Hip (lateral view)

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The lateral hip view is a radiographic projection assessing the relationship of the femoral head to the acetabulum.

Indications

This view assesses the hip joint for any potential fractures, dislocations, bone lesions or degenerative diseases (i.e. suspected osteoarthritis of the hip) in an orthogonal plane to the AP projection. As this particular projection involves rolling the patient onto the side of interest, it is hence not suitable for trauma situations.

For trauma imaging of the hip, see: horizontal beam lateral.

Patient position

  • the patient is rolled at least 45° onto the side of interest with a hip flexion of 90° 
  • the unaffected leg is bent to stabilize the patient position i.e. foot firm on the bed to ensure stability 

Technical factors

  • lateral projection
  • centering point
    • the midpoint between the anterior superior iliac spine (ASIS) and pubic symphysis
  • collimation
    • anterior-posterior to include borders of the femur 
    • superiorly to include acetabulum
    • inferior to include the proximal third of the femur
  • orientation
    • landscape
  • detector size
    • 24 x 30 cm
  • exposure
    • 70-80 kVp
    • 10-18 mAs
  • SID
    • 100 cm
  • grid
    • yes

Image technical evaluation

  • the bony pelvis is imaged from ASIS to the proximal shaft of the femur
  • the obturator foramina are closed due to superimposition of the pubic rami
  • greater and lesser trochanter of the proximal femur is in profile
  • proximal one-third of the femur is visible
  • there will be some foreshortening of the femoral neck due to superimposition

Practical points

  • the lateral hip projection often referred to as the rolled lateral, can be technically challenging on larger patients
    • ensure you are centered around the mid groin region if bony landmarks are difficult to appreciate
    • by understanding your lower limb anatomy and palpating for the distal femur (if possible), you can then align the long axis of your collimation parallel to where the proximal femur should lie
  • this is not an ideal projection to assess for suspected fractures due to requiring patient movement and the femoral head becoming foreshortened