Test 3: Toes Foot Ankle Heel Lower Leg Knee Fenur Hip And Pelvis Flashcards
Routine projection and CR location for FOOT:
Routine: AP OBL LAT
CR: base of 3rd MTP joint
*AP has 10 degree angle towards heel
*oblique with 30 degree medial rotation
Routine projection and CR location for CALCANEUS:
Routine: plantodorsal (axial) and mediolateral
CR: axial- angled 40 degrees cephalad, centered at base of 3rd metatarsal.
Mediolateral- 1inch inferior to medial malleolus
Routine projection and CR location for ANKLE:
Routine: AP, mortise, medial oblique, lateral
CR: midway between malleoli, lateral is centered on medial malleolus.
Mortise-malleoli are parallel to IR (15 degree medial rotation)
Routine projection and CR location for LOWER LEG:
Routine: AP, mediolateral
CR: midpoint of lower leg
Routine projection and CR location for KNEE:
Routine: AP, medial and lateral Oblique, and Mediolateral
CR: 1/2 inch below patellar apex, lateral- 1 inch below medial epicondyle, CR angled 5-7 degrees cephalad.
Routine projection and CR location for FEMUR:
Routine: AP and lateral
CR: midpoint of IR.
Routine projection and CR location for PELVIS:
Routine: AP
CR: midway between level of ASIS and symphysis pubis.
Routine projection and CR location for HIP:
Routine: AP pelvis, AP hip, unilateral frog
CR: perp to midfemoral neck
What type of joint is the ankle joint?
Synovial ginglymus hinge type
What type of joint is the proximal tibiofibular joint?
Synovial diarthroidal gliding joint
What type of joint is the distal tibiofibular joint?
Fibrous syndesmosis type, only slightly moveable (ampiarthroidal)
* only joint in the leg that isn’t freely moveable
What is osgood schlatter disease?
Tibial tuberosity pulls away from the bone due to detachment of the patellar tendon. Seen in athletic young people most commonly boys from 10-15 years old. Visible on lateral knee or tibfib
What is the most common fracture site on the foot?
Base of the 5th metatarsal
What is a trimalleolar fracture?
Ankle fracture involving medial and lateral malleoli and posterior tip of distal tibia
What are the radiographic considerations for the lower limb?
Lower leg, ankle, foot, toes and calcaneus=TT
Femur, knee, hip and pelvis=Table Bucky
High kvp to keep the dose down
What is required to image the femur in its entirety?
Two images- proximal and distal. Also use the anode heel effect (fat cat)
What anatomy is best demonstrated on oblique views of the knee?
Proximal tibfib joint
Routine projection and CR location for TOES:
Routine: AP, oblique, lateral
CR: metatarsophalangeal joint.
*10-15 degree angle towards heel on AP and OBL
How does rotation of the lower limb occur?
Ball and socket hip joint
What’s the difference between the pelvis and the pelvic girdle?
Pelvis=sacrum and coccyx.
Pelvic girdle=only hip bones
What does camp Coventry method demonstrate and how is it performed?
Intercondylar fossa, PA axial. patient is prone, knee flexed 40 degrees, 8x10 cassette is under knee, CR is angled 40 degrees and is at mid popliteal crease
What is the Homblad method and what does it demonstrate?
Intercondylar fossa, patient is on hands and knees, cassette under knee, knee is flexed 60-70 degrees, CR is at mid popliteal crease
What is the Beclere method and what does it demonstrate?
Intercondylar fossa, AP axial. Patient is supine, knees flexed 40-45 degrees, cassette is placed as close to knee as possible, CR is at 1/2 inch distal to apex of knee. This position is not recommended due to gonadal dose and distortion
What is the Settegast method and what does it demonstrate?
Patella, patient is prone, leg flexed 90 degrees, cassette under knee, CR angled 15-20 degrees cephalad and enters at patellofemoral joint
What is the inferosuperior projection and what does it demonstrate?
Tangential patella. Patient is supine, knees flexed 45 degrees, angle tube up 10-15 degrees (100-105) place cassette on mid thigh, CR at patellofemoral joint
What is the Hughston method and what does it demonstrate?
Patella. Patient is prone knee flexed 45 degrees, CR angled inferosuperiorly to the patellofemoral joint.
What type of joint is the femorotibial joint?
Bycondylar, capable of flexion, extension and some gliding
What type of joint is the patellofemoral joint?
Sellar, largest joint space in the body
What type of joint is the sacroiliac joint?
Synovial, ampiarthroidal. Not freely movable
What type of joint is the symphysis pubis?
Ampiarthroidal. Not freely movable
What type of joint is the Union of the acetabulum joint?
Synarthroidal. Immovable
What type of joint is the hip joint?
Synovial, diarthroidal freely movable. Ball and socket
What are the differences between the male and female pelvis?
Male: narrow, less flare, inlet is oval shaped, angle of pubic arch is less than 90 degrees.
Female: broader and more flared, inlet is round shaped, angle of public arch is greater than 90 degrees
Why is the leg internally rotated for the hip/pelvis and what should not be visualized when done so?
Rotation places femoral neck closer to the IR, and the lesser trochanters should not be seen
What are two common fracture sites of the femur?
Femoral neck and intertrochanteric crests
How do you locate the head and neck of the femur?
Draw a line between asis and symphysis pubis, drop down 1 1/2” from the middle of the line to locate femoral head, and drop down 2 1/2” from middle of line to locate the neck
Where is the MTP joint?
Metatarsophalangeal joint: between the proximal phalanx of each digit and the head of the metatarsal. Condyloid type
Where is the TM joint?
Tarsometatarsel joint: between the tarsals and the base of the metatarsals
**3rd TM joint is centering point for the foot
Where are sesamoid bones usually present?
Plantar surface at the head of the first metatarsal of the foot near the MP joint
What’s an arthrogram?
Radiography of a synovial joint and related soft tissue structures with contrast media
What does an arthrogram demonstrate?
The soft tissue structures of the joint
Ex. Menisci, ligaments, articular cartilage, bursae
What is the positive contrast used in an arthrogram?
Opaque arthrography, water soluble iodinated contrast
What is the negative contrast used in an arthrogram?
Pneumoarthrography, gas or air injected into the joint. Radiolucent
What joints are arthrograms performed on?
Knee, shoulder, hip, ankle, elbow, wrists, TMJ’s
Explain the steps of an arthrogram:
- Explain the procedure to patient
- Following sterile technique a needle will be inserted into the joint space and contrast will be injected
- needle is removed and the part is manipulated to disperse the contrast in the joint space.
- Fluoro spot images are taken
- special views may be requested by the radiologist post fluoro
What are the important radiography positioning land marks?
Iliac crest, ASIS, greater trochanter, ischial tuberosity
What is the modified axiolateral Clements nakayama method?
Trauma hip performed in case of bilateral trauma since its performed w/o moving the legs. Done for assessment of possible hip fracture or for hip prosthesis.
What is the judet method?
Done for evaluation for acetabular fracture or hip dislocations, or acetabular fracture and pelvis injury
What is the danelius Miller method?
Demonstrates entire femoral head and neck, trochanter and acetabulum. Common for trauma surgery and post surgery patients or others who cannot move leg to do frog lateral
What does Taylor method outlet and inlet demonstrate?
Outlet- symphysis pubis and ischium
Inlet- axial projections of pelvic ring
How is the danelius Miller projection performed?
Cross table lateral.
How is Clements nakayama performed?
Place IR on extended Bucky tray which puts it 2” below the table top. Tilt IR 15 degrees and center to femoral neck
How is the judet method performed?
Demonstrates acetabular fx. Place patient in 45 degree posterior OBL with both pelvis and thorax 45 degrees from tabletop. CR at level of femoral head
