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Quiz #2 Flashcards

1
Q

Foot

A
  • Considerable differences in thickness
  • Consists of 26 bones divided into three parts:
    • Tarsus or tarsal bones
    • Metatarsals (bones of the “instep”)
    • Phalanges
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2
Q

Phalanges

A
  • 14 phalanges
  • Two in the great toe; three in each of other four toes
  • Named by location
  • The interphalangeal (IP) joints also named by location
  • IP joints are synovial, diarthrodial hinge type
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3
Q

Metatarsals

A
  • Five metatarsals numbered one to five beginning at the medial aspect, or great toe side
  • Consist of body (shaft) and two articular extremities
    • Proximal end – base
    • Distal end – head
  • Distal ends (heads articulate with proximal phalanges)
    • Metatarsophalangeal (MTP) joints
  • MTP joints classified as ellipsoidal-type joints
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4
Q

Tarsals

A
  • Seven tarsal bones of the ankle
    • Calcaneus (os calcis) – bone of the heel
    • Talus
    • Navicular
    • Cuboid
  • Three cuneiforms differentiated medially to laterally as first, second, and third or internal, middle, and external
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5
Q

Calcaneus

A
  • Largest tarsal bone

- Usually examined separate from the foot, if injured

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6
Q

Talus

A
  • Occupies the highest position and is second largest

- The talus articulates with the calcaneus at the “subtalar” joint

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7
Q

Cuboid

A
  • On lateral side between calcaneus and the fourth and fifth metatarsals
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8
Q

Navicular

A
  • On medial side between calcaneus and the cuneiforms
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9
Q

Cuneiforms

A
  • Named by location
    • Medial
    • Intermediate
    • Lateral
  • Occupy the central and medial aspect of the foot between the navicular and the first, second, and third metatarsals
  • Medial cuneiform is the largest
  • Intermediate is the smallest
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10
Q

Tarsals

A
  • Mneumonic can aid in remembering tarsal names:
    • Chubby - Calcaneus
    • Twisted - Talus
    • Never - Navicular
    • Could - Cuboid
    • Cha Cuneiform—medial
    • Cha Cuneiform—intermediate
    • Cha Cuneiform—lateral
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11
Q

Ankle joint

A
  • The ankle joint is formed by articulation between the talus tarsal and the:
    • Lateral malleolus of fibula
    • Inferior surface of tibia
    • Medial malleolus of tibia
  • Classified as a synovial, hinge-type joint; allows flexion and extension
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12
Q

Ankle

A
  • The slight adduction/abduction and rotation motions of the ankle result from the intertarsals’ gliding movements rather than the ankle joint proper
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13
Q

Sesamoid bones

A
  • Small detached bones found in the foot
  • Usually form in points of stress near a joint
  • Usually found on posterior (plantar) surface of first MTP joint
  • Is possible to fracture one or both because of plantar location
  • Very painful when fractured
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14
Q

Patient preparation

A
  • Remove artifacts from anatomy of interest
    • Shoes
    • Socks or hose (elastic = artifact)
    • Heavy fabric (e.g., denim) rolled above anatomy of interest
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15
Q

Patient position

A
  • Ambulatory patients
    • Seated on x-ray table
    • Affected limb rests on the IR placed on the tabletop
  • Nonambulatory patients
    • Alter positioning to maximize patient comfort
    • Transfer from stretcher to table is not necessary
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16
Q

IR and SID

A

Image Receptor
- 10” x 12” IR collimated to the specific part

Source to Image Distance
- 40”

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17
Q

ID markers

A
  • Right or left side markers must be included on at least one of the projections on an IR
  • Avoid using digital annotation to place side markers on images
  • Other required ID markers must be in the blocker or elsewhere on the final image
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18
Q

Radiation protection

A

Shield ALL patients

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19
Q

Patient Instructions

A
  • Explain and demonstrate positions

- Breathing instructions not required for distal lower limb procedures

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20
Q

Essential toe projections

A
  • Anteroposterior (AP) or AP axial
  • AP oblique
  • Lateral (mediolateral or lateromedial)
  • All use same collimated field size
    • 1” on all sides of the toes, including 1” proximal to the MTP joint
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21
Q

AP or AP axial toes

A
  • AP axial recommended to open the joint spaces and reduce foreshortening
  • Part position
    • Knee flexed with sole of foot on IR
    • Toes centered to IR
    • May be elevated on a 15-degree wedge sponge for axial
    • Long axis of foot aligned parallel
  • Central ray (CR)
    • AP
      • Perpendicular to IR
    • Axial
      • Angled 15 degrees posteriorly
      • May be perpendicular if toes are elevated on 15-degree wedge sponge
    ** Enters at third MTP joint
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22
Q

AP oblique toes: Medial rotation

A
  • Part position
    • Knee flexed
    • Leg and foot medially rotated enough to place plantar surface of foot at 30- to 45-degree angle from plane of IR
    • Center toes to IR
  • CR
    • Perpendicular to third MTP joint
23
Q

Lateral: Great and second toe

A
  • Patient position
    • Lateral recumbent on unaffected side
  • Part position
    • Lateral with gauze separating toe of interest from others
    • Tape other toes in flexion
  • CR
    • Perpendicular to MTP joint of great toe
    • Perpendicular to proximal interphalangeal (PIP) joint of second toe
24
Q

Lateral: Third to fifth toes

A
  • Patient position
    • Lateral recumbent on affected side
  • Part position
    • Lateral
    • Separated from other toes with immobilization
  • CR
    • Directed perpendicular to PIP joint of affected toe
25
Q

Foot projections

A
  • AP or AP axial
  • AP oblique (medial rotation)
  • AP oblique (lateral rotation)
  • Lateral (mediolateral)
26
Q

AP or AP axial foot

A
  • The axial projection demonstrates the tarsometatarsal joint spaces better and reduces foreshortening
  • Part position
    • Flex knee, and rest plantar surface of foot on IR
    • Leg vertical
    • Long axis of foot aligned parallel
  • CR
    • AP
      • Perpendicular to base of third metatarsal
    • AP axial
      • Angled 10 degrees toward heel to the base of the third metatarsal
  • Collimated field
    • 1” on the sides and 1” beyond the calcaneus and distal tip of the toes
27
Q

AP oblique foot: Medial rotation

A
  • Part position
    • Knee flexed
    • Leg and foot rotated medially enough to place plantar surface 30 degrees from IR
    • Align long axis of foot parallel
    • Foot centered to middle of IR
  • CR
    • Perpendicular to base of third metatarsal
  • Collimated field
    • 1” on the sides and 1” beyond the calcaneus and distal tip of the toes
28
Q

AP oblique foot: Lateral rotation

A
  • Part position
    • Knee flexed
    • Leg and foot rotated laterally enough to place plantar surface 30 degrees from IR
    • Align long axis of foot parallel
    • Foot centered to middle of IR
  • CR
    • Perpendicular to base of third metatarsal
  • Collimated field
    • 1” on the sides and 1” beyond the calcaneus and distal tip of the toes
29
Q

Lateral foot

A
  • Patient position
    • Recumbent on table
    • Turned toward affected side until leg and foot are lateral
  • Part position
    • Elevate knee to place patella perpendicular to table
    • Center foot to IR
    • Align long axis of foot parallel
    • Dorsiflex foot to 90 degrees from leg
  • CR
    • Perpendicular to base of metatarsals
  • Collimated field
    • 1” on all sides of the shadow of the foot, including 1” proximal to the medial malleolus
30
Q

Calcaneus projections

A
  • Axial (plantodorsal)

- Lateral (mediolateral)

31
Q

Axial (plantodorsal) Calcaneus

A
  • Part position
    • Leg extended
    • Ankle in right-angle dorsiflexion
    • Support may be needed
    • Ankle centered to IR
  • CR
    • 40 degrees cephalic
    • Enters plantar surface at base of third metatarsal
  • Collimated field
    • 1” on three sides of the shadow of the calcaneus
32
Q

Lateral calcaneus

A
  • Patient position
    • Resting on affected side
    • Leg almost lateral
  • Part position
    • Calcaneus centered to IR
    • Long axis aligned with IR
  • CR
    • Perpendicular to calcaneus
    • Center 1” distal to medial malleolus at subtalar joint
  • Collimated field
    • Adjust collimator to 1” past the posterior and inferior shadow of the heel
    • Include medial malleolus and base of the fifth metatarsal
33
Q

Ankle projections

A
  • AP
  • Lateral (mediolateral)
  • AP oblique Medial Rotation
    • Ankle
    • Mortise joint
  • AP Oblique Lateral Rotation
  • AP (stress)
34
Q

AP ankle

A
  • Part position
    • Leg extended
    • Ankle centered to IR
    • Ankle flexed to place long axis of foot vertical
  • CR
    • Perpendicular through ankle to midway between the malleoli
  • Collimated field
    • 1” on the sides of the ankle and 8” lengthwise to include the heel
35
Q

Lateral ankle

A
  • Patient position
    • Turned toward affected side
    • Place leg and ankle in lateral position
  • Part position
    • Center ankle to IR
    • Dorsiflex foot to right angle
  • CR
    • Perpendicular to ankle joint
    • Enters medial malleolus
  • Collimated field
    • 1” on the sides of the ankle and 8” lengthwise
    • Include the heel and the fifth metatarsal base
36
Q

AP oblique ankle: Medial rotation

A
  • Part position
    • Leg extended
    • Ankle centered to IR
    • Foot dorsiflexed to right angle
    • Leg and foot rotated medially 45 degrees
  • CR
    • Perpendicular to ankle joint, midway between the malleoli
  • Collimated field
    • 1” on the sides of the ankle and about 8” lengthwise to include the heel
37
Q

AP oblique: Mortise joint

A
  • Part position
    • Leg extended
    • Ankle centered to IR
    • Foot dorsiflexed to right angle
    • Leg and foot rotated medially 15 to 20 degrees
    • Intermalleolar plane parallel with IR
  • CR
    • Perpendicular to ankle joint, entering midway between malleoli
  • Collimated field
    • 1” on the sides of the ankle and about 8” lengthwise to include the heel
38
Q

AP oblique ankle: Lateral rotation

A
  • Part position
    • Leg extended
    • Ankle centered to IR
    • Foot dorsiflexed to right angle (plantar surface vertical)
    • Leg and foot rotated laterally 45 degrees
  • CR
    • Perpendicular to ankle joint, midway between the malleoli
  • Collimated field
    • 1” on the sides of the ankle and about 8” lengthwise to include the heel
39
Q

AP (stress) ankle

A
  • Stress is used to verify ligamentous tears
  • Part position
    • Same as for AP
    • Physician places foot in extreme inversion and eversion positions
    • Immobilization of stress position is needed for each exposure
40
Q

AP or AP axial toes

A
  • Evidence of proper collimation
  • Entire toes, including distal ends of the metatarsals
  • Toes separated from each other
  • No rotation of phalanges; soft tissue width and midshaft concavity equal on both sides
  • Open IP and MTP joint spaces on axial projections
  • Soft tissues and bony trabecular detail
41
Q

AP oblique toes

A
  • Evidence of proper collimation
  • Entire toes, including distal ends of the metatarsals
  • Toes separated from each other
  • Proper rotation of toes, as demonstrated by more soft tissue width and more midshaft concavity on elevated side
  • Open IP and second through fifth MTP joint spaces
  • First MTP joint (not always opened)
  • Soft tissue and bony trabecular detail
42
Q

Lateral toes

A
  • Evidence of proper collimation
  • Entire toe, without superimposition of adjacent toes; when superimposition cannot be avoided, the proximal phalanx must be shown
  • Toe(s) in a true lateral position
  • Toenail in profile, if visualized and normal
  • Concave, plantar surfaces of the phalanges
  • No rotation of the phalanges
  • Open IP joint spaces; the MTP joints are overlapped but may be seen in some patients
  • Soft tissue and bony trabecular detail
43
Q

AP or AP axial foot

A
  • Evidence of proper collimation
  • Anatomy from toes to tarsals; may include portions of talus and calcaneus
  • No rotation of the foot, as demonstrated by equal amounts of space between the second through fourth metatarsals
  • Overlap of the second through fifth metatarsal bases
  • Axial projection resulting in improved demonstration of IP, MTP, and TMT joint spaces
  • Open joint space between medial and intermediate cuneiforms
  • Soft tissue and bony trabecular detail
44
Q

AP oblique foot: Medial rotation

A
  • Evidence of proper collimation
  • Entire foot, from toes to heel
  • Proper rotation of foot
    • Third through fifth metacarpals free of superimposition
    • Bases of the first and second metatarsals superimposed on medial and intermediate cuneiforms
    • Navicular, lateral cuneiform, and cuboid with less superimposition than in the AP projection
    • Tuberosity of the fifth metatarsal
    • Lateral TMT and intertarsal joints
    • Sinus tarsi
    • Soft tissue and bony trabecular detail
45
Q

AP oblique foot: Lateral rotation

A
  • Evidence of proper collimation
  • Entire foot, from toes to heel
  • Proper rotation of foot
    • Third through fifth metacarpals free of superimposition
    • Minimal superimposition between medial and intermediate cuneiforms
    • Navicular seen with less forshortening than in the medial rotation AP oblique projection
    • Soft tissue and bony trabecular detail
46
Q

Lateral foot

A
  • Evidence of proper collimation
  • Entire foot and distal leg
  • Superimposed plantar surfaces of the metatarsal heads
  • Fibula overlapping the posterior portion of the tibia
  • Tibiotalar joint
  • Soft tissue and bony trabecular detail
47
Q

Axial calcaneus

A
  • Evidence of proper collimation
  • Calcaneus and subtalar joint
  • No rotation of the calcaneus—the first or fifth metatarsals not projected to the sides of the foot
  • Anterior portion of the calcaneus with brightness similar to the posterior portion
    • Two images may be needed for the two regions of thickness
  • Soft tissue and bony trabecular detail
48
Q

Lateral calcaneus

A
  • Evidence of proper collimation
  • Entire calcaneus, including ankle joint and adjacent tarsals
  • No rotation of the calcaneus
    • Tuberosity in profile
    • Sinus tarsi open
    • Calcaneocuboid and talonavicular joints open
  • Soft tissue and bony trabecular detail
49
Q

AP ankle

A
  • Evidence of proper collimation
  • Ankle joint centered to exposure area
  • Medial and lateral malleoli
  • Talus with proper density
  • No rotation of the ankle
    • Normal overlapping of the tibiofibular articulation with the anterior tubercle slightly superimposed over the fibula
    • Talus slightly overlapping the distal fibula
    • No overlapping of the medial talomalleolar articulation
  • Tibiotalar joint space
  • Soft tissue and bony trabecular detail
50
Q

Lateral ankle

A
  • Evidence of proper collimation
  • Ankle joint centered to exposure area
  • Distal tibia and fibula, talus, calcaneus, and adjacent tarsals
  • Ankle in true lateral position
    • Tibiotalar joint well visualized, with the medial and lateral talar domes superimposed
    • Fibula over the posterior half of the tibia
  • Fifth metatarsal base and tuberosity should be seen to check for Jones fracture
  • Brightness and contrast of the ankle sufficient to see the outline of distal portion of the fibula
  • Soft tissue and bony trabecular detail
51
Q

AP oblique ankle: Medial rotation

A
  • Evidence of proper collimation
  • Ankle joint centered to exposure area
  • Distal tibia, fibula, and talus
  • Proper 45-degree rotation of ankle
    • Tibiofibular articulation open
    • Distal tibia and fibula overlap some of the talus
  • Soft tissue and bony trabecular detail
52
Q

AP oblique: Mortise joint

A
  • Evidence of proper collimation
  • Entire ankle mortise joint centered to exposure area
  • Distal tibia, fibula, and talus
  • Proper 15- to 20-degree rotation of ankle
    • Talofibular articulation open
    • Tibiotalar articulation open
    • No overlap of the anterior tubercle of the tibia and the superolateral portion of the talus with the fibula
  • Soft tissue and bony trabecular detail
53
Q

AP oblique ankle: Lateral rotation

A
  • Evidence of proper collimation
  • Ankle joint centered to exposure area
  • Ankle joint from toes to tarsals; may include talus and calcaneous
  • Proper 45-degree rotation of ankle
    • Tibiofibular articulation open
    • Distal tibia and fibula overlap some of the talus
  • Soft tissue and bony trabecular detail

Rad Positioning (1 decks)

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