WO2010094143A1 - Device for positioning a patient with regard to an x-ray device - Google Patents

Device for positioning a patient with regard to an x-ray device Download PDF

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Publication number
WO2010094143A1
WO2010094143A1 PCT/CH2009/000065 CH2009000065W WO2010094143A1 WO 2010094143 A1 WO2010094143 A1 WO 2010094143A1 CH 2009000065 W CH2009000065 W CH 2009000065W WO 2010094143 A1 WO2010094143 A1 WO 2010094143A1
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WO
WIPO (PCT)
Prior art keywords
patient
arm
ray
reference plate
positioning
Prior art date
Application number
PCT/CH2009/000065
Other languages
French (fr)
Inventor
Volker Braunstein
Christoph Martin Sprecher
Dieter Wahl
Ernst Wiedemann
Original Assignee
Ao Technology Ag
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Publication date
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Priority to PCT/CH2009/000065 priority Critical patent/WO2010094143A1/en
Publication of WO2010094143A1 publication Critical patent/WO2010094143A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/04—Positioning of patients; Tiltable beds or the like

Definitions

  • the invention relates to a device for positioning a patient with respect to the radiation beam of an X-ray device according to the concept of claim 1 , to a method for positioning a patient for true anterior posterior shoulder-joint X-rays according to the concept of claim 18, to the use of the device for positioning a patient in order to perform true anterior posterior shoulder-joint X-rays according to the concept of claim 23 and to the use of the device for positioning a patient according to the X-ray techniques of LAUENSTEIN according to the concept of claim 24.
  • Radiographic studies of fractured bones and fracture dislocations or examination of bone joints requires X-ray images of high interpretability.
  • an overlapping of the parts of a bone joint can result in a significant loss of interpretability of the bone portions of interest.
  • the patient is visually positioned by turning its body about 45° towards the film. This often results in an overlapping of the humeral head and the glenoid such causing a limited interpretability of the X-ray image.
  • the variance of the ante- respectively retroversion of the glenoid orientation is between about -10° to +10°, resulting in a net variance of 20°.
  • true anterior-posterior shoulder X-rays is the "true" or Grashey anterior-posterior view which differs from the standard anterior- posterior view in that the patient is rotated posteriorly approximately 45° so that the plane of the scapula rather than the frontal plane parallels the X-ray film cassette.
  • the goal of this projection is to visualize the joint space without any overlapping of the humeral head and the glenoid.
  • the visible part of the glenoid articular surface should be as small as possible.
  • the anterior and the posterior glenoid rims are exactly superimposed and therefore appear as just one single line.
  • the invention is based on the objective of providing a device facilitating a positioning of a desired portion of a patient's body with respect to the central ray of the radiation beam of an X-ray device.
  • the invention solves the posed problem with a device for positioning a patient with respect to the radiation beam of an X-ray device that displays the features of claim 1 , with a method for positioning a patient for true anterior posterior shoulder-joint X-rays according to the concept of claim 18, the use of the device for positioning a patient in order to perform true anterior posterior shoulder-joint X-rays according to the concept of claim 23 and the use of the device for positioning a patient according to the X-ray techniques of LAUENSTEIN according to the concept of claim 24.
  • the position of the patient with respect to the X-ray images can be exactly reproduced such allowing to study the course of a disease, the consequences of an injury or the position of an implant, i.e. the patient is always equally positioned with the result that the same view of the bone or the joint is achieved for the various X-ray images.
  • the device according to the invention is particularly useful in case of an application for X-rays of the shoulder joint or for the X-ray techniques of the hip-joint according to Lauenstein.
  • Particular advantages of the device and the method according to the invention in their application for X-rays of the shoulder joint are:
  • the anterior tip of the coracoid and the posterolateral angle of the acromion are two anatomical landmarks easy to identify on every body surface (even in case of skinny or diverent patients);
  • fuller axis the line between the anterior tip of the coracoid and the posterolateral angle of the acromion (fulcrum axis) is closely related to the plane of the glenoid. It has been found that the axis between the anterior tip of the coracoid and the posterolateral acromion angle (fulcrum axis) is approximately in parallel to the glenoid joint plane. Hence, the positioning of patients according to the fulcrum axis allows for improved quality of true anterior-posterior shoulder X-rays;
  • the deviation between the fulcrum axis and the plane of the glenoid fossa has been found to be just 1.8°. Therefore, the fulcrum axis and the plane of the glenoid fossa are almost in parallel and true anterior-posterior X-rays projected along this axis allows for significantly improved quality of the X-ray images.
  • the X-ray images used for the different above X-ray techniques can be obtained by using an X-ray plate, an X-ray cassette with an X-ray film or an X-ray detector which allows to transfer the acquired image, e.g. as a set of binary data to a computer.
  • said arm comprises at least one hinge with a single articulation axis which is orthogonal to said single plane.
  • This particular configuration allows the advantage of a simple configuration of the arm with at least two arm segments connected by one hinge.
  • the bendability of said arm is realised by said at least one hinge allowing a defined bendability of the arm.
  • said at least one hinge is self-locking such resulting in the advantage that the arm can easily be mounted to a portion of a patient's body without loosing its bended shape.
  • said arm comprises fewer than eight arm segments wherein any two arm segments are connected by one hinge.
  • a typical configuration is an arm with five arm segments.
  • said arm has a free first end and a second end which is fixed to said reference plate in such manner that said single plane is orthogonal to said front side of said reference plate.
  • said front side of said reference plate has a planar area A.
  • the clinical advantage is achievable that the patient with the attached reference plate can by precisely aligned to a plane cover surface of an X-ray cassette, plate or an X-ray detector by means of a surface contact of two planar surfaces.
  • said arm and said reference plate are made of a radiolucent material.
  • the arm and the reference plate can be made of a carbon fiber reinforced plastic, preferably a carbon fiber reinforced polyetheretherketone (PEEK) with the particular advantage of a light weight construction with high stability and stiffness and which is easy to clean.
  • PEEK polyetheretherketone
  • said arm is made of an optically non-transparent material.
  • the optically non-transparent arm allows to clearly position the arm along a reference line which is marked on the skin of a patient's body.
  • said reference plate is made of an optically transparent material. This configuration allows the advantage that the optically transparent reference plate allows to visually position the arm with respect to anatomical landmarks marked on the skin of a patient's body which are covered by the reference plate when attached to the patient's body.
  • said reference means define a straight reference line arranged parallel to said front side and within said area A.
  • the straight reference line can be realised by e.g. three linearly arranged dots.
  • the reference means are preferably arranged at the periphery of said reference plate such not interfering with the area to be examined in the X-ray image.
  • the reference means can comprise two reference lines which are orthogonal to each other and are located each at a periphery of said reference plate.
  • said reference means are realised by one or more three- dimensional, preferably cylindrical markers. This configuration allows to detect angles of the reference plate with respect to the central ray of the X-ray beam which might inadvertently occur.
  • said arm has a free first end and a second end which is linked to said reference plate by means of a releasably lockable joint.
  • the arm can such be pivoted and used as a reference for positioning a patient's limb.
  • said joint has a single rotational axis orthogonal to said front side of said reference plate.
  • said joint is provided with a protractor with a scale ranging from -90° to +90°.
  • the device can be used for an X-ray application at the hip joint according to Lauenstein.
  • said joint comprises snap-in means allowing to releasably secure said arm at a defined angle of rotation about said rotational axis.
  • said snap-in means allow to releasably secure said arm at angles of rotation about said rotational axis of -20°, -45°, +45° and +20°.
  • This configuration allows the advantage of an easy alignment of the arm, e.g. to a desired abduction angle for the leg according to the X-ray technique of Lauenstein.
  • at least one hinge comprises a snap-in device for releasably locking the two adjacent arm segments at an angle of 180° between each other. Such configuration results in the advantage that said arm segments can be brought in a releasably fixed position in such manner that said arm is linear.
  • said reference plate has an oblong shape.
  • the reference plate can have an oval or rectangular shape and can be connected to the arm with its longer axis parallel or orthogonal to said single plane defined by said arm.
  • Such a patient with the reference plate attached can be moved and brought in position at the stationary X-ray cassette, plate or X-ray detector of the X-ray device.
  • said front side of said reference plate having a planar area A is used and the patient is positioned in such manner that said planar area A contacts the X-ray cassette, plate or X-ray detector of an X-ray device.
  • the patient with the reference plate including an X-ray cassette or X- ray detector attached is brought in position with respect to the stationary X-ray source.
  • Fig. 1 illustrates a perspective view of an embodiment of the device according to the invention
  • Fig. 2 illustrates a plan view onto the back side of the embodiment of fig. 1 ;
  • Fig. 3 illustrates a lateral view on the embodiment of fig. 1 ;
  • Fig. 4 illustrates a plan view onto the back side of another embodiment of device according to the invention.
  • Fig. 5 illustrates a lateral view on the embodiment of fig. 4.
  • an embodiment of the device 1 according to the invention which comprises a reference plate 2 with a back side 11 and a planar front side 12 with an area A and an arm 4 connected to said reference plate 2.
  • the arm 4 comprises four arm segments 8 whereof any two arm segments 8 are connected by one hinge 6.
  • the hinges 6 are self-locking, e.g. by means of frictional engagement of the hinge axes and the respective bearings.
  • the arm 4 has a free first end 15 and a second end 14 which is fixed to the back side 11 of said reference plate 2.
  • Each hinge 6 has a single articulation axis 7 whereby said hinges 6 are arranged in such manner that all articulation axes 7 are parallel.
  • the arm 4 is bendable in a single plane 5 only.
  • the arm 4 and the reference plate 2 are made of a radiolucent material whereby said arm 4 is made of a carbon fiber reinforced plastic.
  • the reference plate 2 has a rectangular shape with a long axis 30 and a short axis 31 whereby said arm 4 is attached to said reference plate 2 in such manner that the long axis 30 is orthogonal to said single plane 5.
  • said reference plate 2 is provided with a radiopaque reference means 20 which is realised by a reference line 21 orthogonal to said single plane 5 and arranged near the periphery of said reference plate 2.
  • Figs. 4 and 5 illustrate another embodiment of the device 1 according to the invention which is specially adapted to the X-ray techniques of LAUENSTEIN.
  • This embodiment of the device 1 differs from the device 1 of figs. 1 to 3 only therein that the second end 14 of the arm 4 is attached to the reference plate 2 by means of a releasably lockable pivot joint 25 with a single rotational axis 26 which is orthogonal to the front side 12 of said reference plate 2.
  • a protractor 27 having a scale indicating the angle ⁇ ranging from -90° to +90° with regard to a coordinate axis parallel or coinciding with said long axis 30 of said reference plate 2.
  • the pivot joint 25 is provided with a snap-in means as known in the art, e.g. a ratchet clutch or the like allowing to releasably secure said arm 4 at a defined angle of rotation about said rotational axis 26, e.g. at steps -20°, -45°, +20° and +45°.
  • said reference plate 2 is provided with a radiopaque reference means 20 which is realised by a cylindrical marker 22 arranged near one corner of said reference plate 2 with the cylinder axis orthogonal to said front side 12 of said reference plate 2.
  • the method for positioning a patient in order to perform true anterior posterior shoulder- joint X-rays essentially comprises the steps of: a) determining the anterior tip of the coracoid (processus coracoideus) and the posterolateral angle of the acromion (angulus posterlateralis acromii) as the at least two relevant anatomical landmarks at a patient; b) marking said determined anatomical landmarks; c) marking a reference line connecting said two anatomical landmarks on the skin of a patient's body; and d) positioning said arm 4 relative to said patient or positioning said patient relative to said arm 4 with said reference plate 2 located posteriorly of the patient's body until said arm 4 extends along said reference line.
  • the reference plate 2 the following options are possible:
  • a patient with the reference plate 2 attached is moved and brought in position at a stationary X-ray cassette or X-ray detector of the X-ray device such performing the further steps of:
  • a patient with the reference plate 2 including an X-ray cassette X-ray detector attached to the reference plate 2 is brought in position with respect to the stationary X- ray source such performing the further steps of:
  • the reference plate 2 of the device is fixed to a stationary X-ray cassette X-ray detector.
  • the patient is moved and positioned with respect to the reference plate 2 such performing the further steps of:
  • the angle of abduction is 45° in case of an X-ray image according to this technique.
  • the trochanter major is projected onto the femoral neck and the trochanter minor is represented interiorly terminal.
  • X-ray images according to LAUENSTEIN I are used for an examination of the femoral head.
  • the reference plate 2 of the device 1 is positioned between the patient's body and the examination table in such manner that:
  • the arm segments 8 of the arm 4 are aligned at an angle ⁇ of 180° relative to each other such that the snap-in means are locked in order to arrest the arm 4 in a linear position; b) the device 1 is aligned in such manner that the linear arm 4 with the pivot joint 25 arrested at an angle ⁇ of 0° is parallel to the patient's medial sagittal plane; c) the linear arm 4 is rotated about an angle ⁇ of - 45° (fig. 4) if a patient's leg on the right side is to be examined, respectively an angle ⁇ of + 45° if a patient's leg on the left side is to be examined; and d) the respective leg is aligned to the adjusted arm 4.
  • the leg is slightly abducted with an angle of abduction of maximum 20°. It is important the hip is not rotated together with the femur.
  • the X-ray technique according to LAUENSTEIN counts as a standard X-ray projection besides or additionally to an overview of the pelvis with an antero-posterior X-ray beam path.
  • a detailed summary of such standard X-ray projections is published in:

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Abstract

A device (1) for positioning a patient with respect to the radiation beam of an X-ray device comprising: A) a reference plate (2) with a back side (11), a front side (12) and radiopaque reference means (20); B) an arm (4) connected to said reference plate (2), wherein C) said arm (4) is bendable in a single plane (5) only.

Description

Device for positioning a patient with regard to an X-ray device
The invention relates to a device for positioning a patient with respect to the radiation beam of an X-ray device according to the concept of claim 1 , to a method for positioning a patient for true anterior posterior shoulder-joint X-rays according to the concept of claim 18, to the use of the device for positioning a patient in order to perform true anterior posterior shoulder-joint X-rays according to the concept of claim 23 and to the use of the device for positioning a patient according to the X-ray techniques of LAUENSTEIN according to the concept of claim 24.
Radiographic studies of fractured bones and fracture dislocations or examination of bone joints requires X-ray images of high interpretability. For example, an overlapping of the parts of a bone joint can result in a significant loss of interpretability of the bone portions of interest. So far, for so-called "true" anterior-posterior X-rays the patient is visually positioned by turning its body about 45° towards the film. This often results in an overlapping of the humeral head and the glenoid such causing a limited interpretability of the X-ray image. According to literature the variance of the ante- respectively retroversion of the glenoid orientation is between about -10° to +10°, resulting in a net variance of 20°.
The present state of the art regarding true anterior-posterior shoulder X-rays is the "true" or Grashey anterior-posterior view which differs from the standard anterior- posterior view in that the patient is rotated posteriorly approximately 45° so that the plane of the scapula rather than the frontal plane parallels the X-ray film cassette.
The goal of this projection is to visualize the joint space without any overlapping of the humeral head and the glenoid. Hence, the visible part of the glenoid articular surface should be as small as possible. Ideally, the anterior and the posterior glenoid rims are exactly superimposed and therefore appear as just one single line.
Despite correct positioning (approximately 45° posterior rotation) of the patient an undesired overlapping of the humeral head and the glenoid results in many cases. The lack of reliance on superficial anatomical landmarks that could give information about the orientation of the glenohumeral joint space while positioning the patient for a true anterior-posterior X-ray of the shoulder could account for the difficulty in obtaining consistently high quality radiographs.
The invention is based on the objective of providing a device facilitating a positioning of a desired portion of a patient's body with respect to the central ray of the radiation beam of an X-ray device.
The invention solves the posed problem with a device for positioning a patient with respect to the radiation beam of an X-ray device that displays the features of claim 1 , with a method for positioning a patient for true anterior posterior shoulder-joint X-rays according to the concept of claim 18, the use of the device for positioning a patient in order to perform true anterior posterior shoulder-joint X-rays according to the concept of claim 23 and the use of the device for positioning a patient according to the X-ray techniques of LAUENSTEIN according to the concept of claim 24.
The general advantages achieved by the invention are essentially to be seen in the fact that, thanks to the device according to the invention:
- exact positioning of the patient while performing any kind of X-rays of bones and joints is significantly facilitated;
- a hindering overlapping of bone structures in the X-ray image can be avoided such increasing the quality and interpretability of the particular X-ray image;
- a reduction of the average number of X-rays and consequently the patient's radiation exposure can be reduced;
- the position of the patient with respect to the X-ray images can be exactly reproduced such allowing to study the course of a disease, the consequences of an injury or the position of an implant, i.e. the patient is always equally positioned with the result that the same view of the bone or the joint is achieved for the various X-ray images.
The device according to the invention is particularly useful in case of an application for X-rays of the shoulder joint or for the X-ray techniques of the hip-joint according to Lauenstein. Particular advantages of the device and the method according to the invention in their application for X-rays of the shoulder joint are:
- a positioning of the patient such that the central ray of the radiation beam of the X-ray device coincides or is parallel to the glenoid joint plane is easily obtainable;
- the anterior tip of the coracoid and the posterolateral angle of the acromion are two anatomical landmarks easy to identify on every body surface (even in case of skinny or corpulent patients);
- the line between the anterior tip of the coracoid and the posterolateral angle of the acromion (fulcrum axis) is closely related to the plane of the glenoid. It has been found that the axis between the anterior tip of the coracoid and the posterolateral acromion angle (fulcrum axis) is approximately in parallel to the glenoid joint plane. Hence, the positioning of patients according to the fulcrum axis allows for improved quality of true anterior-posterior shoulder X-rays;
- the deviation between the fulcrum axis and the plane of the glenoid fossa has been found to be just 1.8°. Therefore, the fulcrum axis and the plane of the glenoid fossa are almost in parallel and true anterior-posterior X-rays projected along this axis allows for significantly improved quality of the X-ray images.
The X-ray images used for the different above X-ray techniques can be obtained by using an X-ray plate, an X-ray cassette with an X-ray film or an X-ray detector which allows to transfer the acquired image, e.g. as a set of binary data to a computer.
In one special embodiment said arm comprises at least one hinge with a single articulation axis which is orthogonal to said single plane. This particular configuration allows the advantage of a simple configuration of the arm with at least two arm segments connected by one hinge. The bendability of said arm is realised by said at least one hinge allowing a defined bendability of the arm.
In a further embodiment said at least one hinge is self-locking such resulting in the advantage that the arm can easily be mounted to a portion of a patient's body without loosing its bended shape. Preferably said arm comprises fewer than eight arm segments wherein any two arm segments are connected by one hinge. A typical configuration is an arm with five arm segments.
In another embodiment said arm has a free first end and a second end which is fixed to said reference plate in such manner that said single plane is orthogonal to said front side of said reference plate. This configuration of the device allows the advantage that the reference plate and the arm are in a known and fixed position relative to each other.
In yet another embodiment said front side of said reference plate has a planar area A. Herewith the clinical advantage is achievable that the patient with the attached reference plate can by precisely aligned to a plane cover surface of an X-ray cassette, plate or an X-ray detector by means of a surface contact of two planar surfaces.
In a further embodiment said arm and said reference plate are made of a radiolucent material. Such configuration allows the advantage that neither the arm nor the reference plate are visible on the X-ray image such reducing interfering effects on the X-ray image. The arm and the reference plate can be made of a carbon fiber reinforced plastic, preferably a carbon fiber reinforced polyetheretherketone (PEEK) with the particular advantage of a light weight construction with high stability and stiffness and which is easy to clean.
In still a further embodiment said arm is made of an optically non-transparent material. The optically non-transparent arm allows to clearly position the arm along a reference line which is marked on the skin of a patient's body.
In another embodiment said reference plate is made of an optically transparent material. This configuration allows the advantage that the optically transparent reference plate allows to visually position the arm with respect to anatomical landmarks marked on the skin of a patient's body which are covered by the reference plate when attached to the patient's body.
In again a further embodiment said reference means define a straight reference line arranged parallel to said front side and within said area A. The straight reference line can be realised by e.g. three linearly arranged dots. The reference means are preferably arranged at the periphery of said reference plate such not interfering with the area to be examined in the X-ray image. The reference means can comprise two reference lines which are orthogonal to each other and are located each at a periphery of said reference plate.
In another embodiment said reference means are realised by one or more three- dimensional, preferably cylindrical markers. This configuration allows to detect angles of the reference plate with respect to the central ray of the X-ray beam which might inadvertently occur.
In a further embodiment said arm has a free first end and a second end which is linked to said reference plate by means of a releasably lockable joint. The arm can such be pivoted and used as a reference for positioning a patient's limb.
In still a further embodiment said joint has a single rotational axis orthogonal to said front side of said reference plate. This configuration results in the advantage that the device - with the arm in a first position - can be positioned relative to a patient by aligning the arm to a body portion in a position at rest and subsequently the arm can be brought in a second position such that a desired body portion of the patient can be aligned to the arm in the second position, e.g. adjusting the angle of abduction of one leg.
In another embodiment said joint is provided with a protractor with a scale ranging from -90° to +90°. By this means the device can be used for an X-ray application at the hip joint according to Lauenstein.
In a further embodiment said joint comprises snap-in means allowing to releasably secure said arm at a defined angle of rotation about said rotational axis. Preferably, said snap-in means allow to releasably secure said arm at angles of rotation about said rotational axis of -20°, -45°, +45° and +20°. This configuration allows the advantage of an easy alignment of the arm, e.g. to a desired abduction angle for the leg according to the X-ray technique of Lauenstein. In again another embodiment at least one hinge comprises a snap-in device for releasably locking the two adjacent arm segments at an angle of 180° between each other. Such configuration results in the advantage that said arm segments can be brought in a releasably fixed position in such manner that said arm is linear.
In yet a further embodiment said reference plate has an oblong shape. The reference plate can have an oval or rectangular shape and can be connected to the arm with its longer axis parallel or orthogonal to said single plane defined by said arm.
In one special embodiment of the method the following further steps are performed:
- bending said arm to clamp to said desired portion of a patient's body; and
- positioning the patient in such manner that said front side of said reference plate contacts the X-ray cassette, plate or X-ray detector of an X-ray device.
Such a patient with the reference plate attached can be moved and brought in position at the stationary X-ray cassette, plate or X-ray detector of the X-ray device.
In a further embodiment of the method said front side of said reference plate having a planar area A is used and the patient is positioned in such manner that said planar area A contacts the X-ray cassette, plate or X-ray detector of an X-ray device.
In again another embodiment of the method the following steps are additionally performed:
- attaching the X-ray cassette or X-ray detector to the front side of said reference plate; and
- positioning the patient having said device including said X-ray cassette or X-ray detector attached with respect to an X-ray source.
In this embodiment the patient with the reference plate including an X-ray cassette or X- ray detector attached is brought in position with respect to the stationary X-ray source.
In yet another embodiment of the method the following step is additionally performed:
- positioning said patient relative to said arm with said reference plate fixed at the stationary X-ray cassette or X-ray detector both located posteriorly of the patient's body until said arm extends along said reference line. This embodiment is applied if the reference plate of the device is fixed to the X-ray cassette or X-ray detector. The patient is then moved and positioned with respect to the reference plate.
The invention is explained in even more detail with reference to the partially schematic illustration of two embodiments, wherein
Fig. 1 illustrates a perspective view of an embodiment of the device according to the invention;
Fig. 2 illustrates a plan view onto the back side of the embodiment of fig. 1 ;
Fig. 3 illustrates a lateral view on the embodiment of fig. 1 ;
Fig. 4 illustrates a plan view onto the back side of another embodiment of device according to the invention; and
Fig. 5 illustrates a lateral view on the embodiment of fig. 4.
In figs. 1 to 3 an embodiment of the device 1 according to the invention is illustrated which comprises a reference plate 2 with a back side 11 and a planar front side 12 with an area A and an arm 4 connected to said reference plate 2. The arm 4 comprises four arm segments 8 whereof any two arm segments 8 are connected by one hinge 6. The hinges 6 are self-locking, e.g. by means of frictional engagement of the hinge axes and the respective bearings. The arm 4 has a free first end 15 and a second end 14 which is fixed to the back side 11 of said reference plate 2. Each hinge 6 has a single articulation axis 7 whereby said hinges 6 are arranged in such manner that all articulation axes 7 are parallel. Due to such configuration said arm 4 is bendable in a single plane 5 only. In the present embodiment the arm 4 and the reference plate 2 are made of a radiolucent material whereby said arm 4 is made of a carbon fiber reinforced plastic. The reference plate 2 has a rectangular shape with a long axis 30 and a short axis 31 whereby said arm 4 is attached to said reference plate 2 in such manner that the long axis 30 is orthogonal to said single plane 5. Further, said reference plate 2 is provided with a radiopaque reference means 20 which is realised by a reference line 21 orthogonal to said single plane 5 and arranged near the periphery of said reference plate 2.
Figs. 4 and 5 illustrate another embodiment of the device 1 according to the invention which is specially adapted to the X-ray techniques of LAUENSTEIN. This embodiment of the device 1 differs from the device 1 of figs. 1 to 3 only therein that the second end 14 of the arm 4 is attached to the reference plate 2 by means of a releasably lockable pivot joint 25 with a single rotational axis 26 which is orthogonal to the front side 12 of said reference plate 2. Further, a protractor 27 having a scale indicating the angle α ranging from -90° to +90° with regard to a coordinate axis parallel or coinciding with said long axis 30 of said reference plate 2. The pivot joint 25 is provided with a snap-in means as known in the art, e.g. a ratchet clutch or the like allowing to releasably secure said arm 4 at a defined angle of rotation about said rotational axis 26, e.g. at steps -20°, -45°, +20° and +45°. Further, said reference plate 2 is provided with a radiopaque reference means 20 which is realised by a cylindrical marker 22 arranged near one corner of said reference plate 2 with the cylinder axis orthogonal to said front side 12 of said reference plate 2.
Brief description of the X-ray technique according to invention applied to the shoulder-joint:
The method for positioning a patient in order to perform true anterior posterior shoulder- joint X-rays essentially comprises the steps of: a) determining the anterior tip of the coracoid (processus coracoideus) and the posterolateral angle of the acromion (angulus posterlateralis acromii) as the at least two relevant anatomical landmarks at a patient; b) marking said determined anatomical landmarks; c) marking a reference line connecting said two anatomical landmarks on the skin of a patient's body; and d) positioning said arm 4 relative to said patient or positioning said patient relative to said arm 4 with said reference plate 2 located posteriorly of the patient's body until said arm 4 extends along said reference line. Depending on the embodiment of the reference plate 2 the following options are possible:
A) A patient with the reference plate 2 attached is moved and brought in position at a stationary X-ray cassette or X-ray detector of the X-ray device such performing the further steps of:
- bending said arm 4 to clamp to said desired portion of a patient's body;
- positioning the patient in such manner that said area A of said front side 12 of said reference plate 2 contacts the X-ray cassette X-ray detector of an X-ray device; and
- acquiring an X-ray image of the shoulder-joint of the so positioned patient.
B) A patient with the reference plate 2 including an X-ray cassette X-ray detector attached to the reference plate 2 is brought in position with respect to the stationary X- ray source such performing the further steps of:
- attaching the X-ray cassette X-ray detector to the front side 12 of said reference plate 2;
- positioning the patient having said device 1 including said X-ray cassette X-ray detector attached with respect to an X-ray source; and
- acquiring an X-ray image of the shoulder-joint of the so positioned patient.
C) The reference plate 2 of the device is fixed to a stationary X-ray cassette X-ray detector. The patient is moved and positioned with respect to the reference plate 2 such performing the further steps of:
- positioning said patient relative to said arm 4 with said reference plate 2 fixed at the stationary X-ray cassette X-ray detector both located posteriorly of the patient's body until said arm 4 extends along said reference line; and
- acquiring an X-ray image of the shoulder-joint of the so positioned patient.
Brief description of the X-rav techniques according to LAUENSTEIN applied to the hip-ioint:
1. Technique according to LAUENSTEIN I with a clear representation of the femoral head: - the patient is positioned in supine position on the examination table with his healthy leg stretched;
- the leg of the side to be examined is bent in the hip and the knee about 45°; and
- the angle of abduction is 45° in case of an X-ray image according to this technique.
The trochanter major is projected onto the femoral neck and the trochanter minor is represented interiorly terminal. X-ray images according to LAUENSTEIN I are used for an examination of the femoral head.
In order to exactly align the angle of abduction of the leg to be examined the reference plate 2 of the device 1 according to the invention is positioned between the patient's body and the examination table in such manner that:
a) the arm segments 8 of the arm 4 are aligned at an angle β of 180° relative to each other such that the snap-in means are locked in order to arrest the arm 4 in a linear position; b) the device 1 is aligned in such manner that the linear arm 4 with the pivot joint 25 arrested at an angle α of 0° is parallel to the patient's medial sagittal plane; c) the linear arm 4 is rotated about an angle α of - 45° (fig. 4) if a patient's leg on the right side is to be examined, respectively an angle α of + 45° if a patient's leg on the left side is to be examined; and d) the respective leg is aligned to the adjusted arm 4.
2. Technique according to LAUENSTEIN Il with a clear representation of the femoral neck without a foreshortening and without a superposition by the trochanter massive:
- the patient is positioned in supine position on the examination table with his healthy leg stretched;
- the leg of the side to be examined is strongly bent in the hip and the knee whereby the foot rests flat on the examination table with its sole; - the ankle is situated near to the buttocks such that the femur is nearly orthogonal to the examination table; and
- the leg is slightly abducted with an angle of abduction of maximum 20°. It is important the hip is not rotated together with the femur.
The X-ray technique according to LAUENSTEIN counts as a standard X-ray projection besides or additionally to an overview of the pelvis with an antero-posterior X-ray beam path. A detailed summary of such standard X-ray projections is published in:
M. Kushma, F. Bachelier, G. Schneider, M. Dienst "Radiologische Untersuchung des Hϋftgelenks", Orthopadie 2006, 35:16 - 21 , Springer Medizin Verlag 2005
The application of the X-ray technique according to LAUENSTEIN particularly for the image based diagnosis of the hip joint is described in detail in:
U. Manitz, Th. Kittner "Bildgebende Diagnostik des Hϋftgelenkes unter Praxisbedingungen", Manuelle Medizin 2007, 45:265 - 270, Springer Medizin Verlag 2007

Claims

Claims
1. A device (1) for positioning a patient with respect to the radiation beam of an X-ray device comprising
A) a reference plate (2) with a back side (11), a front side (12) and radiopaque reference means (20);
B) an arm (4) connected to said reference plate (2), wherein
C) said arm (4) is bendable in a single plane (5) only.
2. The device (1) according to claim 1 , wherein said arm (4) comprises at least one hinge (6) with a single articulation axis (7) which is orthogonal to said single plane (5).
3. The device (1) according to claim 1 or 2, wherein said at least one hinge (6) is self- locking.
4. The device (1) according to one of the claims 1 to 3, wherein said arm (4) has a free first end (15) and a second end (14) which is fixed to said reference plate (2) in such manner that said single plane (5) is orthogonal to said front side (20) of said reference plate (2).
5. The device (1) according to one of the claims 1 to 4, wherein said front side (12) of said reference plate (2) has a planar area A.
6. The device (1) according to one of the claims 1 to 5, wherein said arm (4) and said reference plate (1) are made of a radiolucent material.
7. The device (1) according to one of the claims 1 to 6, wherein said arm (4) is made of an optically non-transparent material.
8. The device (1) according to one of the claims 1 to 7, wherein said reference plate (2) is made of an optically transparent material.
9. The device (1) according to one of the claims 1 to 8, wherein said reference means (20) define a straight reference line (21) arranged parallel to said front side (12) and within said area A
10. The device (1) according to one of the claims 1 to 8, wherein said reference means (20) are realised by one or more three-dimensional, preferably cylindrical markers (22).
11. The device (1) according to one of the claims 1 to 3 or 5 to 10, wherein said arm (4) has a free first end (15) and a second end (14) which is linked to said reference plate (2) by means of a releasably lockable joint (25).
12. The device (1) according to claim 11 , wherein said joint (25) has a single rotational axis (26) orthogonal to said front side (12) of said reference plate (2).
13. The device (1) according to claim 12, wherein said joint (25) is provided with a protractor (27) with a scale ranging from -90° to +90°.
14. The device (1) according to claim 12 or 13, wherein said joint (25) comprises snap- in means allowing to releasably secure said arm (4) at a defined angle of rotation about said rotational axis (26).
15. The device (1) according to claim 14, wherein said snap-in means allow to releasably secure said arm (4) at angles of rotation about said rotational axis (26) of - 20°, -45°, +45° and +20°.
16. The device (1) according to one of the claims 2 to 15, wherein at least one hinge (6) comprises a snap-in device for releasably locking the two adjacent arm segments (8) at an angle of 180° between each other.
17. The device (1) according to one of the claims 1 to 16, wherein said reference plate (2) has an oblong shape.
18. Method for positioning a patient for true anterior posterior shoulder-joint X-rays using the device (1) according to one of the claims 1 to 17 comprising the steps of: a) determining at least two relevant anatomical landmarks at a patient which allow to define a reference line; b) marking said determined anatomical landmarks; c) marking a reference line connecting said two anatomical landmarks on the skin of a patient's body; and d) positioning said arm (4) relative to said patient or positioning said patient relative to said arm (4) with said reference plate (2) located posteriorly of the patient's body until said arm (4) extends along said reference line.
19. The method according to claim 18 further comprising the steps of: e1) bending said arm (4) to clamp to said desired portion of a patient's body; and f1) positioning the patient in such manner that said front side (12) of said reference plate
(2) contacts the X-ray cassette, plate or X-ray detector of an X-ray device.
20. The method according to claim 19, wherein said front side (12) of said reference plate (2) has a planar area A and the patient is positioned in such manner that said planar area A contacts the X-ray cassette, plate or X-ray detector of an X-ray device.
21. The method according to claim 18 further comprising the steps of: e2) attaching the X-ray cassette or X-ray detector to the front side (12) of said reference plate (2); and f2) positioning the patient having said device (1) including said X-ray cassette or X-ray detector attached with respect to an X-ray source.
22. The method according to claim 18 further comprising the step of: f3) positioning said patient relative to said arm (4) with said reference plate (2) fixed at the stationary X-ray cassette or X-ray detector both located posteriorly of the patient's body until said arm (4) extends along said reference line.
23. Use of the device (1) according to one of the claims 1 to 18 for positioning a patient in order to perform true anterior posterior shoulder-joint X-rays.
24. Use of the device (1) according to one of the claims 1 to 18 for positioning a patient according to the X-ray technique of the hip joint according to Lauenstein.
PCT/CH2009/000065 2009-02-17 2009-02-17 Device for positioning a patient with regard to an x-ray device WO2010094143A1 (en)

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN103841892A (en) * 2012-08-06 2014-06-04 株式会社东芝 X-ray image capture device

Citations (3)

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Publication number Priority date Publication date Assignee Title
US3178574A (en) * 1962-07-12 1965-04-13 Stryker Corp Locating apparatus for determining the position of the neck of a femur under x-ray examination
US5947981A (en) * 1995-01-31 1999-09-07 Cosman; Eric R. Head and neck localizer
US20040199072A1 (en) * 2003-04-01 2004-10-07 Stacy Sprouse Integrated electromagnetic navigation and patient positioning device

Patent Citations (3)

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Publication number Priority date Publication date Assignee Title
US3178574A (en) * 1962-07-12 1965-04-13 Stryker Corp Locating apparatus for determining the position of the neck of a femur under x-ray examination
US5947981A (en) * 1995-01-31 1999-09-07 Cosman; Eric R. Head and neck localizer
US20040199072A1 (en) * 2003-04-01 2004-10-07 Stacy Sprouse Integrated electromagnetic navigation and patient positioning device

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN103841892A (en) * 2012-08-06 2014-06-04 株式会社东芝 X-ray image capture device

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