Hip and pelvis image evaluation

00:33:20
https://www.youtube.com/watch?v=I_3hzafuVtU

Summary

TLDRThe video discusses the importance of proper imaging techniques for the pelvis and hip, focusing on the sacroiliac joints, hip joints, and overall pelvic anatomy. It emphasizes the need for accurate positioning, centering, and image quality to effectively visualize anatomical landmarks. The speaker explains how to assess images for alignment, distortion, and visibility of key structures, such as the acetabulum and femoral head. Specific imaging methods, including the Cleaves method for lateral hip imaging, are highlighted, along with the significance of understanding patient positioning and technique in diagnosing potential fractures or abnormalities.

Takeaways

  • 🦴 Focus on the SI joints, hip, and pelvis anatomy.
  • 📸 Ensure images are centered and free from distortion.
  • 🔍 Use anatomical landmarks for accurate image evaluation.
  • 🧑‍⚕️ Assess patient positioning to avoid rotation errors.
  • ⚙️ Higher contrast images provide clearer bone visibility.
  • 🩺 Include all relevant hardware in hip replacement images.
  • 📏 Evaluate joint spaces for proper imaging technique.
  • 🗣️ Articulate findings clearly during surgical discussions.
  • 🧠 Understand the significance of the femoral neck in imaging.
  • 🔄 Repeat overexposed images for better clarity.

Timeline

  • 00:00:00 - 00:05:00

    The discussion begins with an overview of the pelvis and hip anatomy, focusing on the SI joints, hip, and pelvis. The importance of accurately describing images of these areas is emphasized, particularly in a surgical context where clear communication is essential.

  • 00:05:00 - 00:10:00

    An appropriate image of the left SI joint is analyzed, noting its centered position and lack of distortion. The significance of using precise terminology to describe the image is highlighted, as it aids in effective communication during procedures.

  • 00:10:00 - 00:15:00

    The hip joint is examined next, with attention to its centering and the inclusion of relevant anatomy such as the acetabulum and femoral head. The importance of proper collimation and the visibility of joint spaces is discussed, along with the need for adequate contrast in the image.

  • 00:15:00 - 00:20:00

    The technique for capturing images of the hip is addressed, emphasizing the need to see both bone and soft tissue. The significance of the obturator foramen's appearance in determining patient rotation is also mentioned, as it helps assess the quality of the image.

  • 00:20:00 - 00:25:00

    The Cleaves method for lateral hip imaging is introduced, with a focus on centering the acetabulum and ensuring proper patient positioning. The importance of evaluating the greater and lesser trochanters is discussed, along with the need for appropriate technique to visualize the femoral neck clearly.

  • 00:25:00 - 00:33:20

    Finally, the pelvis is examined, with a focus on centering and the inclusion of key anatomical landmarks. The discussion concludes with an analysis of potential artifacts and the importance of assessing patient positioning to ensure accurate imaging.

Show more

Mind Map

Video Q&A

  • What are the key areas of focus in pelvic and hip imaging?

    The key areas of focus are the sacroiliac (SI) joints, hip joints, and pelvis anatomy.

  • How can we determine if an image is centered correctly?

    An image is centered correctly if the anatomy of interest, such as the SI joint or hip joint, is centered without distortion or superimposition.

  • What is the Cleaves method?

    The Cleaves method is a specific imaging technique used for lateral hip imaging, particularly in patients without suspected fractures.

  • Why is it important to assess the obturator foramen in imaging?

    The obturator foramen helps determine if the patient is appropriately positioned and if there is any rotation present in the image.

  • What should be included in the imaging of a hip replacement?

    All hardware related to the hip replacement should be included in the image to ensure proper evaluation.

  • What does a higher contrast image indicate?

    A higher contrast image indicates a clear distinction between the bone and soft tissue, which is important for evaluating fractures.

  • What anatomical landmarks should be visible in a hip image?

    The acetabulum, femoral head, greater and lesser trochanters, and the neck of the femur should be visible.

  • How can we tell if a patient is rotated in an image?

    We can tell if a patient is rotated by examining the size and appearance of the obturator foramen and the profile of the greater trochanters.

  • What is the significance of the femoral neck in imaging?

    The femoral neck is crucial for evaluating potential fractures and should be centered in the image.

  • What should be done if an image appears overexposed?

    If an image appears overexposed, it may need to be repeated to ensure proper visibility of anatomical structures.

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  • 00:00:00
    okay so let's talk real quickly just
  • 00:00:02
    about the pelvis and the hip and uh how
  • 00:00:06
    to know we've got good pictures of those
  • 00:00:09
    parts of the
  • 00:00:13
    anatomy so quick overview um we're
  • 00:00:16
    really just going to be looking at um
  • 00:00:18
    three areas uh the SI joints the hip and
  • 00:00:22
    the pelvis
  • 00:00:24
    okay go ahead and close
  • 00:00:28
    that um
  • 00:00:31
    so here's an appropriate image of an APO
  • 00:00:35
    BL um of the patient's left SI joint
  • 00:00:41
    um
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    and we have the patient rotated to the
  • 00:00:47
    left side for this image um and then we
  • 00:00:51
    try to get the marker as close as we can
  • 00:00:53
    so we can cone in um in terms of looking
  • 00:00:56
    at this picture and saying what we're
  • 00:00:58
    seeing really kind of the name of the
  • 00:01:00
    game here in this image analysis stuff
  • 00:01:02
    is to just be able to describe to use
  • 00:01:04
    the language and the terminology that
  • 00:01:06
    we've learned to describe what we're
  • 00:01:07
    seeing on this image so what are some of
  • 00:01:10
    the things that we're seeing
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    um
  • 00:01:16
    uh what can we say about the SI joint
  • 00:01:19
    itself the sacral iliac joint how would
  • 00:01:22
    we describe its appearance on this
  • 00:01:28
    image
  • 00:01:34
    is it to the left or to the right on the
  • 00:01:37
    image is
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    it too much up or too much down on the
  • 00:01:46
    image you put on your critical thinking
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    hat because I'm going to be asking more
  • 00:01:50
    questions in this class this time around
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    how would we describe let's just talk
  • 00:01:55
    through the Paceman stuff in terms of
  • 00:01:58
    this left SI joint where is it at on the
  • 00:02:01
    image can we point it out yes you can
  • 00:02:04
    point it out but then use your words to
  • 00:02:06
    tell me where it's at on the
  • 00:02:08
    image it's centered on the image thank
  • 00:02:11
    you good good we have an SI
  • 00:02:15
    joint centered on the image the name of
  • 00:02:19
    the game all right I'll try to clarify
  • 00:02:21
    the name of the game is to see is to
  • 00:02:24
    just describe what we're seeing on this
  • 00:02:26
    picture now I know that seems incredibly
  • 00:02:29
    child in a way but um it's also really
  • 00:02:33
    really helpful to be able to to
  • 00:02:35
    articulate what we're seeing if we're in
  • 00:02:37
    the middle of a surgery and we're trying
  • 00:02:40
    to visualize something on an
  • 00:02:42
    image and we need to ask the doctor what
  • 00:02:45
    they're looking for we need to be able
  • 00:02:46
    to articulate what it is they want to
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    see on the image so that we can address
  • 00:02:50
    that um so even though it may seem a
  • 00:02:53
    little childish what we're seeing is the
  • 00:02:56
    SI joint not only is it centered on the
  • 00:03:00
    image it's demonstrated without any
  • 00:03:03
    superimposition and it is not magnified
  • 00:03:06
    or elongated or distorted right if we
  • 00:03:10
    had the patient
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    tilted um we might get some
  • 00:03:14
    magnification or Distortion of this
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    Anatomy right so we have the SI joint
  • 00:03:19
    centered without magnification or
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    Distortion
  • 00:03:25
    um what's another way that we might
  • 00:03:28
    describe what we're seeing on this image
  • 00:03:30
    any other ideas I mean really it's it's
  • 00:03:32
    up to y'all y'all tell
  • 00:03:41
    me one thing that might be helpful this
  • 00:03:44
    is not from Imaging but I can see where
  • 00:03:47
    this is from film
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    studies um we can break up this image
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    into four quadrants right like this what
  • 00:03:57
    we're saying is gives we're giving
  • 00:04:00
    priority to is this space right here
  • 00:04:02
    this centering point right um the reason
  • 00:04:07
    this is important is now I know if if
  • 00:04:09
    this Anatomy is centered there that's
  • 00:04:11
    probably the anatomy I'm supposed to be
  • 00:04:13
    paying attention to because that's the
  • 00:04:15
    the technologist went out of their way
  • 00:04:17
    to Center that Anatomy right now they've
  • 00:04:21
    given us further hints for what we're
  • 00:04:23
    looking at here they've given us some
  • 00:04:25
    more hints for what we're looking at
  • 00:04:27
    here and I'll show you how they did
  • 00:04:28
    those visual hint
  • 00:04:30
    right they columnated and when they
  • 00:04:33
    columnated they've reduced the width of
  • 00:04:37
    it right and now they've made the image
  • 00:04:39
    longer so what they're telling me when I
  • 00:04:41
    look at this picture is what I'm looking
  • 00:04:42
    at is something that's long right so in
  • 00:04:47
    addition to saying that the SI joint is
  • 00:04:50
    centered on this image how else could I
  • 00:04:53
    describe what's going on with the SI
  • 00:04:54
    joint right
  • 00:04:58
    now
  • 00:05:01
    how is it
  • 00:05:10
    aligned yeah you got it rather's on it
  • 00:05:14
    the SI joint is a is aligned to the long
  • 00:05:18
    axis of the image all
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    right I know this seems really really
  • 00:05:24
    nutty but if you can help me kind of
  • 00:05:26
    unpack what we're seeing on this picture
  • 00:05:28
    I guarantee you this is is a very
  • 00:05:29
    powerful way of learning this stuff so
  • 00:05:32
    we have an SI joint that is
  • 00:05:35
    Woo you're almost doing X-ray on me all
  • 00:05:39
    right SI
  • 00:05:41
    joint that is aligned to the long axis
  • 00:05:44
    of the image and centered right so I can
  • 00:05:48
    even draw that on here if I want to it's
  • 00:05:51
    a line to the long axis and
  • 00:05:53
    centered
  • 00:05:58
    um
  • 00:06:01
    and then we also talked about how it's
  • 00:06:03
    demonstrated without any foreshortening
  • 00:06:05
    or angulation right that's basically the
  • 00:06:09
    criteria of how we know if we have a
  • 00:06:11
    good image of the SI joint right so
  • 00:06:19
    centered
  • 00:06:22
    aligned not
  • 00:06:28
    distorted
  • 00:06:31
    all right let's talk about the
  • 00:06:37
    hip in terms of just what we're looking
  • 00:06:40
    at on this image let's talk a little bit
  • 00:06:43
    about what we see okay um there are no
  • 00:06:47
    wrong answers here all right but it's
  • 00:06:51
    centered yes we have a center we have it
  • 00:06:54
    centered on the hip so we know that
  • 00:06:57
    that's probably what they want us to be
  • 00:06:58
    paying attention to now as simple as
  • 00:07:01
    that sounds right is it easy to Center
  • 00:07:03
    on the hip every single time no it's
  • 00:07:06
    hard it's hard so even though it's easy
  • 00:07:09
    to say it's centered on the hip we know
  • 00:07:11
    that doing this position is difficult um
  • 00:07:16
    and nevertheless we need to have words
  • 00:07:18
    that say it's not centered right it's
  • 00:07:21
    not columnated appropriately so that's
  • 00:07:23
    what I'm trying to encourage us to do
  • 00:07:25
    but this is centered on it what else can
  • 00:07:28
    we say about this image it's columnated
  • 00:07:31
    it is columnated appropriately what what
  • 00:07:34
    Anatomy have we included within our
  • 00:07:38
    colation acetabulum right so we see that
  • 00:07:41
    right
  • 00:07:44
    here uhhuh the what was that
  • 00:07:47
    again yeah greater tro caner right and
  • 00:07:52
    what do we call this portion right here
  • 00:07:53
    of the femur the head the
  • 00:07:56
    femur
  • 00:07:57
    um so uh that's more or less what we're
  • 00:08:00
    trying to Center on is that joint
  • 00:08:02
    between the head of the femur and the
  • 00:08:04
    acetabulum of the pelvis right so it's
  • 00:08:06
    centered on the acetabulum or the head
  • 00:08:08
    of the
  • 00:08:09
    femur um in terms of colation how would
  • 00:08:13
    we describe some of the margins of the
  • 00:08:18
    colation equal it's equal that's good
  • 00:08:22
    what would be okay what's our medial
  • 00:08:24
    border here how do we know that it's
  • 00:08:26
    equal it square it's Square that's
  • 00:08:30
    helpful look at the anatomy what Anatomy
  • 00:08:32
    have we included on that medial
  • 00:08:36
    border part of the pub yes we we get to
  • 00:08:40
    see this portion of the pubic symphysis
  • 00:08:42
    so what do we call that little guy down
  • 00:08:46
    there the
  • 00:08:50
    pelvic this bone right here that I just
  • 00:08:53
    included right here this portion of the
  • 00:08:55
    pelvic bone that's the rain I Ramos RIS
  • 00:09:02
    if it's if it's plural we would say RI
  • 00:09:05
    okay right um Ramis so that is the
  • 00:09:09
    patient's right pelvic Ramis that's
  • 00:09:12
    going to be more or less what we want to
  • 00:09:14
    see now if in surgery they may want to
  • 00:09:17
    they may ask you to include more right
  • 00:09:19
    they may want to see they may say I want
  • 00:09:21
    to see um both of the isal
  • 00:09:24
    tuberosities because in surgery what
  • 00:09:26
    they might be doing is aligning the
  • 00:09:28
    Lesser choke caner to these isal
  • 00:09:29
    tuberosities for their measurements okay
  • 00:09:32
    those are bony landmarks that they use
  • 00:09:33
    in surgery but for our purposes the main
  • 00:09:36
    thing that we're looking for is
  • 00:09:37
    something that is centered on the head
  • 00:09:39
    of the femur within the
  • 00:09:41
    acetabulum has a medial border related
  • 00:09:44
    to the the that s side's Ramis of the
  • 00:09:48
    pelvis um let me see what else can we
  • 00:09:50
    say about this
  • 00:09:53
    image let's talk a little bit about the
  • 00:09:55
    technique what kind of how do we want a
  • 00:09:58
    tech technique on this kind of
  • 00:10:06
    image do we want to just see bones no no
  • 00:10:11
    what are some of the things we would
  • 00:10:12
    like to also see on this image the joint
  • 00:10:15
    space joint space that's good and so we
  • 00:10:18
    might talk about
  • 00:10:21
    um um some of the measurements that we
  • 00:10:24
    might use just for the the gray like
  • 00:10:27
    kind of the gray scale on this image
  • 00:10:29
    would be muscles like the gluteus ILP
  • 00:10:32
    soas muscle right um and uh these just
  • 00:10:38
    these kind of striad um mus muscular
  • 00:10:41
    patterns in here those let me know that
  • 00:10:43
    I have an adequate amount of contrast
  • 00:10:46
    between the bone and the soft tissue
  • 00:10:48
    around it without completely burning the
  • 00:10:50
    image
  • 00:10:50
    out um let me
  • 00:10:58
    see okay what is this thing right
  • 00:11:04
    here yeah the operator framan right now
  • 00:11:09
    its significance to this image is what
  • 00:11:12
    what can I learn by seeing that it's
  • 00:11:14
    open on this image what do I know about
  • 00:11:16
    this patient's
  • 00:11:19
    position they're not rotated so I know
  • 00:11:22
    that there's no foreshortening or
  • 00:11:24
    elongation of the joint space right here
  • 00:11:27
    because I can see through that fmen
  • 00:11:30
    right if I saw that fmen opened a little
  • 00:11:33
    bit more or closed I would know that the
  • 00:11:36
    patient was rotated in one way or
  • 00:11:37
    another so that's a helpful bony
  • 00:11:40
    Landmark for me when I'm looking at this
  • 00:11:42
    image um to describe kind of what I'm
  • 00:11:44
    seeing um because it's going to let me
  • 00:11:46
    know the femoral head and the neck of
  • 00:11:48
    the femur have not been foreshortened
  • 00:11:50
    right that could look like pathology
  • 00:11:53
    right it could look like a fracture or
  • 00:11:55
    something if I had the person rotated
  • 00:11:58
    and it looked like there was the head of
  • 00:12:01
    the femur was compressed into the shaft
  • 00:12:04
    right
  • 00:12:09
    um okay last question about this image
  • 00:12:14
    this is not apparent on this image but
  • 00:12:16
    let's just pretend that it was I'm going
  • 00:12:19
    to start to draw something you tell me
  • 00:12:20
    what I'm
  • 00:12:21
    drawing um it's going to be a really bad
  • 00:12:25
    drawing what is that supposed to be
  • 00:12:29
    surgical Hardware right like a hip
  • 00:12:31
    replacement if this was the image that
  • 00:12:34
    we had is this image now appropriately
  • 00:12:37
    centered no I need to include all of any
  • 00:12:41
    hardware on this image that may mean
  • 00:12:43
    shooting the entire femur right I've
  • 00:12:46
    been in those cases where something went
  • 00:12:49
    haywire and surgery and now they've got
  • 00:12:51
    wire all over this thing and you you
  • 00:12:54
    know that it's going to be at the end of
  • 00:12:56
    the shaft so you might as well just
  • 00:12:58
    shoot a hip and then shoot a femur
  • 00:13:00
    basically right um but in this case this
  • 00:13:05
    would this image would no longer be
  • 00:13:06
    centered appropriately just because of
  • 00:13:08
    the hardware that's apparent in it okay
  • 00:13:12
    so in terms of patient care we need to
  • 00:13:14
    be asking patients have you had a hip
  • 00:13:18
    replacement um is there any hardware in
  • 00:13:20
    your hip um now a nice cheat is if they
  • 00:13:24
    have had a hip replacement if they're
  • 00:13:26
    posttop you can pretty much shoot from
  • 00:13:28
    the top top of the bandage down to the
  • 00:13:29
    bottom of the bandage you probably got
  • 00:13:31
    what you need right
  • 00:13:35
    okay what do we looking at here what is
  • 00:13:37
    this
  • 00:13:39
    image yeah frog lag
  • 00:13:42
    lateral um what's another name we might
  • 00:13:45
    call
  • 00:13:48
    this let me see if I have it in
  • 00:13:53
    here axial lateral no not axial this is
  • 00:13:57
    uh this is the Cleaves method Cleaves
  • 00:14:00
    method frog leg lateral hip or Cleaves
  • 00:14:03
    method this is not an image that we want
  • 00:14:05
    to do on someone who we suspect as a
  • 00:14:07
    fracture right um but if a patient's
  • 00:14:10
    preop or something like that and uh
  • 00:14:14
    we're just needing to evaluate um The
  • 00:14:16
    Hip from a lateral image as well then we
  • 00:14:19
    have this option right um as this slide
  • 00:14:23
    indicates there's a whole lot of anatomy
  • 00:14:25
    that we can evaluate on this image right
  • 00:14:29
    um but let's talk a little bit about
  • 00:14:31
    what we're seeing and some of this stuff
  • 00:14:33
    we'll probably be able to borrow from
  • 00:14:35
    our last thing right so where are we
  • 00:14:39
    centered yeah right on that
  • 00:14:42
    acetabulum right and we can do that by
  • 00:14:44
    dividing the the film into
  • 00:14:47
    planes um and
  • 00:14:54
    then let's what do we know also what so
  • 00:14:58
    we have now the um obter foren here and
  • 00:15:02
    that's telling us what about what we're
  • 00:15:04
    seeing on this
  • 00:15:06
    image rotated they're not rotated
  • 00:15:09
    they're appropriately positioned in
  • 00:15:10
    terms of the patient's hips people
  • 00:15:13
    sometimes if their hip is hurting
  • 00:15:14
    they're going to start to favor they're
  • 00:15:15
    going to pull they're going to they're
  • 00:15:16
    not going to want to rest it on the
  • 00:15:17
    table right so this is one of the first
  • 00:15:20
    things that we can look at to make sure
  • 00:15:21
    that that they're that they we're not
  • 00:15:23
    getting any kind of foreshortening or
  • 00:15:25
    Distortion of the joint um caused by
  • 00:15:28
    rotation
  • 00:15:30
    um what can what else can we talk about
  • 00:15:33
    what were some of the other things we
  • 00:15:34
    talked about on this on the last image
  • 00:15:36
    that might relate to this
  • 00:15:37
    image I haven't heard from this side of
  • 00:15:40
    the room
  • 00:15:45
    yet what were some of the things we
  • 00:15:47
    talked about on the last image that
  • 00:15:49
    might also relate to this
  • 00:15:55
    image the Ramis yeah you're right so we
  • 00:15:58
    can now I'll see the emphasis pubis
  • 00:16:00
    right
  • 00:16:01
    here so we know that that should be our
  • 00:16:03
    medial border of the image right um what
  • 00:16:07
    else might we look at so we have we have
  • 00:16:11
    positioning concerns what can we talk
  • 00:16:12
    about technique
  • 00:16:23
    wise what did we look at for technique
  • 00:16:25
    on the last one how did we make
  • 00:16:27
    determinations on technique on the last
  • 00:16:33
    one the joint space good and then also
  • 00:16:36
    we see some soft tissue we can see some
  • 00:16:38
    some musculature here now it looks like
  • 00:16:40
    there's some Quantum model here right um
  • 00:16:44
    it looks kind of jaggedy and funny up
  • 00:16:46
    there to me um so if I was evaluating
  • 00:16:49
    this image I would have to be real
  • 00:16:50
    careful because it looks like they have
  • 00:16:52
    appropriately columnated and then what's
  • 00:16:55
    this it's a digital marker right right
  • 00:16:59
    so if we were doing pacan on this image
  • 00:17:01
    we we have some question marks here that
  • 00:17:05
    that are starting to come up because we
  • 00:17:06
    have we have what looks like Quantum
  • 00:17:08
    model down in here and then we have a
  • 00:17:11
    digital marker right we can see
  • 00:17:14
    appropriate evidence of appropriate
  • 00:17:16
    colation here um but not necessarily
  • 00:17:20
    evidence of good
  • 00:17:21
    shielding right um let me think if
  • 00:17:25
    there's anything else we need to talk
  • 00:17:26
    about with this okay yeah let's talk
  • 00:17:29
    about the
  • 00:17:30
    troan um can we see the greater tro
  • 00:17:33
    caner on
  • 00:17:35
    this not really but what do we see we
  • 00:17:38
    see the Lesser tro caner in profile now
  • 00:17:40
    now we would not want to see a whole lot
  • 00:17:42
    of the Lesser tro caner on the other
  • 00:17:44
    image right because that would mean that
  • 00:17:46
    the patient feet were not appropriately
  • 00:17:48
    did yeah we did see some we did see some
  • 00:17:51
    um we would hope to see less because the
  • 00:17:54
    more lesser tro caner that we see on
  • 00:17:55
    that image the less greater tro caner
  • 00:17:57
    we're going to see if that makes any
  • 00:17:59
    sense on this image we want to see the
  • 00:18:01
    Lesser troan we want to be able to
  • 00:18:02
    evaluate it as well as the neck right
  • 00:18:06
    now we can see it free of any
  • 00:18:08
    superimposition so if we did suspect um
  • 00:18:12
    a fracture clearly we're going to need
  • 00:18:13
    to be able to get some kind of lateral
  • 00:18:16
    image of um of the
  • 00:18:21
    femur let see if there's anything else
  • 00:18:23
    we want to talk about with this so we
  • 00:18:26
    can see the acetabulum the greater and
  • 00:18:27
    lesser tro caners but mostly the Lesser
  • 00:18:29
    tro caner on this image um the head and
  • 00:18:32
    neck of the
  • 00:18:34
    femur um half of the sacrum so we've got
  • 00:18:38
    kind of the sacrum cut in half and then
  • 00:18:41
    uh half of the coxic and then that
  • 00:18:43
    symphysis pubis
  • 00:18:47
    right all right so if the patient if the
  • 00:18:51
    patient presented with a fracture we're
  • 00:18:52
    probably going to be doing this image
  • 00:18:54
    right cross table cross table lateral
  • 00:18:57
    hip um
  • 00:18:58
    because if we suspect any kind of
  • 00:19:00
    fracture chances are the fracture is
  • 00:19:02
    going to be right through here and we're
  • 00:19:04
    not going to want um that patient frog
  • 00:19:08
    legging their leg out or they may not
  • 00:19:09
    even be able to at that point in time
  • 00:19:12
    right um so we're familiar with this
  • 00:19:15
    position probably I mean this is the one
  • 00:19:17
    where you have to we used to say aim
  • 00:19:20
    right at their junk that's what we
  • 00:19:22
    always said in in posttop um literally
  • 00:19:25
    and then get a little angle on your on
  • 00:19:27
    your central aray and then an angle on
  • 00:19:29
    your image receptor and uh blast the
  • 00:19:32
    heck out of them basically it requires a
  • 00:19:34
    lot of technique because you're
  • 00:19:35
    typically using a grid um these patients
  • 00:19:39
    it seems like are
  • 00:19:40
    seldom
  • 00:19:42
    uh uh athenic patients so the uh
  • 00:19:48
    proximal femur now is what we're going
  • 00:19:50
    to be looking at for our technique I'm
  • 00:19:52
    no longer interested when I see this
  • 00:19:54
    image I know immediately I'm not
  • 00:19:57
    interested in what's going on on with
  • 00:19:59
    contrast and density in terms of
  • 00:20:03
    musculature right the technique is going
  • 00:20:06
    to be such that I'm not going to be able
  • 00:20:08
    to capture any musculature and get
  • 00:20:13
    sufficient density along the femur so
  • 00:20:16
    the femur now is the measure for my
  • 00:20:21
    technique as I look at this picture this
  • 00:20:23
    is now different from the last two
  • 00:20:25
    images that we looked at and we can see
  • 00:20:27
    a clear difference between this image in
  • 00:20:28
    the last one right this image is less
  • 00:20:31
    bright right that's how I would describe
  • 00:20:33
    this image it is less bright because the
  • 00:20:36
    technologist set a te a technique that
  • 00:20:38
    was sufficient for the
  • 00:20:40
    femur is everyone tracking with me on
  • 00:20:43
    that
  • 00:20:46
    um and it's also
  • 00:20:50
    uh as a consequence it is a higher
  • 00:20:54
    contrast image right the whites are
  • 00:20:57
    really white right in here and the
  • 00:20:59
    blacks are really black right in here
  • 00:21:01
    right there's less gray scale there's
  • 00:21:05
    less Shades of Gray scale here
  • 00:21:08
    right
  • 00:21:10
    um so it is a higher contrast
  • 00:21:16
    image but what's nice about this is we
  • 00:21:18
    have the femoral neck demonstrated
  • 00:21:20
    without any
  • 00:21:21
    foreshortening um and we can see the
  • 00:21:26
    Lesser traner very clear
  • 00:21:29
    so if we suspected a fracture we now
  • 00:21:31
    have a way of Imaging that neck of the
  • 00:21:35
    femur what have we centered on in this
  • 00:21:40
    image right the femoral neck that's what
  • 00:21:43
    we want to see in the middle of this
  • 00:21:44
    picture is that easy to do no um so
  • 00:21:48
    honestly that's probably the first two
  • 00:21:50
    things when we we're going to ask when
  • 00:21:52
    we look at this picture are directly
  • 00:21:54
    related to our discussion how's the
  • 00:21:56
    technique did we Center
  • 00:21:59
    appropriately right um how's the
  • 00:22:02
    technique did we Center appropriately I
  • 00:22:04
    used to think that we were supposed to
  • 00:22:06
    be centered up here when I shot these
  • 00:22:08
    images and I realized that's simply not
  • 00:22:11
    the case I'm not really able to evaluate
  • 00:22:13
    the joint very clearly on this picture
  • 00:22:15
    there's too much superimposition I'm
  • 00:22:17
    going to use the AP to look at the Joint
  • 00:22:20
    right I'm just looking at the neck right
  • 00:22:25
    now one additional criteria would be if
  • 00:22:28
    there's any hardware which chances are
  • 00:22:30
    if we're doing something like this
  • 00:22:31
    there's either a fracture or there's a
  • 00:22:33
    repair right so in the case that there's
  • 00:22:36
    Hardware demonstrated on the image I
  • 00:22:37
    would want to make sure that I've
  • 00:22:39
    included all of the hardware right um if
  • 00:22:43
    I have not included all the hardware I
  • 00:22:45
    may need to
  • 00:22:46
    reenter okay again I can use that
  • 00:22:49
    bandage as a
  • 00:22:50
    cheat um but generally what they're
  • 00:22:52
    looking at for that when they look at
  • 00:22:54
    the hardware on the lateral if it's most
  • 00:22:56
    surgeons will tell you it's been in my
  • 00:22:58
    experience I could be wrong but it's
  • 00:23:01
    surgeon dependent I guess is what I
  • 00:23:02
    should say institution dependent um if
  • 00:23:05
    you have it adequately demonstrated on
  • 00:23:07
    the AP all they're looking at on the
  • 00:23:09
    lateral is to make sure that it's not
  • 00:23:11
    like stuck out here somewhere right that
  • 00:23:14
    it hasn't just like totally missed the
  • 00:23:16
    shaft of the femur and gone off on some
  • 00:23:18
    other crazy
  • 00:23:19
    Direction okay so the femoral neck is at
  • 00:23:23
    the center of the exposure field we want
  • 00:23:25
    to be able to see the acetabulum Lesser
  • 00:23:27
    TR
  • 00:23:28
    caner um issal
  • 00:23:32
    tuberosity all of that within the
  • 00:23:34
    columnated field
  • 00:23:36
    okay
  • 00:23:39
    um any questions about that image okay
  • 00:23:42
    let's move on and talk about the
  • 00:23:45
    pelvis
  • 00:23:48
    um so this image is uh accurately
  • 00:23:53
    positioned but I can't tell what all is
  • 00:23:55
    going on in terms of technique and stuff
  • 00:23:56
    it looks like there's some kind of kind
  • 00:23:58
    of artifact on here or something I don't
  • 00:24:00
    know if y'all can see this there's lines
  • 00:24:02
    that run across it like right there
  • 00:24:05
    um
  • 00:24:07
    so now we have centered our our
  • 00:24:11
    centering has changed
  • 00:24:13
    um so how would we
  • 00:24:17
    describe this
  • 00:24:23
    image centered on what
  • 00:24:26
    now
  • 00:24:31
    it's hard to say really how this image
  • 00:24:33
    is centered because like we're just
  • 00:24:35
    basically centered on this giant hole
  • 00:24:37
    right here right
  • 00:24:39
    um but one of the things that we can do
  • 00:24:42
    is kind of revise our framing right we
  • 00:24:46
    can revise the way that we framed the
  • 00:24:47
    image okay so since we have such a large
  • 00:24:51
    area that we've had to Center on more or
  • 00:24:53
    less it's difficult to say what exactly
  • 00:24:55
    I'm centered on like maybe I'm just
  • 00:24:56
    centered on this fart right here here
  • 00:24:58
    right um but if I redo like how I'm
  • 00:25:02
    thinking about my framing right like
  • 00:25:04
    have you ever seen photographers doing
  • 00:25:05
    this number walking around like that um
  • 00:25:09
    now I know that if I have things within
  • 00:25:11
    that frame right like if I have three
  • 00:25:15
    things basically within that frame then
  • 00:25:17
    I know that I'll also have the fourth
  • 00:25:20
    right um and what I mean is like if if I
  • 00:25:23
    have this iliac
  • 00:25:25
    crest this iliac rest and this greater
  • 00:25:29
    tro caner I know that I also have this
  • 00:25:33
    greater tro caner right so now I know
  • 00:25:36
    I'm appropriately centered if I have
  • 00:25:38
    ConEd appropriately right then I will
  • 00:25:42
    have an image and I'm not going off of
  • 00:25:45
    what what that dot is telling me right
  • 00:25:47
    here because I don't have any that Dot's
  • 00:25:49
    not in anything right now I'm just going
  • 00:25:52
    to talk about the way it's framed right
  • 00:25:55
    so I need to know a little bit about
  • 00:25:57
    about this anatomy in order to be able
  • 00:25:59
    to tell you that all the anatomy is
  • 00:26:00
    included on the image right um so isal
  • 00:26:04
    tuberosities um greater and lesser tro
  • 00:26:07
    canners and then iliac crest are those
  • 00:26:10
    things demonstrated on the image yes is
  • 00:26:13
    it ConEd appropriately yes then it must
  • 00:26:15
    be appropriately
  • 00:26:17
    centered right if I answered no to any
  • 00:26:20
    of those questions then the centering
  • 00:26:22
    must be off does that make sense I've
  • 00:26:25
    just reframed it um
  • 00:26:28
    contrast and density for this also we're
  • 00:26:30
    going to need to show some gray scale
  • 00:26:32
    because we want to be able to evaluate
  • 00:26:34
    the soaz muscles um we want to be able
  • 00:26:37
    to see some of these joint spaces
  • 00:26:40
    right
  • 00:26:42
    um let me
  • 00:26:47
    think
  • 00:26:49
    so again there's a couple of things that
  • 00:26:52
    we'll look at to make sure the patient's
  • 00:26:54
    positioned
  • 00:26:55
    appropriately um so I've pretty much
  • 00:26:58
    established that in terms of looking at
  • 00:26:59
    this image
  • 00:27:01
    that the the central Ray and the
  • 00:27:04
    colation is appropriate right is the
  • 00:27:06
    patient positioned appropriately what
  • 00:27:08
    can we look at to determine whether or
  • 00:27:09
    not this patient's positioned
  • 00:27:11
    appropriately the
  • 00:27:13
    wings good for good we can go right back
  • 00:27:17
    to these guys right The obturator Forum
  • 00:27:20
    and and see are they opened is one of
  • 00:27:23
    them open more than the other does one
  • 00:27:25
    of them look closed like let's say the
  • 00:27:26
    right one look Clos on the left one look
  • 00:27:28
    what looks open what's going on in that
  • 00:27:31
    case they're rotated towards their left
  • 00:27:34
    um so we look and make sure that these
  • 00:27:38
    obter formans are more or less the same
  • 00:27:41
    size that they're equally open um we
  • 00:27:44
    also are going to look at the um the
  • 00:27:48
    greater tro canners what am I looking
  • 00:27:50
    for from the greater tro canners on this
  • 00:27:54
    image how would I describe the
  • 00:27:56
    appearance of the greater TR canner on
  • 00:27:59
    this I'm going to draw a really terrible
  • 00:28:02
    picture profile profile yep I always
  • 00:28:05
    think about
  • 00:28:07
    um Alfred Hitchcock do you all remember
  • 00:28:09
    that TV show I used to grow up watching
  • 00:28:12
    Nickelodeon um it always began with him
  • 00:28:14
    showing his his profile right um he had
  • 00:28:17
    a very distinct profile the greater tro
  • 00:28:19
    caners have a very distinct profile so
  • 00:28:21
    if I see the greater tro caners in
  • 00:28:23
    profile on this image I know that the
  • 00:28:24
    patient's feet were appropriately Rota
  • 00:28:27
    inward right um so that I can see the
  • 00:28:30
    that that
  • 00:28:32
    Anatomy
  • 00:28:34
    uh I think that's
  • 00:28:39
    it okay what's going on with this
  • 00:28:42
    picture let's describe what we're seeing
  • 00:28:49
    here is it it's Overexposed so it looks
  • 00:28:52
    a little dark we don't see as much
  • 00:28:56
    um like like uh don't see as much we see
  • 00:28:59
    more soft tissue yeah we've burned out
  • 00:29:02
    some of our soft
  • 00:29:05
    tissue slightly rotated which way are
  • 00:29:08
    they rotated Katie they're rotated to
  • 00:29:11
    their right you're right because this
  • 00:29:14
    obter formant is open more than the the
  • 00:29:16
    left that's really good what else is
  • 00:29:18
    going on so we've established that it's
  • 00:29:20
    a little bit burned out the patient's a
  • 00:29:22
    little
  • 00:29:26
    rotated they didn't cumate really well
  • 00:29:29
    we can actually it's kind of interesting
  • 00:29:30
    we know this is a radiograph right like
  • 00:29:32
    this is actual film there's a number of
  • 00:29:35
    things that are kind of tipping us off
  • 00:29:36
    here we can see this gradient right down
  • 00:29:39
    here do you see that that fall off
  • 00:29:41
    radiation so we know that they actually
  • 00:29:43
    columnated on this image and we have
  • 00:29:46
    some falloff radiation that's resulting
  • 00:29:48
    from that a little bit of scatter off of
  • 00:29:49
    the patient um what else is going on
  • 00:29:53
    this on this image that looks like a
  • 00:29:55
    digital marker but that's fing that's
  • 00:29:58
    not it's it's possible that yeah I
  • 00:30:00
    noticed that too that's interesting that
  • 00:30:02
    does look like a digital
  • 00:30:04
    marker image to the computer yeah it
  • 00:30:07
    does it they they used we used to do
  • 00:30:10
    that back in the day in all honesty
  • 00:30:11
    shooting a shoot a film and then scan it
  • 00:30:13
    into a computer um and add digital
  • 00:30:16
    markers I'm not sure I maybe it's just
  • 00:30:19
    shot on a digital system most digital
  • 00:30:21
    systems that I've seen it's difficult to
  • 00:30:23
    capture fall off radiation it may just
  • 00:30:25
    be the way it masked it maybe it didn't
  • 00:30:27
    mask it appropriate the two Famers look
  • 00:30:29
    very weird because yes it's like one's
  • 00:30:34
    turn one's not yeah the which which one
  • 00:30:37
    appears to be appropriately
  • 00:30:40
    positioned the right because we can see
  • 00:30:42
    what can we see right here greater tro
  • 00:30:45
    caner in profile can't I don't see the
  • 00:30:48
    greater troan in profile here where is
  • 00:30:50
    the greater tro
  • 00:30:54
    caner how is that possible
  • 00:31:05
    okay bear with me
  • 00:31:08
    here if you got something that's
  • 00:31:10
    supposed to look like that on an image
  • 00:31:13
    right greater choke canner and all of a
  • 00:31:15
    sudden it looks like
  • 00:31:17
    that what might have rot to the right
  • 00:31:21
    they're
  • 00:31:22
    rotated but isn't
  • 00:31:24
    that their feet are pointed inward but
  • 00:31:27
    rotated to the right so it's not in no
  • 00:31:31
    but let's think let's think about that
  • 00:31:33
    because that's a good point that's a
  • 00:31:34
    good point I like what she's I like the
  • 00:31:36
    way she's thinking I don't know if this
  • 00:31:38
    will help or not this looks like I'm G
  • 00:31:40
    to have a hammer she's saying um they're
  • 00:31:43
    rotated they're favoring their rotated
  • 00:31:47
    in right then they're rotated to the
  • 00:31:49
    right they're rotated to the
  • 00:31:51
    right I think it's would so then when
  • 00:31:54
    they rotate to the right their foot is
  • 00:31:56
    like actually
  • 00:31:58
    instead of being rotated in that's
  • 00:32:00
    possible that's
  • 00:32:02
    possible or something's
  • 00:32:10
    broke which
  • 00:32:13
    femur the left the neck of the left
  • 00:32:16
    femur is
  • 00:32:17
    broken um so everything that Kathleen
  • 00:32:20
    said is true um so they they they are um
  • 00:32:25
    they more or less are trying to Main
  • 00:32:27
    main this position they're probably not
  • 00:32:28
    trying to move their foot at all she's
  • 00:32:31
    rotated to the right um because she does
  • 00:32:36
    not want to lay on that left hip right
  • 00:32:39
    so having but we framed the thing
  • 00:32:42
    appropriately probably the reason it's
  • 00:32:44
    dark is because they used a trauma
  • 00:32:46
    exposure right um so I'm not I don't
  • 00:32:49
    think this film needs to be repeated
  • 00:32:51
    even if it is a little a little bit dark
  • 00:32:53
    right um because probably this person's
  • 00:32:55
    about half a surgery already um I would
  • 00:33:00
    hope so this I just brought this up to
  • 00:33:04
    show youall a case of as we're going
  • 00:33:06
    through these criteria it'll also help
  • 00:33:09
    us make determinations of is there
  • 00:33:12
    pathology appearent on these images as
  • 00:33:14
    well so good work y'all that was
  • 00:33:18
    good
Tags
  • pelvis
  • hip
  • sacroiliac joint
  • imaging techniques
  • Cleaves method
  • anatomy
  • radiographic imaging
  • patient positioning
  • fracture diagnosis
  • image quality