Because the anterior and posterior head–neck junctions are not superimposed in this position, a ridge of femoral head osteophytes can give the false-positive appearance of a sclerotic fracture line ( Fig. In external rotation, the greater and lesser trochanters partially or completely overlap the femoral neck and intertrochanteric region ( Fig. The most common positioning error is external rotation. In this position, the contours of both greater and lesser trochanters should be visible, increasing sensitivity in the detection of subtle destructive lesions and nondisplaced fractures. Internal rotation helps to compensate for femoral anteversion and brings the femoral neck and head–neck junction into appropriate planes relative to the beam of the x-ray. doi:10.1016/j.jmir.2018.09.008.In the absence of known trauma or suspected proximal femoral fracture, the ipsilateral hip is internally rotated approximately 15 degrees to obtain the AP view ( Fig. Journal of Medical Imaging and Radiation Sciences (2018). "Keeping Children Still in Medical Imaging Examinations- Immobilisation or Restraint: A Literature Review". Immobilisation in Australian paediatric medical imaging: A pilot study. Poor Utility of Gonadal Shielding for Pediatric Pelvic Radiographs. Gonad Shielding during Pelvic Radiography: A Systematic Review and Meta-analysis. Karami V, Zabihzadeh M, Shams N, Saki Malehi A. What causes the "wet diaper" artifact? computed tomography and magnetic resonance observations. When interpreting a pediatric pelvis x-ray, a number of lines will be inspected where interruption of these lines will indicate pathology: Other departments will make use of restraint devices, there is debate around the use of 'restraint' and if it fits the category of 'immobilization' 6. A radiographer or parent being in the room with the patient holding them still has been cited as a commonly used technique 5 in the Australian context. Therefore, immobilization techniques will vary from department to department. turning around to look at their parent)Īs children are lying supine for the examination, distraction techniques may prove difficult. ensure the child’s distraction lies directly above or in front of them so they are not rotating their body to look at it (e.g.using the swaddling technique wrap the child in a blanket to promote comfort and sleep.distract the patient with toys, games and/or conversation.To overcome this, a variety of techniques can be used: rotation of the pelvis due to patient motion.The major difficulty in pediatric pelvis radiography relates to: However, recent studies no longer recommend the use of gonadal shielding for pediatric pelvis examinations 3,4. When placed incorrectly, additional repeats will be required, thereby increasing the radiation dose to the patient. The use of gonadal shielding will vary from department to department. Wet diapers are also known to create artifact on the radiograph, therefore should be removed 2. Patients should remove any clothing from the waist down especially baby rompers as these often have metal buttons. hip surveillance in cerebral palsy patients.developmental dysplasia of the hip (DDH).Performing pelvis radiography on pediatric patients can be for a number of indications 1:
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