Lower Extremity Critiques -- File 02
AP and Cleaves/Unilateral Hip
Image # 29 & Image # 29A File # 002
Critique: AP and lateral Cleaves appropriately centered and positioned. Projections
demonstrate congenital hypoplasia (defective development of) with dislocation of the proximal
femur. Note: letter A is an IUD. Compare to pages 362, 363 - Vol. I.
Cleaves/lateral Hip
Image # 16
File # 002
Critique: This pediatric case demonstrates an attempt to project the proximal femur laterally.
Note that although there is slight part obliquity, there is no abduction of the proximal femur, and
thus the femoral neck is not in profile. Obliquity of the body alone does not suffice for the
expected unilateral cleaves position. In fact, does this film more closely resemble an AP rather
than a lateral? Compare to page 363 & 365, Vol. I.
AP Knee
Critique: Light leakage covering ≈ 60% of the knee.
Image # 4
File # 002
Transthoracic humerus
Image # 14 File # 002
Critique: Other than body rotation, this film demonstrates an appropriately positioned
transthoracic projection. Question: is this projection intended to demonstrate the distal humerus?
Compare to page 174-175 - Vol. I.
AP and Oblique Ankle
Image # 17
File # 002
Critique: An appropriately positioned AP and Oblique ankle. Note the clearly defined ankle
mortis due to separation of the talus and lateral malleolus despite the existing fracture and
casting material. So how was dorsiflexion achieved in the oblique position ? The technique for
resolving this dilemma will be discussed under special projections later in the semester.
Compare to pages 290, 292, 293 - Vol. I.
AP and Bi-lateral Cleaves Pelvis
Image # 26 & 26 A
File # 002
Critique: Both projections were taken to include a substantial amount of the proximal femur.
Both images demonstrate off-centering to the left side of the patient’s MSP. In addition, both
images demonstrate slight pelvic rotation to toward/to the patient’s right side, i.e., the ilia are
asymmetrical. Compare to pages 354, 355 and 362, Volume I. Look closely at figure7-15
A & B page 355 ,and figure 7-24, page 362 and note the asymmetrical appearance. The
aforementioned figures demonstrate rotation to the patient’s right side. Question, does the
author note the rotation ? To determine rotation, measure from the region of the patient’s ASIS,
to the sacroiliac joint space. In these images, the measurement difference is ≈ one cm. (Measure
ranges from 12.5 on the right to 11.5/4 on the left). Typically, one can always identify rotation
in this manner, and the side to which the patient is rotated is typically the side that measures the
greatest, i.e., the side positioned downward will appear larger in the supine recumbent position.
Would the aforementioned statement be true if the patient were prone ? No. Think about RAO
versus LAO chests, abdomens, and which side is projected.
Note: if the ischial spines are visible, (they are not always visualized) asymmetrical appearance
of these structures would also indicate patient rotation to the side with the largest ischial spine.
AP Pelvis
Image # 2
File # 002
Critique: This image demonstrates a correctly positioned AP pelvis. There is minimal
off\centering to the left of the patient’s MSP. Note the ischial spines not visualized, as they may
not always be. Compare to page 365-355 - Vol. I.
AP Pelvis
Image # 1
File # 002
Critique: The cassette is clearly not one inch above the crest as it should be. This centering
error results in minimal demonstration of the proximal femur. Also note the rotation of the
patient to/toward his/her left side, as indicated by a slight increase in the width of the left ilium.
Once again, to determine rotation, measure from the region of the patient’s ASIS, to the
sacroiliac joint space (both sides). In this image, the measurement difference is ≈ 2 cm. Also
note that the ischial spines are not visualized, which is probably normal for this patient.
Compare to page 354 -355 - Vol. I.
AP Pelvis
Image # 15 File # 002
Critique: Note that there is substantial rotation to the patient’s left side, as evidenced by the
larger left ilium (asymmetrical ilia, which were not measured). Also note that in this patient, the
ischial spines are clearly visible, and the left ischial spine appears substantially larger
(asymmetrical ischial spines), further indicating left-sided rotation. Once again, the ischial
spines (if visualized) and the ilia should be symmetrical. Also note the image is not positioned
vertically one inch above the ilium, on the left side. Compare to page 3354-355 - Vol. I.