Femur - Lateral

Radiographic Positioning

Adult

Other related pages of interest Applied Radiography Radiographic Anatomy Radiographic Protocols

Name of projection	Femur - Lateral This table looks at the proximal femur. See table below for the distal femur. The lateral femur image must cover the entire femur including the hip joint and the knee joint. If the entire femur cannot be included in a single image, two must be taken with a minimum of 5 cm (2 inches) overlap. The size of the second IR will depend on the coverage required. In this case it may be simply an lateral knee
Area Covered	Proximal half to two thirds of femoral shaft, femoral head, femoral neck, trochanters, hip joint
Pathology shown	Fractures, lesions
Radiographic Anatomy	Femur Radiographic Anatomy
IR Size & Orientation	35cm x 43cm Portrait
Film / Screen Combination	Regular (CR and DR as recommended by manufacturer)
Bucky / Grid	Moving or stationary grid
Filter	No
Exposure	70 kVp 16 mAs
FFD / SID	100cm
Central Ray	Directed to mid-femur Perpendicular to IR
Collimation	Centre: align the upper edge of the IR to the level of the anterior superior iliac spines (ASIS's) Shutter A: to the full length (43 cm or 17 inches) of the IR Shutter B: within 1.25cm (half an inch) of the skin-line Note: the position of the proximal and mid femoral shaft is nearer the anterior aspect of the thigh
Markers	Lateral to mid-femur shaft Marker orientation is AP
Shielding	Not usually possible as gonadal shielding may obscure essential anatomy (check your department's policy guidelines)
Respiration	Not applicable
Positioning	Patient supine Roll patient onto affected side until the femur is against the table and the femoral epicondyles are perpendicular to the table The pelvis will be about 10 to 15 degrees posterior from the lateral position Unaffected limb behind and supported on sand-bags
Critique PACEMAN	Positioning Lateral postioning of the proximal femur is evidenced by Femoral shaft is demonstarated without foreshortening Femoral neck is seen on end Greater trochanter should be beneath femoral neck Trochanters are not prominent Femur is centred to field Majority of the femur is visualised No super-imposition of opposite thigh Area Covered Proximal half to two thirds of femoral shaft, femoral head, femoral neck, trochanters, hip joint Collimation Centre: align the upper edge of the IR to the level of the anterior superior iliac spines (ASIS's) Shutter A: to the full length (43 cm or 17 inches) of the IR Shutter B: within 1.25cm (half an inch) of the skin-line Exposure Trabecular markings on femoral shaft are visualised
Special Notes	Effect of incorrect rotation If greater trochanter is shown laterally this indicates that the patient was not rotated enough If the greater trochanter is shown medially, the leg was over rotated If orthopaedic devices are present they should be included in entirety

Name of projection	Femur - Lateral This table looks at the distal femur. See table above for the proximal femur. The lateral femur image must cover the entire femur including the hip joint and the knee joint. If the entire femur cannot be included in a single image, two must be taken with a minimum of 5 cm (2 inches) overlap. The size of the second IR will depend on the coverage required. In this case it may be simply a rolled lateral hip ---- Under Construction ---
Area Covered	Distal 2/3rds of femoral shaft, patella, proximal tibia and fibula, knee joint
Pathology shown	Fractures, lesions
Radiographic Anatomy	Femur Radiographic Anatomy
IR Size & Orientation	35cm x 43cm Portrait
Film / Screen Combination	Regular (CR and DR as recommended by manufacturer)
Bucky / Grid	Moving or stationary grid
Filter	No
Exposure	70 kVp 16 mAs
FFD / SID	100cm
Central Ray	Directed to mid-femur Perpendicular to IR
Collimation	Centre: align the lower edge of the IR to 5cm (2 inches) below the knee joint Shutter A: to the full length (43 cm or 17 inches) of the IR Shutter B: within 1.25cm (half an inch) of the skin-line
Markers	Lateral to mid-femur shaft Marker orientation is AP
Shielding	Gonadal (check your department's policy guidelines)
Respiration	Not applicable
Positioning	From the supine position, roll the patient onto the affected side until the pelvis is lateral The femoral epicondyles should be perpendicular to the IR Flex the knee about 45 degrees Support unaffected leg at hip level
Critique PACEMAN	Positioning Femoral condyes will not be super-imposed due to divergent rays, but the anterior and posterior margins of the condyles should line up the medial condyle will be projected distally, due to beam divergence, closing the knee joint space Femoropatellar joint space Patella in profile Fibula head beeath tibia Area Covered Distal 2/3rds of femoral shaft, patella, proximal tibia and fibula, knee joint Collimation Centre: align the lower edge of the IR to 5cm (2 inches) below the knee joint Shutter A: to the full length (43 cm or 17 inches) of the IR Shutter B: within 1.25cm (half an inch) of the skin-line Exposure Trabecular markings on femoral shaft should be visualised
Special Notes	Mispositioning is assessed by viewing the anterior and posterior margins of the condyles one condyle anterior to the other is indicative of under or over rotation to determine which way indentify the condyles Due to divergent rays the distal condyle is the medial condyle If a fracture is suspected, this projection can be achieved in the supine position using a horizontal ray with the IR against the medial aspect of the affected femur