Proximal Femora (Hips) Projections
Patient Preparation
- Explain the procedure to the patient.
- Remove clothing, metallic objects, or diapers (for pediatric patients) from the pelvic area.
- Ensure patient comfort and immobilization.
- Use lead shielding as appropriate.
- For pediatric patients, gentle restraints or caregiver assistance may be used.
BASIC PROJECTIONS
1. Anteroposterior (AP) Projection — Hip
Positioning:
- Patient supine on the table.
- Leg extended and medially rotated 15–20° to place femoral neck parallel to the IR.
- Center affected hip to the IR.
Central Ray (CR):
- Perpendicular to IR.
- Directed to femoral neck (approximately 2.5 inches distal and 2.5 inches medial from the ASIS).
Collimation:
- Include proximal femur, acetabulum, and surrounding soft tissue.
Evaluation Criteria:
- Femoral head, neck, and proximal shaft clearly visualized.
- Greater trochanter in profile.
- Proper medial rotation of the leg.
2. Lateral Hip (Lauenstein or Hickey Method)
Positioning:
- Patient supine or recumbent on affected side.
- Hip flexed 90° and abducted slightly.
- Knee flexed for comfort.
- Center the femoral head and neck to the IR.
Central Ray (CR):
- Perpendicular to IR.
- Directed to femoral neck.
Collimation:
- Include femoral head, neck, and proximal femur.
Evaluation Criteria:
- Femoral head and neck in profile.
- Acetabulum partially superimposed.
- Greater trochanter projected posteriorly.
3. AP Bilateral Frog-Leg Projection — Hips (Modified Cleaves)
Positioning:
- Patient supine.
- Both hips flexed 45–90° depending on patient comfort.
- Thighs abducted 40–45° from vertical.
- Feet together or supported.
Central Ray (CR):
- Perpendicular to IR.
- Directed 3 inches below ASIS or at femoral neck level.
Collimation:
- Include proximal femora and acetabula bilaterally.
Evaluation Criteria:
- Femoral heads, necks, and greater trochanters visible.
- Symmetric abduction of both thighs.
- Pelvic rotation minimized.
OTHER PROJECTIONS
4. Axiolateral Inferosuperior Projection — Hip (Danelius-Miller Method)
Indication:
- Trauma or suspected fracture when patient cannot abduct leg for frog-leg.
Positioning:
- Patient supine.
- Unaffected leg elevated and out of the way.
- Affected leg in neutral or slightly internally rotated position.
- IR placed vertically against lateral aspect of hip, parallel to femoral neck.
- Flex knee slightly to support leg.
Central Ray (CR):
- Horizontal, perpendicular to femoral neck.
- Entering at midpoint of femoral neck.
Collimation:
- Include femoral head, neck, and proximal shaft.
Evaluation Criteria:
- Femoral head and neck in profile.
- Acetabulum included for joint assessment.
- Clear visualization of fracture lines if present.
Image Evaluation Checklist
- Correct exposure and contrast.
- Femoral head, neck, and proximal shaft visible.
- No rotation or motion artifacts.
- Proper anatomical markers in place.
Common Pathologies Demonstrated
- Hip fractures (femoral neck, intertrochanteric).
- Developmental dysplasia of the hip (pediatric).
- Osteoarthritis or degenerative changes.
- Avascular necrosis of femoral head.
- Soft tissue abnormalities around the hip joint.