Summarize notes for Lower Extremeties.pdf

Notes for lower extremeties

1. Digit
Projection Central Ray Best Demonstrated
1.AP Plantar surface Perpendicular to 3rd MTP IP joint not best seen
AP Axial ‘’ 10-15* posteriorly to 3rd MTP IP joint is best seen due to angulation
2. PA P, Dorsal Aspect Perpendicular to 3rd MTP joint IP joint spaces due to natural divergence of
xray
3. AP Oblique
AP Medial Oblq. MRLF 30-40* Perpendicular to 3rd MTP joint 1
st
-3
rd
digits
AP Lateral Oblq. LRLF 30-40* Perpendicular to 3rd MTP joint 4
th
-5
th
digits
4. Lateral Lateral recumbent LR on unaffected side Perpendicular to PIP joint 1
st
-2
nd
Digits
LR on affected side Perpendicular to PIP joint 3
rd
-5
th
Digits
M/L RLF- Medially/Laterally rotate leg and foot

Sesamoid bone
Projection Position Plantar Surface Central Ray Best Demonstrated
1.Lewis Prone F/A of 15-20* from vertical Perpendicular to tangential to the 1
st
MTP joint Uncomfortable and painful to px
2. Holly Supine F/A of 75* to IR Perpendicular to the head pf the 1
st
MT More comfortable to px
3. Causton LR 1
st
MTP jnt perpendicular to
horizontal plane to IR
40* towards the heel directed to the prominence of the
1
st
MTP jnt
Axiolateral view of sesamoid bone


Foot
Projection Position Central Ray Best Demonstrated
1.AP/Dorsoplantar S Flex knee and plantar surface on
IR
Perpendicular to base of the 3
rd
MT Gen. Survey foot, FB localization, MT and
Phalanges
2. AP Axial S Plantar Surface on IR 10* posteriorly to 3
rd
MT Tarsometatarsal joint
3. AP Oblique
AP Medial Oblique S MR foot 30-45* Perpendicular to base of 3
rd
MT 3
rd
-5
th
MT, Cuboid and sinus tarsi
-Routine oblq. , 5
th
MT tuberosity
AP Lateral Oblique S LR foot 30-45* Perpendicular to base of 3
rd
MT 1
st
-2
nd
MT, Navicular
-Alternative oblq. proj.
4. Plantodorsal Oblique/
Grashey
Prone Dorsal surface closed contact w/
IR

=Medial Rotation P R foot and heel medially 30* Perpendicular to base of 3
rd
MT 1
st
-2
nd
MT, navicular,same as AP Lat Oblq
=Lateral Rotation P R foot and heel laterally 20* Perpendicular to base of 3
rd
MT 3
rd
-5
th
MT, cuboid, 5
th
MT tuberosity,
Same as AP Medial Oblq.
5. Lateral LR Flex knee 45*, PS perpendicular to
IR
Perpendicular to base of 3
rd
MT Lateromedial proj. is true lateral of foot
-entire foot in lateral profile

2. 6. Lateral Projection
Weight Bearing
Erect Have px Horizontal to base of 3
rd
MT Pes Planus or Flat Foot, Structural status
of the Longitudinal arch
7. AP Axial Weight
Bearing
Erect Plantar surface on IR 15* posteriorly at the level of the
base of the MT
Hallux valgus, alignment of MT and
phalanges, WB AP Axial view of foot
8. AP Axial Weight
Bearing/ Composite
Erect Place opposite foot one step
backward
15* posteriorly to base of 3
rd
MT for the exposure of forefoot
‘’ Place opposite foot one step
forward
25* anteriorly to the posterior
surface of the ankle
for the exposure of midfoot
MR/LR-Medially/ Lateral Rotation
WB- Weight Bearing
R- Rotate

Club Foot
Projection Position Central Ray Best Demonstrated
1.AP/ Kite Method S Plantar in contact w/ IR 15* posteriorly Degree of adduction of forefoot, inversion of calcaneus
2.Lateral/ Kite Method LR Foot in true lateral Perpendicular to midtarsal areas Anterior talar subluxation and degree of plantar flexion
(Equinos)
3. Kandel Method E/ BF Plantar in contact w/ IR 40* anterior through the lower leg Recom. Dorsoplantar axial proj. for px w/ club foot
Sustentaculum talar joint fusion
BF- Bending Forward
Calcaneus
Projection Position Foot Central Ray Best Demonstrated
1.Plantodorsal S Dorsiflex PS Perpendicular to IR 40* cephalad to base of 3
rd
MT Axial. Proj. of Calcaneus, Open talacalcaneal joint,
Sustentaculum tali, BD Medial or Lateral
displacement of Calcaneus
2.Dorsoplantar P Dorsiflex PS Perpendicular to IR 40* caudad to dorsal surface
of the ankle joint
3. Lateral LR Dorsiflex Flex knee 45* Perpendicular to 1 inch
inferior to medial malleolus
Calcaneal spur, RoutineProjection
Extent and Alignment of fx
4. Weight Bearing/
Coalition /Lilienfeld
Erect Unaffected foot place
1 step forward
45* Anteriorly to Posteriorly
surface of Flexed ankle at level
of base of 5
th
MT
Calcaneotalar coalition
5. Weight Bearing
Lateromedial Oblique
Erect PS in closed contact
w/ IR
Medially at a caudad angle of
45* to enter lateral malleolus
Stress fx of the calcaneus and calcaneal tuberosity
PS- Plantar Surface

3. Ankle
Projection Position Central Ray Best Demonstrated
1.AP S, MRLF 5* Perpendicular midway between two malleoli Talo-tibial joint
2. Mortise S, MRLF 15-20* Dorsiflex R, Intermalleolar Plane
is parallel
Perpendicular midway between two malleoli Talo-fibular joint, fx in 5
th
MT

3. AP Oblique S, MRLF 45* Plantar F/A of 80-85* from IR
Or 10-15* from the vertical posi
Perpendicular midway between two malleoli Distal tibiofibular joint
4. Lateral LR Perpendicular to 1/2’’ superior to lateral malleolus Talo-tibial joint
5. AP Stress
Study
Ligament tear or rupture
Inversion S, DFF, LFE Invert Foot Perpendicular midway between two malleoli Lateral Ligament tear
Eversion S, DFF, LFE Evert Foot Perpendicular midway between two malleoli Medial Ligament tear
DFF- Dorsiflex Foot LFE-Leg Fully extended MRLF- Medially Rotate Leg and Foot

AP Talo-Tibial joint
Lateral Talo-Tibial Joint
Mortise Talo- Fibular Joint
AP Medial Oblique Talo-Fibular Joint
Inversion Stress Lateral ligament tear
Eversion Stress Medial ligament tear


Subtalar Joint (Talocalcaneal Joint)
Projection Position Wedge Foam Central Ray Best Demonstrated
1.Isherwood/Medial Rotation Foot S or Sitting 45* Perpendicular to 1’’ distal and 1’’ anterior to lateral malleolus Anterior Talar
2. Isherwood/Medial Rotation Ankle Sitting or semi lat 30* 10* cephalad to 1’’ distal and 1’’ anterior to lateral malleolus Middle Talar
3.Isherwood/Lateral Rotation Ankle S or sitting 30* 10* cephalad to 1inch distal to medial malleolus Posterior Talar

Projection Central Ray Best Demonstrated
4. AP Axial Oblique Medial Rotation/
Broden Method
RLF 45*
medially
-10* cephalad
-20-30 * cephalad
-40* cephalad
-Anterior Talar
-Middle Talar
-Posterior Talar
5. AP Axial Oblique Lateral Rotation/
Broden Method
RLF 45*
laterally
15* cephalad to 2 cm below medial
malleolus
-Posterior facet of calcaneus, articulation bet sustenculum tali and taus
RLF- Rotate leg and foot

4. Leg
Projection Position Femoral Epicondyles Central Ray Best Demonstrated
1.AP S/Sitting Medially Rotate leg 5* Parallel to IR Perpendicular to midshaft of leg Slightly overlap of tibia and fibula on Both joint
Routine Projection
2.Lateral LR Flex knee 45* Perpendicular to IR Perpendicular to midshaft of leg Anterior/Posterior displacement of bony structures
Distal fibula seen lying posterior over the half tibia
BD tibial tuberosity in profile
Overlap tibia on the proximal fibular head
3.AP Medial
oblique
RL 45* medially Perpendicular to midshaft of leg Proximal and Distal Tibiofibular joint
AP Lateral
0blique
RL 45* laterally Perpendicular to midshaft of leg Fibula superimposition by the tibia

Knee
Projection Position/RL Central Ray Best Demonstrated
1.AP S/S, RL 5*
Medially
Femoral Epicondyles parallel to IR 5-7* cephalad to 1/2 ‘’ inferior to
patellar apex
Open femorotibial joint space, Commonly
indicated for trauma and degenerative disease
Slight superimpose of the proximal tibia on the
fibular head
2. Lateral LR, Flex knee
20-30*
Femoral Epicondyles
perpendicular to IR
5-7* cephalad to 1 inch distal to
medial condyle
Patella in Profile, Open femorotibial joint space,
Tibia superimposed on the fibular head

3. AP Medial Oblique RL 45*
medially
Perpendicular to midshaft Proximal and distal tibiofibular joint
AP Lateral Oblique RL 45*
laterally
Perpendicular to midshaft Fibula superimposed by the tibia
4. AP Weight Bearing
Method
Erect CR should be angled parallel to
tibial plateau to best demonstrate
an open knee joint
Horizontally to 1/2 ‘’ below patellar
apex
Useful in demonstrating femur and tibia alignment
for valgus (Bow leg) and varus (Knock Knee)
Osteoarthritis (Joint space narrowing)
5. PA Weight standing
flexion/ Rosenberg
Erect Flex knee 45*
Anterior aspect of knee against IR
10* caudad
CR should parallel to tibial plateau
to BD an open knee joint
Alternative proj. for knee AP weight bearing
Joint space narrowing
Imaged produced similar to Intercondyloid fossa

Martensen Method
ASIS Central Ray
Less than 18 cm from ASIS- Buttocks (Thin Pelvis) 3-5 degrees caudad
19-24 cm from ASIS – Buttocks (Average Pelvis) 0 degrees
More than 24 cm from ASIS (Thick Pelvis) 3-5 degrees cephalad

5. Patella
Projection Position/RL Femoral Epicondyles Flex Knee Central Ray Best Demonstrated
1.PA P, Rotate heel
5-10* laterally
Parallel to IR Perpendicular to midpopliteal
area
Provides detail of patella
2. Lateral LR Perpendicular to IR 5-10 *, should not flex more than 10*
to prevent fragment separation in
new or unhealed patellar fx
Perpendicular to
femoropatellar joint space
Suprapatellar effusion
Patella in profile
3.Kuchendorf P 35-40* from the prone position so that no pressure is placed on
the injured patella
25-10* caudad to joint space bet patella and femoral condyles
at the posterior surface of the patella


Patello-Femoral Joint
Tangential Projection (MeSHS)
Method Position Flex Knee Central Ray Best Demonstrated
1.Merchant S 30-90* (40* Reco.) 30* caudad at the level of
Patellofemoral joint
Tangential view of both patellofemoral joints w/ the
use of axial viewer device
2. Settegast P 90* 15-20* tangential to patellofemoral
joint
Vertical fractures of the patella

3. Hughston P 50-60* (55 Reco.) 45* cephalad to PFJ Comfortable to px
Major disadvantage is image distortion due to film-
body part-beam alignment
4. Sunrise/Skyline S/Sitting 40-45* 30* from horizontal Major adv. of this method it does not required to use
special equipment and relatively comfortable to px


Intercondyloid Fossa
Projection Method Position Knee Flexion Central Ray Best Demonstrated
1.PA Homblad Kneeling 70* Perpendicular to mid popliteal are
2. AP Axial Beclere Supine 60* (uses curve IR) Perpendicular to the long axis of tibia
3. PA Axial Camp Coventry Prone 40-50* 40-50* caudad to mid popliteal area

Leg
Projection Position Rotate Leg Femoral Epicondyles Central Ray Best Demonstrated
1.AP S 5* if knee included
10-15* if proximal femur included
Parallel to IR Perpendicular to
midshaft
Most common indication for examination of femur is trauma
Entire length of the femur including knee and hip joint
2. Lateral LR 45* Perpendicular to IR Perpendicular to
midshaft
Superimposed anterior surface of femoral condyles
Patella in profile