Portable X-ray Clements-Nakayama Method

Wednesday, May 3, 2017

Modified Axiolateral Hip and Proximal Femur X-ray

       This is an alternative projection if both limbs have limited movement and the inferosuperior projection cannot be obtained.

Positioning: Modified Axiolateral Projection. X-ray: Lateral Proximal Femur


Exposure Factor:
Analog System: 75 – 85 kVp
Digital System: 80 – 90 kVp

Film Size:
24x30 cm or 10x12 inches Crosswise
Grid – Aligned to central ray to prevent grid cutoff

Patient Position:
  • Patient is lying supine, affected side near edge of table with both legs fully extended.
  • Provide pillow for patient for head, and place his arm across superior chest.
  • Maintain leg in neutral positon like in anatomic position
  • Put Image receptor on extended Bucky tray, which places the bottom edge of the IR about 2 inches or 5cm below the level of the tabletop.
  • Tilt Image Receptor on approximately 15 degrees from vertical and adjust alignment of IR to ensure that the tubeside portion of the image receptor is perpendicular to Central Ray to prevent grid cutoff. Center centerline of IR to projected Central Ray.

Central Ray:

     Angle the central ray mediolaterally as needed so that it is perpendicular to and centered to femoral neck of approximately 15 to 20 degrees posteriorly from horizontal.

SID: 40-44 inches or 102-113cm

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