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

Accepted Answer

B

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

Accepted Answer

The modified Cleaves method for an AP pelvis projection involves abducting the legs until the femurs are at a 45-degree angle to the table, not 60-70 degrees, making statement 1 incorrect. The ASISs should be equidistant from the table to ensure the pelvis is not rotated, making statement 2 correct. The knees and hips are indeed flexed to achieve the required femur angle, making statement 3 correct. The central ray is centered to the pubic symphysis, not the iliac crest, making statement 4 incorrect.

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

Accepted Answer

In an axiolateral hip projection with the affected leg in external rotation, the greater trochanter is typically seen in profile posteriorly.

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

Accepted Answer

External rotation of the leg in an AP hip projection causes the lesser trochanter to appear in profile and the femoral neck to appear foreshortened.

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

Accepted Answer

The central ray is centered to the midsagittal plane at a level 1.5 inches superior to the symphysis pubis, and male patients typically require 5 degrees less central ray angulation than female patients.

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.

Accepted Answer

The IR (Image Receptor) is positioned superior to the iliac crest to ensure it captures the necessary anatomy and compensates for the increased soft-tissue thickness.

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

Accepted Answer

1) The unaffected hip should be in maximum flexion and abduction to minimize superimposition of anatomy.
3) A grid and tight collimation are needed to increase detail visibility and reduce scatter radiation.
2) The central ray should be positioned perpendicular to the femoral neck, not parallel, to visualize the entire femoral head and neck.
4) The affected leg should be internally rotated only if possible, but it may not always be possible due to pain or injury.

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

Accepted Answer

Hip and knee flexion are required for the modified Cleaves method, which is an AP pelvis projection. This projection is used to position the greater trochanter and lesser trochanter in profile. Rotation of the greater trochanter beneath the femoral neck helps to determine the degree of femoral neck foreshortening. Therefore, options 2 and 3 are correct, while options 1 and 4 are incorrect. Hence, the best choice is C, which includes both correct options.

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

Accepted Answer

ASISs should be positioned equally to ensure the hip joint is properly aligned with the IR. The legs should be externally rotated to 45 degrees to open up the femoral neck and joint space. Gonadal shielding is important for patient safety in this exam, but it should still be used, just not directly over the hip joint or obstructing any anatomy. Centering 1.5 inches distal to the midpoint between the ASIS and symphysis pubis is the standard for centering the hip joint in the field.

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

Accepted Answer

The lesser trochanter is obscured and the greater trochanter is medially displaced on an AP hip projection obtained with the knee and hip flexed more than 60 to 70 degrees.

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

Accepted Answer

The modified Cleaves method for an AP hip projection involves flexing and abducting the patient's thighs to demonstrate the proximal femur and hip joint without foreshortening. This positioning results in the lesser trochanter being demonstrated in profile due to the rotation of the femur, and the greater trochanter appearing at a level halfway between the lesser trochanter and femoral head because of the angle of the femur with respect to the imaging plane. The ischial spine is demonstrated with pelvic brim superimposition due to the orientation of the pelvis in this projection. The greater trochanter is not specifically demonstrated medially in this method; its appearance is more related to its anatomical position relative to the lesser trochanter and femoral head as affected by the positioning.

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

Accepted Answer

As the degree of femoral abduction increases, the femoral neck appears shorter due to foreshortening, and the greater trochanter moves closer to the femoral head. However, the lesser trochanter remains in profile, and there is no change in the appearance of the obturator foramen. Therefore, choices 2 and 3 are correct, making option B the best choice. Choice 1 is true but not the only correct option, and choice 4 is incorrect.

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

Accepted Answer

When a patient is rotated toward their left hip for an AP pelvis projection, the anatomy closer to the X-ray source (in this case, the left side of the pelvis) appears larger and more open, while the anatomy further away (the right side) appears narrower. Thus, the symphysis pubis and the sacrum and coccyx appear rotated toward the left hip (1) and right hip (4) respectively, the right iliac wing appears narrower (2), and the left obturator foramen also appears narrower due to the perspective change (3).

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

Accepted Answer

The modified Cleaves method, which involves abduction of the legs, is designed to project the femoral neck without superimposition by the greater trochanter, thus option 3 is correct.

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

Accepted Answer

In the modified Cleaves method, the left ASIS is placed closer to the imaging table than the right ASIS, resulting in the left hip demonstrating a narrowed obturator foramen. Option 1 is correct. The iliac wing will not be widened because it is not affected by the positioning. Option 2 is incorrect. The iliac spine without pelvic brim superimposition will not be seen on this projection. Only the iliac crest is visible. Option 3 is incorrect. The sacrum and coccyx without symphysis pubis alignment will not be seen because the symphysis pubis is aligned perpendicular to the IR. Option 4 is incorrect.

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

Accepted Answer

The female pelvis is generally wider to accommodate childbirth, and the obturator foramen is smaller compared to the male pelvis.

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

Accepted Answer

An optimal AP pelvis projection should show the sacrum and coccyx aligned with the symphysis pubis, the ischial spines aligned with the pelvic brim, and symmetrically appearing obturator foramen, indicating no rotation.

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

Accepted Answer

Internally rotating the affected leg for an axiolateral (inferosuperior) projection of the hip positions the greater trochanter behind the femoral neck and shaft, positions the lesser trochanter in profile, and reduces the posterior decline of the femoral neck. Therefore, the correct choice is 1, 2, and 4 only. Option 3, positioning the greater trochanter in profile, is incorrect as it is already achieved by internally rotating the leg.

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

Accepted Answer

The greater trochanter should be in profile in an AP hip projection as it helps demonstrate the position of the femoral head. The femoral neck can also be seen without foreshortening if the positioning is accurate. However, the sacrum should not be rotated towards the affected hip, so choice 4 is incorrect. Therefore, the correct options are 2 and 3 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

Accepted Answer

An AP axial sacral iliac joint projection with accurate positioning should demonstrate the median sacral crest and symphysis pubis in alignment, the sacroiliac joints without foreshortening, the symphysis pubis superimposed over the inferior sacral segments, and the second sacral segment at the center of the image. These criteria ensure that the sacroiliac joints and related structures are properly visualized.

Quiz 7: Image Analysis of the Hip and Pelvis

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.

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.

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

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.

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.

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.

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.

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.

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.

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.