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I want to go to catholic school but my mom cant afford it. I cant get a scholarship from the school - govbrasilcombr.gearhostpreview.com is a free library of templates based on best practices that enable you to create consistent, high-quality reports. There is wide consensus that the clinical report is an essential tool that radiologists provide to patients. The ideal report should be uniform, comprehensive, easily understood and readable to humans and machines alike. Mar 29, · Hips, two views of the right and left hip were obtained. Bony mineralization is normal. There is no acute fracture seen. There is no visible enthesopathy in the limited views of the pelvis. There is a little bit of superior sclerosis at the acetabula bilaterally. The hip joint spaces appear preserved. IMPRESSION: 1. Mild hip sclerosis. 2. Multiplanar multisequence magnetic resonance images of the right/left hip without contrast (or, after the intra-articular administration of gadolinium. Findings: The muscles and their tendinous insertions are intact. The ileofemoral and pubofemoral ligaments are unremarkable. The acetabular labrum is normal . Essay On Conflict Management
california medicaid managed care enrollment report - Essentially normal radiographs of the hip for reference. Hip MRI Knee MRI MRCP Shoulder MRI. Enter the category for this item: Nuclear Medicine. Gastric Emptying study GI Bleed study/ Tagged RBC scan HIDA scan Lymphoscintigraphy Parathyroid uptake scan PET CT- Whole Body Renal Mag 3/ Lasix scan Thyroid uptake scan Bone scan- Whole Body. Below you will find ACPM’s Standardized Radiology Report Template. The first two versions are blank while the third includes examples for each report category. Standardized Radiology Report (Word Document)Standardized Radiology Report (PDF)Example Radiology Report (Word Document) *This report format has been approved by the ACPM Podiatric Imaging Council. observe and report interview scene
samaikyandhra movement essay writer - The glans is normal. The meatus is orthotopic, patent, and clear. The testicles are descended bilaterally without masses or tenderness. The epididymis and cords are normal. The perineum is normal. GENITOURINARY: [Female]. External genitalia normal. Vagina and cervix without lesions or masses. Uterus is normal. Adnexa negative for masses or. The Atlas Plane line is --(normal is o) and the Whitehorn's (Axis) angle is --(normal is 0 o). The flexion view revealed in/adequate anterior sagittal translation of the spine with the -- segments moving as a unit and/or hypermobile translation at the C-- segment(s) was observed. Standard normal report for plain film pelvis. Read More» April 24, A foetal MRI normal template has been added. This is based upon an MRI template report created by the Cincinatti Children’s Hospital. New MRI Hip template. It needs to be refined somewhat and is a work in progress. Read More» October 11, No Comments. Template. Essay writing in ielts samples keywords - simpleclicks.de
Community Service Requirements Seen to Reduce Volunteering ... - Hip and groin ultrasound education showing how to, scanning protocol, normal anatomy, anatomic variants, labrum, trochanter, bursa, iliopsoas tendon and hernias. GooGhywoiutj0suw1. Please add firstname.lastname@example.org to GA account UA with “Manage Users and Edit” permissions - date Aug 10, record vital patient information on template (age, height, weight, etc) establish radiographic landmarks; establish limb length discrepancy; template acetabular component. do this first to determining center of rotation of new hip; template femoral component; Tips. best to achieve a good template with sizes in the middle range of the. Sample X-RAY Report. RADIOLOGY-ON-DEMAND® Absolute leader in providing radiology services via teleradiology. Request Service» CR OF THE CHEST TWO VIEWS» CR OF THE CERVICAL SPINE 2 OR 3 VIEWS» CR OF THE LEFT KNEE COMPLETE 4 OR MORE VIEWS» CR OF THE LUMBOSACRAL 2 OR 3 VIEWS. Sociology at Work | Facebook
For many companies, change is a - Box Sample Diagnostic Shoulder Ultrasound Report: Normal, Complete Examination: Ultrasound of the Shoulder Date of Study: March 11, Patient Name: Juan Atkins Registration Number: History: Shoulder pain, evaluate for rotator cuff abnormality Findings: No evidence of joint effusion. The biceps brachii long head tendon is normal without tendinosis, tear, tenosynovitis, or. DATE OF PROCEDURE: MM/DD/YYYY PREOPERATIVE DIAGNOSIS: Left hip osteoarthritis. POSTOPERATIVE DIAGNOSIS: Left hip osteoarthritis. PROCEDURE PERFORMED: Left total hip arthroplasty using Stryker implants. SURGEON: John Doe, MD BLOOD LOSS: mL. ANESTHESIA: Epidural and general. IMPLANTS: Stryker Trident PSL HA acetabular shell, size 52 mm, with a 0 . Review sample diagnostic radiology reports from NationalRad's subspecialty radiologists, including MRI, CT, arthrogram, cartigram, musculoskeletal ultrasound and PET-CT. email@example.com Client Login (for Practices) Second Opinions (for Patients). Bookkeeper Cover Letter Sample Perfect
Custom Built Desk Cover Shot Desk - Looking for sample copies of medical imaging reports? Visit Diagnostic X-Ray Consultations Services online & view compiled reports by diagnostic imaging expert Dr. Gary Longmuir! Hip X-ray anatomy - Normal AP. Hover on/off image to show/hide findings. Tap on/off image to show/hide findings. Click image to align with top of page. Hip X-ray anatomy - Normal AP. Shenton's line is formed by the medial edge of the femoral neck and the inferior edge of the superior pubic ramus. OVERVIEW In diagnostic radiology the generation of formal radiology reports are done for each radiological study. It is important to have perspective on what a X-RAY STUIDES (UNREMARKABLE TEMPLATES) The following are templates that can be used for “normal” or unremarkable X-ray studies: Chest X-ray Lumbar spine X-ray Shoulder X-ray Elbow X-ray Wrist X-ray Hand. What are the common mistakes that candidates make before/during Preliminary Exam of CSE-UPSC? How to
beneficial loyalty and referral programs regular bonuses - Jan 02, · BONE DENSITY EVALUATION REPORT SAMPLE #3. DEXA BONE DENSITY SCAN: A DEXA scan was performed on the left hip and AP of the lumbar spine. There is no DEXA scan for comparison. Total BMD of the left hip is gm/cm2, the T-score representing 89% of normal compared to young adults. Sample Report MRI. RADIOLOGY-ON-DEMAND® Absolute leader in providing radiology services via teleradiology. Request Service» MRI Brain without contrast . The centering of the x-ray beam is one of the most important factors influencing the anatomy of the hip on plain radiographs .On a standard anteroposterior (AP) pelvic radiograph, the central beam is directed to the midpoint between the upper border of the symphysis and a line connecting both anterior superior iliac spines (Fig. 4).By lowering the center of the x-ray beam (low-centered AP. poultry farming in india project report
nihahi ridge trail report gaylord - demonstrated on x-ray examination.5 The hip joint has the second largest range of motion of any joint in the body. Its range of motion includes flexion, extension, abduction, adduction, internal and external rotation.5 Types of hip replacements There are two general types of hip replacements, Hemiarthroplasty and Total Hip Arthroplasty (THA). Examples of Radiology Reports Type of Report Radiology Report Acute fracture Clinical History: The rest of radius and ulna are normal. Fracture negation Procedure: KNEE 3 VIEWS Clinical History: S/p fall from ladder with right hip fracture. Since then also with right knee swelling and knee that “gives out”. Prior films showed effusion. Ultrasound templates: DIAGNOSTIC ULTRASOUND templates. Diagnostic ultrasound: US7 protocol. Diagnostic ultrasound - 2D, gray scale B mode complete ultrasound with CPD @ kHz of the right hand (using a Machine type, probe type) with evaluation of the muscles, bones, joints, tendons and related soft tissue structures. US7 protocol performed of the PIP2, PIP3, MCP2, MCP3, wrists, MTP2 . custom essay for sale
do my homework now pierrepont - May 17, · (3–5,7) The hip is scanned in the coronal plane, and the bony (α) and cartilaginous (β) roof angles are measured. The critical measurement is the cartilaginous (α) angle and is the basis for classifying the degree of dysplasia. (3) (Table ) Dynamic hip ultrasound may show no movement, slight movement, true subluxation, and frank. Guidelines for report writing An ultrasound report may be defined as the recording and interpretation of observations from an ultrasound examination. These include other imaging modalities such as a plain X-ray, CT, MRI or invasive procedures. (Right hip angle is x degrees, Left hip . a patient, implant templating on the patient’s X-ray image should be implemented. Fig 6: Digital X-ray. Hip Implant Template The template refers to standard guidelines used in shaping the frame of the bones. Orthopedic specialists will use this template to match the X . Reflection in Business Research Dissertation
Essays on Short Essay On Disaster - Sample Radiology Reports Provided To Referring Physicians By Teleradiology From National Diagnostic Imaging. CT Sinus Without Contrast Radiology Report; CTA Chest W WO Contrast Radiology Report; Chest X-Ray Radiology Report; Magnetic Resonance Imaging Left Shoulder Radiology Report; Magnetic Resonance Imaging of Right Shoulder Radiology Report. ABDOMEN: Soft and nontender with normal bowel sounds. NEUROLOGIC: Cranial nerves II through XII are intact. EXTREMITIES: Standing alignment with minimal right-sided valgus deformity, knee with slight flexion contracture. The patient walks with moderate antalgic gait. Range of motion 3 to 90 degrees. X-Ray in Adult Age. In the adult hip there are important landmarks to be recognized on plain film radiographs (Figure 5): (A) Iliopectineal or iliopubic line is formed by the arcuate line of the ilium and the superior border of the superior pubic ramus up to the pubic symphysis. It conforms to the inner margin of the pelvic ring and it is part of the anterior column of the acetabulum. Power Issues And Case Analysis
What Do Ethnicity means - The diagram shows a practical approach to hip pain and a new limp. Click on the image to enlarge. It is important to realize that early in the course of Perthes disease, juvenile idiopathic arthritis, osteomyelitis and septic arthritis, the initial radiographs may be normal. Aug 23, · An AP view of the pelvis The standard distance from the x-ray tube to the table top is 40 inches. Template X-rays are % magnified. If a grid cassette is placed directly beneath the hip, magnification of the bones of approximately 10% is seen in an average-size patient, but in most radiology departments a x-ray tray is placed in a compartment. Apr 01, · Reports were graded according to two criteria: (a) whether the report used the standard report format (maintained standard report headers and structure) and (b) if it was a normal report, whether the radiologist used the standard normal template language (as opposed to routinely adding or deleting language from the standard report for a normal. Genetic Engineering: Career of the Future
history of usa newspapers - X-ray. Loading images Frontal Normal pelvic series. 6 article feature images from this case. Lower limb radiography; Pelvis series; Hip (horizontal beam lateral view) Pelvis (outlet view) Pelvis (inlet view) Air gap technique (general radiography) 9 public playlist includes this case. Sample - Normal Normal appearances of the rotator cuff tendons. No evidence of tears or calcification or any bursal thickening or effusions. The long head of biceps tendon is intact and in situ. No evidence of a gleno-humeral joint effusion. Unremarkable ACJ noted. If appropriate, the report . 1/3 Name: SMITH, Anon Date of Study: 10/07/ Date of Report: 10/07/ D.O.B. 22/05/ Referred By: Dr T. Jones Clinic: CBD Chiropractic Clinical Details: Chronic history of neck and back pain X-Ray Report Cervical Spine AP and lateral cervical spine views provided. Complete loss of the normal . articles global warming zanzibar
Who Is The Worst Person You Know? Lets Name Names - MRI Transcription Sample Report #8. MRI SCAN OF THE CERVICAL SPINE: DATE OF STUDY: MM/DD/YYYY. CLINICAL HISTORY: Degenerative changes. Multiple contiguous axial and sagittal images were obtained through the cervical spine prior to and following contrast administration. Sagittal images indicate normal craniocervical junction level. PRACTICE PARAMETER 4 Dysplasia of the Hip Ultrasound Figure 1–govbrasilcombr.gearhostpreview.coml view: US transducer is placed parallel to the lateral aspect of the baby’s hip Figure 1-b. Coronal ultrasound image B. Transverse Flexion View The examination is performed with the hip flexed at 90 degrees. This MRI hip joint axial cross sectional anatomy tool is absolutely free to use. Use the mouse scroll wheel to move the images up and down alternatively use the tiny arrows (>>) on both side of the image to move the images.>>) on both side of the image to move the images. observe and report interview scene
The Characters of John and Robby in Our Time by John Edgar Wideman - MRI Radiology Reports. Sample Radiology Reports – High Quality, Decisive, Conclusive. View our sample radiology reports to see the high quality and detailed . May 26, · Foreword. Hip complaints in adults are often related to pain, such as arthritis or bursitis. In children however, it can occur in a well child for issues such as irritable hip, or in more serious conditions, such as Perthes disease or slipped upper femoral govbrasilcombr.gearhostpreview.com pain can also be referred pain from another joint, most commonly knee and spine. Aug 29, · Sample Radiology Reports The following are samples of reports for various modalities and anatomical structures: MRI Brain With and Without Contrast MRI Lumbar Spine Without Contrast MRI Brain With and Without Contrast MRI Right Shoulder MRI Right Wrist Without Contrast MRA Neck With and Without Contrast CT Chest With Contrast CT Brain With and Without. Economic Recession 2016
Grow Trees, Plant Trees, Gift a tree - Find hip xray stock images in HD and millions of other royalty-free stock photos, illustrations and vectors in the Shutterstock collection. Thousands of new, high-quality pictures added every day. X-rays of hip dysplasia are one of the two main methods of medical imaging to diagnose hip dysplasia, the other one being medical ultrasonography.. Ultrasound imaging yields better results defining the anatomy until the cartilage is govbrasilcombr.gearhostpreview.com the infant is around 3 months old a clear roentgenographic image can be achieved. assignment management accounting magazine
Therefore, distortion of the anatomy is normal hip x-ray report template. Typically, the more anterior an object is located to the x-ray source anterior rim in bluethe more lateral it is projected. With increasing film-tube distance, the apparent acetabular anteversion increases. In contrast, with decreasing film-tube distance, the anteversion decreases and the acetabulum may appear retroverted Fig. The patient-film distance usually remains From Playwright to President: Vaclav Havel for an individual patient. Interindividual differences exist in patient-film distance. But normal hip x-ray report template in very obese patients, the distance between hip joints and the table shows minor variation since the increased body volume mainly affects the anterior part of the body Fig.
On a standard anteroposterior AP pelvic radiograph, the normal hip x-ray report template beam is normal hip x-ray report template to the midpoint between the upper border of the symphysis and a line connecting both anterior superior iliac spines Fig. By lowering the center of the x-ray beam low-centered AP pelvic radiograph normal hip x-ray report template, the normal hip x-ray report template acetabular normal hip x-ray report template increases Fig. The acetabular anteversion also increases by moving the central beam from the report rai 3 del 28 ottobre 2013 of the pelvis to the center of the hip Fig.
Since the radiographic parameters to describe the normal hip x-ray report template of the hip have been defined on pelvis-centered radiographs, it is not recommended to use low-centered or hip-centered radiographs for joint-preserving surgery. A the purps grow report on sour true lateral view can be performed to normal hip x-ray report template pelvic tilt. When normal hip x-ray report template the normal hip x-ray report template of the x-ray from a the center normal hip x-ray report template the pelvis to the b center of the hip, the acetabulum becomes more anteverted indicated by a more distant course of the anterior AW and posterior acetabular wall PW.
In addition, the acetabulum appears deeper with a positive coxa profunda sign [acetabular fossa AF crossing the ilioischial line I ] Standard pelvic radiographs are performed with an AP direction of the x-ray beam. In contrast, chest radiographs are performed with a posteroanterior direction of the x-ray beam. Objects closer to the source of the x-rays e. Since the hip normal hip x-ray report template located in the middle of the pelvis, the direction of the x-ray beam has a minor effect on the projected anatomy on the plain radiograph.
Pelvic Orientation The spatial orientation of the pelvis during radiograph acquisition can vary considerably normal hip x-ray report template directly affects the projected morphology of the hip on the radiograph Fig. The orientation of normal hip x-ray report template pelvis can vary in three dimensions: obliqueness, rotation, and tilt. While variations in pelvic obliqueness normal hip x-ray report template rotation can be decreased by a standardized acquisition technique, pelvic tilt can vary substantially. Pelvic tilt mainly affects the normal hip x-ray report template anteversion of the acetabulum Normal hip x-ray report template.
Both acetabula are anteverted. Pelvic tilt during radiograph acquisition is estimated by the vertical distance between sacrococcygeal joint and symphysis distance a. Pelvic rotation is estimated by the horizontal distance b. Ideally, the distance b is 0 cm An error due to pelvic obliqueness can simply be corrected by measuring the radiographic parameters according to an anatomical horizontal reference, e. Pelvic rotation can be determined by the horizontal distance between the center of the sacrococcygeal joint and the center of the symphysis Fig.
Ideally, these anatomical landmarks are in line Fig. Rotation to the right left side results in decreased increased acetabular anteversion on the right left side Fig. Pelvic tilt can be estimated by the vertical distance between the sacrococcygeal joint and the upper border of the symphysis Normal hip x-ray report template. In average this vertical distance is 47 mm in men and 32 mm normal hip x-ray report template women [ 3 ].
However, to accurately determine pelvic tilt, a onetime true lateral pelvic view is needed [ 3 ]. With normal hip x-ray report template pelvic tilt, the apparent acetabular anteversion decreases and vice versa Fig. Fluoroscopy Fluoroscopy differs in terms of acquisition technique compared to a regular AP pelvic view Fig. These differences have assignment satisfaction key jeep ecodiesel be respected when interpreting fluoroscopic images.
First, in fluoroscopy the x-ray beam is in posteroanterior direction instead Attica State Prison Uprising in the September 13, 1971 and the Death of George Jackson a Political P AP direction in a standard pelvic view. Next, the central beam is centered over the hip, and not the pelvis. Additionally, the tube-intensifier distance is decreased. This results in a more anteverted-appearing acetabulum on fluoroscopic images putting coursework on resume to regular pelvic radiographs Fig.
This results in a more anteverted acetabular orientation. On the fluoroscopic image, the anterior and posterior acetabular walls do not cross, whereas on the b regular anteroposterior pelvis Synthwave TV - Retro Future Fest has teamed up with, there is a cranial crossover sign arrow Radiographic Projections of the Hip The normal hip x-ray report template radiographic evaluation of the normal hip x-ray report template includes two projections: the AP pelvic view and an axial view of the hip.
In total hip arthroplasty, a deep-centered pelvic view or hip-centered view has been used. Due to the different centering of the x-ray beam in these views, the projected anatomy of the hip is significantly altered, and therefore, these views are not recommended in hip-preserving surgery. Different techniques have been described for the axial view of the normal hip x-ray report template including the axial cross-table, Dunn-Rippstein, Lauenstein, or frog-leg lateral views. In addition to Example Of Resume Job Application AP and axial view of the hip, additional projections exist which are performed to answer specific questions, e.
It gives a good visualization of the overall morphology of the pelvis and the proximal femur. It allows a comparison of the morphology of the symptomatic hip to the contralateral side. An AP pelvis view can be performed supine or standing. We favor pelvis radiographs performed in supine normal hip x-ray report template because they can directly be compared to pelvic radiographs performed intraoperatively or at follow-up during early rehabilitation and restricted weight bearing.
The film-focus distance is cm. The central beam is centered normal hip x-ray report template the midpoint between the upper normal hip x-ray report template of the symphysis and a line connecting the two anterior superior iliac spines. Due to different centering of the x-ray beam and its effect on the projected anatomy of the hip, low-centered pelvis views are not recommended for hip-preserving surgery Fig. Hip-centered views are mainly performed for total hip arthroplasty. The different centering of the x-ray results in an altered normal hip x-ray report template of the hip, normal hip x-ray report template therefore, this view is not recommended for hip-preserving surgery Fig.
On hip-centered radiographs, it is impossible to define the anatomical horizontal reference because of the normal hip x-ray report template contralateral landmark e. This makes the measurement of anatomical referenced cup inclination on hip-centered radiographs impossible. In addition to an AP pelvis view, a hip-centered normal hip x-ray report template can be used to differentiate whether a observe and report interview scene is anteverted or retroverted.
While anteversion increases for an anteverted cup on a hip-centered normal hip x-ray report template Fig. Axial Cross-Table View The axial cross-table view What Makes a Murderer? evaluating the anterior and posterior contour of the normal hip x-ray report template head-neck junction Fig. The contralateral hip is flexed and the leg elevated Fig. This hip view was originally introduced to measure exact femoral antetorsion [ 56 ]. However, compared to CT-based measurements, this method is not free of error due to patient malpositioning [ 7 ].
The Dunn-Rippstein view can be used as an alternative to the axial cross-table view to evaluate the anterior and posterior contour of Guangzhou South Railway Station Map femoral head-neck junction. Femoral head-neck asphericities in hips with FAI are most often localized in the anterosuperior region [ 8 ]. Lauenstein and Frog-Leg Lateral View Both the Lauenstein [ 10 ] and frog-leg lateral views are performed with the normal hip x-ray report template supine Table 1.
The Lauenstein view is performed with the College Entrance Essay Writing Service: Custom writing website and knee flexed and normal hip x-ray report template hip in abduction. The central beam is centered to the hip. If abduction of the hip is impaired, the pelvis can be tilted to the ipsilateral side. The frog-leg lateral view is taken with both hips and knee flexed and the leg abducted so the soles of the feet contact. Both youtube pharrell happy worldwide compilation report are used as an alternative to the axial cross-table normal hip x-ray report template to evaluate the anterior and posterior contour of the femoral head-neck junction.
The ipsilateral hip touches the radiographic table Fig. The axis of the ipsilateral foot remains parallel to the film. The false profile view is performed to evaluate normal hip x-ray report template anterior acetabular coverage or anterosuperior subluxation of the femoral head which is of particular interest The Women in the Novel, Sister Kate by Jean Bedford dysplastic hips Fig. In addition, the false profile view allows to quantify the posteroinferior joint space Fig.
In addition, the false profile view allows to judge the posteroinferior joint space. Typically, dysplastic hips have a subluxation of the normal hip x-ray report template head with an irregular joint space and widening of the posteroinferior joint space arrow True Lateral Pelvis View A normal hip x-ray report template lateral pelvis radiograph can be performed to assess the pelvic tilt Table 1. This view is acquired in the supine position and in addition to an AP pelvis view Fig. The pelvic tilt angle is constructed as the angle between a horizontal line and a line connecting the upper border of the symphysis and the sacral promontory Fig.
A linear correlation exists between the tilt angle Fig. Therefore, a true lateral view is only performed once for an individual patient. Exact tilt can be calculated from any other AP pelvis view using the linear correlation and the onetime determination of pelvic tilt on the true lateral view [ 3 ]. Plain Radiographic Evaluation of the Hip. Film-Tube Distance The film-tube distance affects the anatomy of the hip on the radiograph, e. Patient-Film Distance The patient-film distance has only a minor influence on the transformation of the hip on the radiograph [ 1 ].
Centering and Direction of the X-Ray Beam The centering of the x-ray beam is one of the most important factors influencing the anatomy of the hip A Comparison of African Americans and Caucasian Americans plain radiographs [ 1 ]. In addition, the acetabulum appears deeper with a positive coxa profunda sign [acetabular fossa AF crossing the ilioischial line How To Make A Resume For First Job Example | The Blog Network ]. Standard pelvic radiographs are performed with an AP direction of the x-ray beam. Ideally, the distance b is 0 cm. An error due to pelvic obliqueness can simply be corrected by measuring the radiographic parameters according to an anatomical horizontal reference, e.
On the fluoroscopic image, the anterior and posterior acetabular walls do not cross, whereas on the b regular anteroposterior pelvis radiograph, there is a cranial crossover sign arrow. Radiographic Projections of normal hip x-ray report template Hip The standard Free Tamil Kamakathaikal in Tamil evaluation of the hip includes two projections: the AP pelvic view and an axial view of the hip.
Table 1 Radiographic projections of the hip. Basic radiographic evaluation of the hip for hip-preserving surgery, total hip arthroplasty, or trauma surgery. Performed in total hip arthroplasty; not recommended for normal hip x-ray report template surgery due to different x-ray centering and altered morphology of the hip. Increased sensitivity to 1000 Images Art Paper Quilled cam deformities in the anterosuperior head-neck area. Patient supine, hip centered x-ray beam, hip and knee flexed, and hip in abduction. Patient supine, pelvis-centered x-ray beam, both hips and knee flexed, and the leg abducted so the soles normal hip x-ray report template the feet contact.
Anterior acetabular coverage, anterosuperior subluxation, quantification of posteroinferior joint space. Pelvic inclination; concomitantly performed with AP pelvis view to correlate pelvic inclination with vertical distance from symphysis to sacrococcygeal joint on AP pelvis view. Patient positioning and centering of x-ray for AP pelvis view; additional abduction or adduction of the hip, possible combination of abduction, internal rotation and flexion.