Hip - Axiolateral (Clements-Nakayama)

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Radiographic Positioning

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Name of projection Hip - Axiolateral (Clements-Nakayama)
Area Covered Hip and proximal femur
Pathology shown Fractures, dislocation
Radiographic Anatomy Hip Radiographic Anatomy
IR Size & Orientation 24 x 30 cm
Film / Screen Combination Regular
(CR and DR as recommended by manufacturer)
Bucky / Grid Moving or Stationary Grid
Filter Decubitus filter may be used for film
Not required with CR / DR
Exposure 80 kVp
40 mAs
FFD / SID 100cm
Central Ray CR angled 15° posterior, perpendicular to the femoral neck
Collimation Four sides of collimation
Closely collimate to area of interest
Markers Distal and Superior
Marker orientation AP
Shielding Gonadal shielding is not possible without obscuring essential anatomy (check your department's policy guidelines)
Respiration Suspended
  • Patient supine on the table, arms across upper chest
  • Cushion for patients head
  • The leg is not internally rotated as in other hip views but remains in a neutral or slightly externally rotated position (the CR is angled 15° posterior instead of the leg being internally rotated)
  • Place IR in crease above iliac crest and adjust so that it is parrallel to femoral neck (use a dedicated cassette holder)
  • Make sure IR is tilted 15° back to be perpendicular to CR to avoid grid cutoff
  • CR angled 15° posterior, perpendicular to the femoral neck


Area Covered
Special Notes