?

Accepted Answer

The AP axial (Taylor) "outlet" projection specifically aims to demonstrate the symmetrical appearance of the obturator foramina. If the foramina appear asymmetric, it indicates a rotational error in the positioning of the pelvis. This could be due to a number of factors, including rotation of the patient's trunk or pelvic girdle or the presence of spinal curvature. The other options, tilt of the pelvis, off-center CR, and fracture of the pubis or ischium, are less likely to be the cause of the observed asymmetry on the radiograph.

Question 19

A radiograph of an AP pelvis reveals that the lesser trochanters are not visualized.This pelvis projection was performed for nontraumatic reasons.What should the technologist do (if anything) to correct this on the repeat exposure?

Accepted Answer

If the lesser trochanters are not visualized, it indicates proper internal rotation of the lower limbs, which is desired for an AP pelvis projection. Therefore, no correction is needed.

Question 20

A nontrauma patient comes to radiology with a history of chronic pain of the right hip.The patient is ambulatory but has not had previous radiographs taken of that hip.Which of the following routines would be best suited for this patient?

Accepted Answer

The AP pelvis will provide a general overview of the hip joint, while the axiolateral frog-leg projection will specifically target the hip joint and allow for better visualization of the femoral head and neck. This is the most commonly used routine for evaluating hip pain in nontrauma patients. The other options may be used in certain cases, but are not the best choice for this particular patient.

Quiz 7: Femur and Pelvic Girdle