Pelvic x-ray is an radiography examination that allows you to assess the condition of the iliac, pubic and sciatic bones, sacrum, coccyx and hip joints. In traumatology, it is carried out when a pelvic fracture and osteomyelitis are suspected, in gynecology it is used to identify a narrow obstetric pelvis. In other branches of medicine, it can be prescribed for developmental anomalies, neoplasms, inflammatory processes in the pelvic bones and some other pathologies. As planned, it is carried out after special training, no training is required during an emergency study.
Pelvic x-ray in traumatology is prescribed if osteomyelitis and fractures of the pelvic bones are suspected. In addition, this diagnostic procedure is performed for all patients with severe combined trauma. In gynecology, the technique allows to detect a narrow pelvis in women planning pregnancy. In other areas of medicine, the study is performed for inflammatory processes, benign and malignant tumors, malformations, other diseases and conditions that may be accompanied by pelvic bone damage.
Methodology of conducting
Pelvic x-ray begins with a large overview image, which shows all the pelvic bones, all the joints of the pelvic bones with each other and with neighboring bone formations. An overview radiograph of the pelvis shows two iliac, two sciatic and two pubic bones, the pubic and sacroiliac joints, sacrum, coccyx, hip joints and upper parts of the femurs. Overview radiography allows you to identify all injuries to the bones and joints of the pelvis as reliably as possible. There are also various types of pelvic sighting images that can be used to clarify the changes detected on the survey radiograph.
Pelvic x-ray for emergency indications is carried out without preparation. If pelvic scans are performed as planned, before the study, the patient is recommended to clean the intestines so that gas bubbles do not impair the reading of the images and do not complicate the diagnosis. During the study, the patient lies on his back with his legs straightened. The feet are somewhat turned outwards (in this position, the iliac bones are better viewed). After an overview image of the pelvis in traumatology, additional targeted radiographs of any department are often performed (for example, the pubic articulation, the wing of the ilium, etc.).
Immediately after the radiography, the radiologist begins to decipher and describe the images. To do this, he needs to evaluate the following qualitative and quantitative indicators:
- the size of the cervical-diaphyseal angle;
- the magnitude of the Viberg angle and the degree of change;
- the magnitude of the angle of the femoral neck (to detect antetorsion, incline);
- the value of the width of the sacroiliac joint;
- the value of the width of the gap between the bones of the hip joint.
The following additional pathological signs are also accepted for analysis:
- deformation of the femoral head;
- dislocations and subluxations of the hip joint;
- rotation of the fragments of the joint bones;
- displacement of the femur in width or length;
- expansion/contraction of the symphysis.
When deciphering, the radiologist does not make a specific diagnosis. He describes the pathological signs that are visualized in the pictures, and the attending physician already correlates them with other pronounced clinical signs and makes a conclusion about the presence of a particular disease.
Indicators of the norm
The X-ray image should show a symmetrical image of the two halves of the pelvis, sacrum, intervertebral openings of the sacrum, as well as branches of the pubic bones and sciatic. The substance of the bone should be clearly visible, the contours of the two acetabulums and the neck of the femurs should be visible.
There are certain indicators of the norm of the condition and structure of the hip joint, with which the actual data are compared when deciphering. For example, the angle of the Viberg should normally be located between the line of the center of the femoral head, the upper-outer edge of the acetabulum. The normal value of the angle is approximately 30 degrees. The angle of inclination of the entrance to the acetabulum also has a norm of 31-42 degrees. The cervical-diaphyseal angle should normally be from 115 to 140 degrees.
Pelvic x-ray and other organs, bones and joints, as shown by numerous studies, can have a negative impact on the human body. Although, of course, there are very few practical cases of detecting pathologies caused by X-rays. Nevertheless, there are several contraindications to the pelvic X-ray that need to be taken into account when prescribing this procedure:
- pregnancy (all trimesters);
- children under 15 years of age;
- the patient’s serious condition.
If the appointment of an X-ray is undesirable, doctors can choose another diagnostic technique, with the help of which it is also possible to assess the condition of the hip joint. For example, an MRI or CT scan.