SMALL ANIMAL PELVIS AND PELVIC LIMB CHAPTER 21

CHAPTER OUTLINE • Objectives • Key terms • Overview • Radiographic and patient concerns • Pelvic limb positions • Key points Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 2

Overview and Concerns • Reasons for imaging • High contrast preferred • Minimum two views are required—exceptions • Contralateral limb—older or younger animals • Field of view: Long bone vs. joints Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 3

Terminology Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994

In General • Table top • If using one film for both views • Label placement • Measure • Center ray at area of interest • Parallel and perpendicular Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 5

Protocol Anatomical location Routine views Optional views Pelvis Lateral, Ventrodorsal hip-extended Ventrodorsal - frog leg Penn. HIP*-VD-extended, compression, distraction Femur Lateral, Craniocaudal Caudocranial Stifle Lateral, Caudocranial Proximodistal Tibia / fibula Lateral, Caudocranial Foot- tarsus, metatarsus and digits Lateral, Plantarodorsal Extended or flexed laterals, Obliques Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 6

Checklist • Settings, image receptor, correct body part, center, and borders correct • Label placement: • Measure at: • Measure in: • Central ray: • Parallel: • Perpendicular: Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 7

Pelvis • Ventrodorsal hip-extended and lateral • Frog leg—optional • OFA (Orthopedic Foundation for Animals) • VD hip extended for coxofemoral joint certification • Hip dysplasia—abnormal development of the femoral joint • Penn. HIP® (Pennsylvania Hip Improvement Program) • To determine degree of laxity in coxofemoral joints • Concern that VD extended masks joint laxity • Permanent ID important: Include: Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 8

Normal Pelvic Anatomy Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003,

Pelvis Ventrodorsal—Hip Extended View • Measure: • Central Ray: • Borders: Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 10

Positioning • Place: • Head : • Forelimbs Brown: Lavin’s Radiography for Veterinary Technicians

Hind Limbs • Grasp limb at metatarsus • Rotate femurs • Femurs parallel • Patellae over patellar groove • Tape around proximal stifle • Tape at digits and extend • Sandbag over distal limbs Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 12

Comments/ Tips • Chemical restraint • Labeled/markers • Symmetry required • Include Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 13

Pelvis Lateral • Measure: • Central Ray: • Borders: Brown: Lavin’s Radiography for Veterinary

Pelvis Lateral • Positioning: • Place: • Head and forelimb: • Hind Limbs: Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 15

Pelvis Lateral Comments/ Tips • Note superimposition • Magnification • Mental check list Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 16

Pelvis VD Frog Leg • Measure : • Central Ray: • Borders: Brown: Lavin’s

Pelvis VD Frog Leg Positioning • Place: • Head: • Forelimb: • Hind Limbs: Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 18

Pelvis Frog Leg Comments/ Tips Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014,

Penn. HIP ® • Joint laxity • Canine hip dysplasia (CHD) and osteoarthritis • Degenerative joint disease (DJD) • Breed comparison • 16 weeks of age (OFA -24 months) • Must be certified • Radiographs sent to University of Pennsylvania Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 20

Penn. HIP® 3 radiographs: 1. Standard VD hip extended view 2. Distraction view • Acrylic distractor rods • Lateralizes the femoral heads 3. Compression view • Medial pressure lateral to the greater trochanters Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 21

Penn. HIP ® Distraction View • Hips in neutral orientation—stance phase • • Ranges from 0 to 1 • • • Degree of displacement from the acetabulum = distraction index formula 0 = full congruency of hip joint 1= complete luxation Average DI varies by breed Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 22

Penn. HIP ® • OFA Rating of Good • Distraction Projection Brown: Lavin’s Radiography

Penn. HIP® • Compression view radiograph • Compression View • Measurement also taken Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 24

Femur Lateral (Mediolateral) • Measure : • Central Ray: • Borders: Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 25

Femur Lateral Positioning • Place: • Head • Forelimb • Hind Limbs Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 26

Femur Lateral Comments/Tips • • • Angle beam? Palpate joint Abduct affected limb 2 radiographs? Fluid bag Cathode Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 27

Femur Craniocaudal • Measure : • Central Ray: • Borders: Brown: Lavin’s Radiography for

Femur Craniocaudal • Positioning: • Place • Head • Forelimbs • Hind Limbs Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 29

Femur Craniocaudal • Comments/Tips: • Extend completely • Measure correctly Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 30

Femur Caudocranial Horizontal view • Measure : • Central ray: • Borders: • Positioning: • Place: • Head and forelimb: • Hind limbs: • Comments/Tips: Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 31

Stifle Lateral (Mediolateral) • Measure : • Central ray: • Borders: Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 32

Stifle Lateral Positioning • Place: • Head • Forelimb • Hind limbs Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 33

Stifle Lateral Comments/Tips Unaffected limb Affected limb • Femoral condyle • Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 34

Stifle Caudocranial • Measure : • Central ray: • Borders: Brown: Lavin’s Radiography for

Stifle Caudocranial • Positioning: • Place • Head • Forelimbs • Hind limbs Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 36

Stifle Caudocranial • Comments/Tips: • • Rest on patella and palpate Raise unaffected limb Angle tube head Horizontal beam Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 37

Patella Proximodistal • Positioning: • Place: • Head and Forelimb: • Hind limbs: • Comments/Tips: Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 38

Patella • Horizontal Beam • Radiograph—skyline view Brown: Lavin’s Radiography for Veterinary Technicians Copyright

Tibia/Fibula Lateral (Mediolateral) • Measure : • Central ray: • Borders: Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 40

Tibia/Fibula Lateral • Place: • Head • Forelimbs • Hind limbs Brown: Lavin’s Radiography

Tibia/Fibula Lateral • Comments/ Tips • Elevate tarsus Brown: Lavin’s Radiography for Veterinary Technicians

Tibia/Fibula Caudocranial • Measure: • Central ray: • Borders: Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 43

Tibia/Fibula Caudocranial • Positioning: • Place • Head • Forelimbs • Hind limbs Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 44

Tibia/Fibula Caudocranial • Comments/ Tips: • Rest on patella • Palpate • Raise unaffected limb • Horizontal beam Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 45

Bones of the Tarsal Skeleton Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014,

Tarsus/Metatarsus/Digits Lateral • Measure : • Central ray: • Borders: Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 47

Tarsus/ Metatarsus/ Digits Lateral • Place: • Head • Forelimbs • Hind Limbs Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 48

Tarsus/ Metatarsus/Digits Lateral Comments/Tips • Natural lateral view • For the digits: • Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 49

Tarsus/Flexed Lateral • Place: • Head • Forelimbs • Hind limbs Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 50

Tarsus Lateral • Natural Projection • Flexed Projection Brown: Lavin’s Radiography for Veterinary Technicians

Tarsus/Metatarsus/Digits Plantarodorsal • Measure : • Central ray: • Borders: Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 52

Tarsus/Metatarsus/Digits Plantarodorsal • Positioning: • Place: • Head • Forelimb: • Hind limbs: Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 53

Tarsus/Metatarsus Digits Dorsoplantar • Not routine • Less OFD Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 54

Tarsus/Metatarsus/Digits Oblique • Measure : • Central ray: • Borders: • Nomenclature: Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 55

Tarsus/Metatarsus/Digits Oblique • Positioning: • Place: • Head • Forelimb: • Hind limbs: Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 56

Key Points • Orthogonal views • Proximal limb: • Distal limb: • Center, measure, include, true symmetry • Place the label properly • Include the proper borders • Joints: • Long bones: Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 57

Mystery Radiograph • What has caused a density issue in this radiograph? Brown: Lavin’s Radiography for Veterinary Technicians Copyright © 2014, 2007, 2003, 1999, 1994 by Saunders, an imprint of Elsevier Inc. 58