What are the two differences in the phalanges of the foot as compared with the phalanges of the hand?
- 1. phalanges of the foot are smaller
- 2. movements are limited
Which tuberosity of the foot is palpable and a common site of foot trauma?
base of the 5th metatarsal
Where are the sesamoid bones of the foot most commonly located?
plantar surface at the head of the first metatarsal
What is the largest and strongest tarsal bone?
calcaneus
What is the name of the joint found between the talus and calcaneus?
subtalar joint
For a small to medium plaster cast, how much would you increase the exposure?
increase mAs 50% to 60% or +5 to 7 kV
For a large plaster cast, how much would you increase the exposure?
increase mAs 100% or +8 to 10 kV
For a fiberglass cast, how much would you increase the exposure?
increase mAs 25% to 30% or +3 to 4 kV
True or False
The cuboid articulates with the four bones of the foot.True
The calcaneus articulates with the talus and the:
cuboid
What are the two arches of the foot?
- 1. longitudinal
- 2. transverse
Which three bones make up the ankle joint?
- 1. talus
- 2. tibia
- 3. fibula
The three bones of the ankle form a deep socket into which the talus fits. This socket is called the ____________.
ankle mortise
The distal tibial joint surface forming the roof of the distal ankle joint is called the
tibial plafond
True or False
The medial malleolus is approximately 1/2 inch (1 cm) posterior to the lateral malleolus.False.
The ______ is the weight-bearing bone of the lower leg.
tibia
What is the name of the large prominence located on the midanterior surface of the proximal tibia that serves as a distal attachment for the patellar tendon?
tibial tuberosity
What is the name of the small prominence located on the posterolateral aspect of the medial condyle of the femur that is an identifying landmark to determine possible rotation of a lateral knee?
adductor tubercle
A small, triangular depression located on the tibia that helps form the distal tibiofibular joint is called the
fibular notch
The articular facets of the proximal tibia are also referred to as the
tibial plateau
The articular facets slope _________ degrees posteriorly.
10 to 15 degrees
The most proximal aspect of the fibula is the
apex or styloid process
The extreme distal end of the fibula forms the
lateral malleolus
What is the name of the largest sesamoid bone in the body?
patella
What are two other names for the patellar surface of the femur?
- 1. intercondylar sulcus
- 2. trochlear groove
What is the name of the depression located on the posterior aspect of the distal femur?
intercondylar fossa
Why must the CR be angled 5 to 7 degrees cephalad for a lateral knee position?
the medial condyle extends lower than the lateral condyle
-
The slightly raised area located on the posterolateral aspect of the medial femoral condyle is called the
adductor tubercle
What are the two palpable bony landmarks found on the distal femur?
- 1. medial epicondyle
- 2. lateral epicondyle
The general region of the posterior knee is called the
popliteal region
True or False
Flexion of 20 degrees of the knee forces the patella firmly against the patellar surface of the femur.false
True or False
The patella acts like a pivot to increase the leverage of a large muscle found in the anterior thigh.true
True or False
The posterior surface of the patella is normally rough.False
List the two bursae found in the knee joint.
- 1. suprapatellar bursa
- 2. infrapatellar bursa
inward turning or bending of ankle
inversion (varus)
decreasing the angle between the dorsum pedis and anterior lower leg
dorsiflexion
extending the ankle or pointing the foot and toe downward
plantar flexion
outward turning or bending of ankle
eversion (valgus)
True or False
The recommended SID for lower limb is 40 inches.true
True or False
To reduce scatter radiation during table top procedures, the Bucky tray should be positioned over the lower limb being radiographed.false
True or False
During DR, lead masking should be placed on the regions of the IR, not within the collimation field.true
True or False
A kV range between 50 and 70 should be used for film-screen lower limb radiography.true
True or False
kV range for CR and DR is typically lower as compared with film-screen ranges.false
an inflammatory condition involving the anterior, proximal tibia
Osgood-Schlatter disease
also known as osteitis deformans
Paget's disease
malignant tumor of the cartilage
chondrosarcoma
inherited type of arthritis that commonly affects males
Gout
benign, neoplastic bone lesion caused by overproduction of bone at a joint
exostosis
benign bone lesion usually developing in teens or young adults
osteoid osteoma
most prevalent primary bone malignancy in pediatric patients
Ewing's sarcoma
benign, neoplastic bone lesion filled with clear fluid
bone cyst
injury to a large ligament located between the bases of the first and second metatarsal
lisfranc joint injury
condition affecting the sacroiliac joints and lower limbs of young men, especially the posterosuperior margin of the calcaneus
Reiter's syndrome
The formal name for "runner's knee" is
chondromalacia patellae
What is another name for osteomalacia?
rickets
asymmetric erosion of joint spaces with calcaneal erosion
reiter syndrome
uric acid deposits in joint spaces
gout
well-circumscribed lucency
bone cyst
small, round/oval density with lucent center
osteoid osteoma
narrowed, irregular joint surfaces with sclerotic articular surfaces
osteoarthritis
fragmentation or detachment of the tibial tuberosity
Osgood-Schlatter disease
ill-defined area of bone destruction with surrounding "onion peel"
Ewing's sarcoma
decreased bone density and bowing deformities of weight-bearing limbs
osteomalacia
Why is the CR angled 10 to 15 degrees toward the calcaneus for an AP projection of the toes?
opens up the IP and MTP joints
Where is the CR centered for an AP oblique projection of the foot?
base of the third metatarsal
Which projection is best for demonstrating the sesamoid bones of the foot?
Tangential
The foot should be dorsiflexed so that the plantar surface of the foot is __________ degrees from vertical for the sesamoid projection.
15 to 20
Why should the CR be perp to the metatarsals for an AP projection of the foot?
opens up the MTP and certain intertarsal joints
Rotation can be determined on a film of an AP foot projection by the near-equal distance between the _______ metatarsals.
2nd - 5th
Which oblique projection of the foot best demonstrates the majority of the tarsal bones?
AP oblique with medial rotation
Which oblique projection of the foot best demonstrates the navicular and the first and second cuneiforms with minimal superimposition?
AP oblique with lateral rotation
Which projection tends to place the foot into a truer lateral position: mediolateral or lateromedial?
lateromedial
Which type of study should be performed to best evaluate the condition of the longitudinal arches of the foot?
AP & lateral weight-bearing projections
How should the CR be angled from the long axis of the foot for the plantodorsal axial projection of the calcaneus?
40 degree cephalad
Which calcaneal structure should appear medially on a well-positioned plantodorsal projection?
sustentaculum tali
Where is the CR placed for a lateral projection of the calcaneus?
1" inferior to medial malleolus
Which joint surface of the ankle is not typically visualized with a correctly positioned AP projection of the ankle?
lateral surface of joint
Why should AP, 45 degree oblique, and lateral ankle radiographs include the proximal metatarsals?
to demonstrate a possible fracture of the 5th metatarsal tuberosity
How much (if any) should the foot and ankle be rotated for an AP mortise projection of the ankle?
15 to 20 degrees medially
Which projection of the ankle best demonstrates a possible fracture of a lateral malleolus?
45 degree AP oblique with medial rotation
What is the basic positioning routine for a study of the tibia and fibula?
AP & lateral
To include both joints for a lateral projection of the tibia and fibula for an adult, the tech may place the IR ________ in relation to the part.
diagonally
Where is the CR centered for an AP projection of the knee?
1/2 inch distal to apex of patella
What is the recommended CR angulation for an AP projection of the knee for a patient with thick thighs and buttocks?
3 to 5 degrees cephalad
Which basic projection of a knee best demonstrates the proximal fibula free of superimposition?
AP oblique, 45 degree medial rotation
What is the recommended CR placement for a lateral knee position on a tall, slender male patient with a narrow pelvis?
5 degree cephalad
How much flexion is recommended for a lateral projection of the knee?
20 to 30 degrees
Which positioning error is present if the distal borders of the femoral condyles are not superimposed on a radiograph of a lateral knee?
improper angle of the CR
Which positioning error is present if the posterior portions of the femoral condyles are not superimposed on a lateral knee radiograph?
overrotation or underrotation of the knee
Which special projection of the knee best demonstrates the intercondylar fossa?
Holmblad
How much flexion of the lower leg is required for the Camp-Coventry projection when the CR is angled 40 degrees caudad?
40 degree flexion
How much knee flexion is required for the PA axial projection (Holmblad method)?
60 to 70 degrees
What type of CR angle is required for the PA axial (Holmblad method)?
None. CR is perp to IR.
How much part flexion is recommended for a lateral projection of the patella?
5 to 10 degrees
How much CR angle from the long axis of the femora is required for a Merchant bilateral projection?
30 degrees from horizontal
How much part flexion is required for the following methods?
a. Hughston method
b. Settegast method- a. 45 to 55 degrees
- b. 90 degrees
What type of CR angle is required for the superoinferior sitting tangential method for patella?
none
can be performed using a wheelchair or lowered radiographic table
Holmblad method (variation)
patient prone; requires 90 degree knee flexion
Settegast method
patient prone with 40 to 50 degree knee flexion and with equal 40 to 50 degree caudad CR angle
Camp-Coventry method
IR is placed on a foot stool to minimize the OID
superoinferior sitting tangential method
patient prone with 45 degree knee flexion and 10 to 20 degree cephalad CR angle from long axis of lower leg
Hughston method
patient supine with IR resting on midthighs
inferosuperior axial for patellofemoral joint
patient supine with 40 degree knee flexion and with 30 degree caudad CR angle from horizontal
Merchant method
Which projection of the intercondylar fossa recommends using a curved cassette?
Beclere method
A radiograph of an AP projection of the foot reveals that the metatarsophalangeal joints are not open and the metatarsals are somewhat foreshortened. What was the positioning error involved?
CR is not angled correctly
A radiograph of an AP oblique-medial rotation projection of the foot reveals that the proximal third to fifth metatarsals are superimposed. What type of positioning error led to this radiographic outcome?
overrotation of foot
A radiograph of a plantodorsal axial projection of the calcaneus reveals considerable foreshortening of the calcaneus. What type of positioning modification is needed on the repeat exposure?
increase cephalad angle of the CR to correctly elongate the calcaneus
A patient with a possible Lisfranc joint injury. Which radiographic position(s) would best demonstrate this type of injury?
AP and lateral weight-bearing projections
A radiograph of a mediolateral knee projection demonstrates that the medial femoral condyle is projected inferior to the lateral condyle. What can the tech do to correct this problem during the repeat exposure?
angle the CR 5 to 7 cephalad
Where are the sesamoid bones of the foot most commonly located?
plantar surface near head of first metatarsal
What is the name of the tarsal bone found on the medial side of the foot between the talus and three cuneiforms?
navicular
Which tarsal bone is considered to be the smallest?
intermediate cuneiform
What is another term for the talocalcaneal joint?
subtalar joint
The distal tibial joint surface is called the
tibial plafond
The largest and strongest bone of the body is the _________
femur
A small depression located in the center of the femoral head is the ____________
fovea capitis
The lesser trochanter is located on the ___________ aspect of the proximal femur. It projects ____________ from the junction between the neck and shaft.
medial; posteriorly
List the four bones comprising the pelvis.
- right hip bone
- left hip bone
- sacrum
- coccyx
List the two bones comprising the pelvic girdle.
- right hip bone
- left hip bone
List the three divisions of the hip bone.
- ilium
- ischium
- pubis
All three divisions of the hip bone eventually fuse at the ___________ at the age of mid teens.
acetabulum
What are the two radiographic landmarks found on the ilium?
- iliac crest
- ASIS
Which bony landmark is found on the most inferior aspect of the posterior pelvis?
ischial tuberosity
The ____________ of the pelvis is the largest foramen in the skeletal system.
obturator foramen
An imaginary plane that divides the pelvic region into the greater and lesser pelvis is called the
pelvic brim
Alternate term for the greater pelvis
false pelvis
Alternate term for the lesser pelvis
true pelvis
List the three aspects of the lesser pelvis, which also describe birth route during the delivery process.
- inlet
- cavity
- outlet
In the past, which radiographic examination was performed to measure the fetal head in comparison with the maternal pelvis to predict possible birthing problems?
cephalopelvimentary exams
List the characteristics of the male pelvis.
- heart-shaped inlet
- narrow ilia that are less flared
- pubic arch angle of 75 degrees
List the characteristics of the female pelvis.
- wide, more flared ilia
- pubic arch angle of 110 degrees
- larger and more round-shaped inlet
To achieve a true AP position of the proximal femur, the lower limb must be rotated _________ internally.
15 to 20 degrees
Which structures on an AP pelvis or hip radiograph indicate whether the proximal head and neck are in position for a true AP projection?
lesser trochanter should not be visible
Which physical sign may indicate that a patient has a hip fracture?
involved foot is externally rotated
Which condition is a common clinical indication for performing pelvic and hip examinations on a pediatric (newborn) patient?
developmental dysplasia of hip (DDH)
a degenerative joint disease
osteoarthritis
most common fracture in older patients because of high incidence of osteoporosis or avascular necrosis
proximal hip fracture
-
a malignant tumor of the cartilage of hip
chondrosarcoma
a disease producing extensive calcification of the longitudinal ligament of the spinal column
ankylosing spondylitis
a fracture resulting from a severe blow to one side of the pelvis
pelvic ring fracture
malignancy spread to bone via the circulatory and lymphatic systems or direct invasion
matastatic carcinoma
now referred to as developmental dysplasia of the hip
congenital dislocation
Where is the CR placed for an AP pelvis projection?
midway between the ASIS and symphysis pubis
Which specific positioning error is present when the left iliac wing is elongated on an AP pelvis radiograph?
rotation toward left side
Which specific positioning error is present when the left obturator foramen is more open than the right side on an AP pelvis radiograph?
right rotation
Trauma or Non trauma
a. Danelius-Miller projection
b. unilateral frog-leg
c. modified Cleaves (bilateral frog-leg)
d. Clements-Nakayama
e. anterior pelvic bones- a. trauma
- b. non trauma
- c. non trauma
- d. trauma
- e. trauma
Which projection is recommended to demonstrate the superoposterior wall of the acetabulum?
PA axial oblique
How many degrees are the femurs abducted (from the vertical plane) for the bilateral frog-leg projection?
40 to 45 degrees
Where is the CR placed for a unilateral frog-leg projection?
midfemoral neck
Where is the CR placed for an AP bilateral frog-leg projection?
- 3" below level of ASIS
- 1" superior to the symphysis pubis
Which CR angle is required for the "outlet" projection (Taylor method) for a female patient?
30 to 45 degrees cephalad
Which type of pathologic feature is best demonstrated with the Judet method?
acetabular fractures
How much obliquity of the body is required for the Judet method?
45 degrees
What type of CR angle is used for a PA axial oblique (Teufel) projection?
12 degrees cephalad
How is the pelvis (body) positioned for a PA axial oblique (Teufel) projection?
PA 35 to 40 degrees toward affected side
How is the unaffected leg positioned for the axiolateral hip projection?
flexed and elevated
The modified axiolateral requires the CR to be angled __________ degrees posteriorly from horizontal.
15 to 20
Which special projection of the hip demonstrates the anterior and posterior rims of the acetabulum and the ilioischial and iliopubic columns?
Posterior Oblique of Acetabulum (Judet method)
What is the name of a special AP axial projection of the pelvis used to assess trauma to pubic and ischial structures?
AP Axial Outlet Projection (Taylor method)
Axiolateral (inferosuperior)
Danelius-Miller
modified axiolateral
Clements-Nakayama
bilateral or unilateral frog-leg
modified Cleaves
PA axial oblique for acetabulum
Teufel
AP axial for pelvic "outlet" bones
Taylor
posterior oblique for acetabulum
Judet
What is the optimal amount of hip abduction applied for the unilateral "frog-leg" projection to demonstrate the femoral neck without distortion?
20 to 30 degrees from vertical
How much is the IR tilted for the modified axiolateral projection of the hip?
15 degrees from vertical
A radiograph of an AP pelvis projection reveals that the lesser trochanters are readily demonstrated on the medial side of the proximal femurs. The patient is ambulatory but has a history of early osteoarthritis in both hips. Which positioning modification needs to be made to prevent this positioning error?
rotate the lower limbs 15 to 20 degrees internally to place the proximal femurs in a true AP position
A radiograph of an AP pelvis reveals that the right iliac wing is forshortened as compared with the left side. Which specific positioning error has been made?
the patient is rotated toward the left - LPO
-
A very young child comes to the radiology dept. with a clinical history of DDH. What is the most common positioning routine for this condition?
AP pelvis & bilateral "frog-leg" projections
What projection of the foot will best demonstrate the status of the longitudinal arch?
Chapter 7.
procedure.
Foot PA Oblique (Medial Rotation)
Cuboid is shown in profile. Position of patient Lateral recumbent position on affected side. Fully extend leg. Turn patient toward prone position until plantar surface of foot forms an angle of 45 degrees to plane of IR.
Aligning the 5th toe to the center of the calcaneus is a practical way to gauge optimal internal rotation needed to demonstrate the mortise joint. Another way to ensure correct positioning is by rotating the leg internally until the central line of the collimation field is in line with the 5th metatarsal.