From the Guidelines
X-ray imaging, specifically an anteroposterior (AP) view of the pelvis, is the best initial diagnostic tool for evaluating the pelvis. This approach is recommended because it allows for the detection of fractures, dislocations, arthritis, and bony abnormalities, while also enabling comparison of potential abnormalities to the contralateral asymptomatic side 1. According to the American College of Radiology, an AP view of the pelvis along with orthogonal views of the symptomatic hip is the standard approach for evaluating suspected proximal femur fracture, as patients with this condition often have fractures of the pelvis, including the sacrum and pubic rami 1.
Some key points to consider when using X-ray imaging for pelvic evaluation include:
- The importance of additional views, such as lateral, inlet, and outlet views, for comprehensive assessment
- The value of X-rays in trauma situations for quickly identifying fractures or dislocations
- The usefulness of X-rays in evaluating arthritis progression, bone tumors, or congenital abnormalities
- The preference for X-rays as the first-line imaging modality due to their availability, cost-effectiveness, quick performance, and relatively low radiation exposure compared to CT scans 1.
It is essential to note that while CT scans and MRIs offer more detailed imaging and better visualization of soft tissues, X-rays remain the appropriate starting point for most pelvic evaluations before considering these more advanced imaging techniques. Additionally, pelvis radiographs share the same limitations in sensitivity and specificity for fracture detection as hip radiographs, and a negative radiograph alone cannot exclude fracture 1.
From the Research
Imaging Modalities for Pelvis Evaluation
- The best imaging modality for evaluating the pelvis is not explicitly stated as X-ray in the provided studies, however, other imaging modalities such as Computed Tomography (CT) and Ultrasound are discussed in the context of pelvic evaluation 2, 3.
- CT is considered essential in the diagnostic evaluation of the female pelvic area, allowing for accurate delineation of neoplastic and inflammatory processes, as well as guiding percutaneous needle biopsy and aspiration/drainage of fluid collections 2.
- Ultrasound is considered the most appropriate first imaging test for suspected gynecologic pathology, but CT may be used as a first imaging test in certain situations, such as in acute care facilities or emergency departments 3.
Comparison of Imaging Modalities
- A study comparing X-ray imaging and CT scans in the evaluation of knee trauma found that X-ray imaging has low sensitivity in identifying knee fractures, and CT scanning should be performed in patients whose fracture type and characteristics cannot be determined exactly with X-ray imaging 4.
- Another study discussed the use of Cone Beam Computed Tomography (CBCT) in musculoskeletal disorders, highlighting its potential as a complementary imaging technique to other modalities such as conventional radiography, Multidetector Computed Tomography, and Magnetic Resonance Imaging 5.
Pelvic Evaluation with CT
- CT allows for accurate delineation of neoplastic and inflammatory processes in the female pelvic area, and provides an effective means of guiding percutaneous needle biopsy and aspiration/drainage of fluid collections 2.
- In pregnant women, pelvimetry and excretory urography can be performed using the CT scout view with a significantly lower radiation dose than conventional X-ray techniques 2.