Many different radiographic measurements have been described as indicators of structural disease. In particular, measurements such as the lateral center-edge angle of Wiberg16, the anterior center-edge angle of Lequesne17, the acetabular index of depth to width described by Heyman and Herndon18, the femoral head extrusion index19, and the Tönnis angle20 have been used as markers for acetabular dysplasia. Similarly, measurements of acetabular version21, the headneck offset (initially described by Eijer) 3, 22, and the alpha angle19 have been used in the diagnosis of femoroacetabular impingement. Nevertheless, there is limited literature that provides comprehensive information regarding the details of radiographic evaluation in the young patient with hip symptoms. This paper summarizes the recommendations of the ANCHOR (Academic Network for Conservational Hip Outcomes Research) study group regarding the most important aspects of radiographic technique and image interpretation to evaluate the symptomatic, skeletally mature hip.

Radiographic Techniques n order to fully evaluate patients who present with a complaint of hip pain, the following radiographic views can be considered: an anteroposterior view of the pelvis (anteroposterior pelvic view) 21, 23, a cross-table lateral view22, a 45 or 90 Dunn view24, 25, a frog-leg lateral view26, and a false-profile view17 (Figs. 1-A through 1-F). Each radiographic view provides discrete information regarding the structural anatomy of the hip, and individual physicians will have distinct preferences for the views obtained. Image quality is highly technique-dependent, and variability in patient positioning can substantially impact the ability to properly diagnose structural abnormalities. To improve diagnostic accuracy and disease classification, radiographs must be obtained with use of the same standardized imaging protocol. The following section will address the proper technique for obtaining each of the noted views.