Merrill's ch. 6 Lower Limb
What is the appropriate collimated field size for the AP projection of the foot?
1 inch of all sides, including 1 inch beyond the calcaneus and distal tip of the toes
AP projection leg: The placement of the top border of the IR should extend at least _________inches ___________cm above the knee joint to avoid being projected off by beam divergence
1-1.5" ; 2.5-3.8 cm
Which tarsal bone is located between the calcaneus and the fourth and fifth metatarsal?
cuboid
Which bones articulate distally with the tarsal navicular?
cuneiforms
How many degrees and in what direction should the central ray be directed for the AP axial projection of the foot?
10° cephalad (toward the heel)
How should the central ray be directed for the best demonstration of the tarsometatarsal joint spaces of the midfoot for the AP projection of the foot?
10° posteriorly (toward the heel)
How should the central ray be directed for best demonstration of tarsometatarsal joint's with a dorsoplantar projection?
10° posteriorly - toward that heel
How many and what kind of bones compromise the foot and ankle?
14 phalanges 5 metatarsals 7 tarsals
Mortise joint: from the supine position how many degrees should the lower limb and but be rotated to position the ankle for this projection
15 to 20°
How many degrees and in which direction should the foot and leg be rotated for the best demonstration of the mortise joint for the AP oblique projection of the ankle?
15 to 20° medially
What is the central ray orientation if the joint spaces of the toes are a primary interest?
15° posteriorly-toward the heel
For the lateral projection of the knee, how many degrees should the knee be flexed?
20 to 30°
How many bones are found in one lower limb?
30
How many degrees and in what direction should the foot be rotated for the AP oblique projection of The foot?
30 degrees medially
How many degrees of rotation are needed to rotate the fit properly for the AP oblique projection of toes?
30 to 45°
How many degrees and in what direction should the foot be rotated for the AP oblique projection for the best demonstration of the great toe?
30 to 45° medially
How many degrees and in what direction should the foot be rotated for the AP oblique projection to demonstrate the second toe?
30 to 45° medially
For the AP oblique projection, the leg should be rotated medially until the plantar surface of the foot forms an angle of _________with the IR.
30°
How many degrees and in what direction should the central ray be directed for the axial (plantodorsal) projection of the calcaneus?
40° cephalad
How many degrees and in what direction should the leg and foot be rotated in the AP oblique projection medial rotation of the ankle
45° medially
How many degrees and in what direction should the central ray be directed for the lateral projection of the knee?
5 to 7° cephalad
How many degrees of angulation should be performed between the femur and the radiographic table for the PA axial projection (Holmblad method) of the knee?
70°
How long should the collimated field be for the AP and AP oblique projections of the ankle?
8 inches
A. Apex fibula B. Fibular head C. Lateral condyle D. Intercondyle E. Medial condyle F. Tuberosity G. Fibular body H. Tibial body I. Lateral malleolus J. Medial malleolus
Anterior aspect of a tibia and fibula
Which bones articulate with the metatarsals?
Cuneiforms and cuboid
Mid foot bones
Cuneiforms, cuboid, navicular
Define the articulations of the tibia
Femorotibial Proximal tibiofibular Distal tibiofibular Tibiotalar
Location: Trochlear groove Femur, tibia, fibula?
Femur
Location: into condylar fossa Femur, tibia, fibula?
Femur
Location: trochanter's Femur, tibia, fibula?
Femur
Name the largest bone of the limb
Femur
Location: Head Femur, tibia, fibula?
Femur and fibula
Location: condyles Femur, tibia, fibula?
Femur and tibia
Lateral bone of the leg
Fibula
Lateral lower leg bone
Fibula
Location: Apex
Fibula
Location: lateral malleolus Femur, tibia, fibula?
Fibula
Name of the lateral bone of the leg
Fibula
Name the smaller of the bones of the lower leg
Fibula
Which metatarsal has a tuberosity that is prominent at its base?
Fifth metatarsal
What two metatarsal spaces appear overlapped in the image of the AP oblique projection medial rotation?
First and second
For the lateral projection of the patella, which positioning maneuver reduces the femoropateller joint space?
Flexing the knee more than 10°
Joint Movements: Interphalangeal Gliding, flexion, extension, abduction, adduction, circumduction, rotational (around a single axis), syndesmosis (slight movement)
Flexion and extension
Joint Movements: ankle Gliding, flexion, extension, abduction, adduction, circumduction, rotational (around a single axis), syndesmosis (slight movement)
Flexion and extension
Joint Movements: knee Gliding, flexion, extension, abduction, adduction, circumduction, rotational (around a single axis), syndesmosis (slight movement)
Flexion and extension
What types of movement do the interphalangeal joint's permit?
Flexion and extension
Joint Movements: metatarsophalangeal Gliding, flexion, extension, abduction, adduction, circumduction, rotational (around a single axis), syndesmosis (slight movement)
Flexion, extension, abduction, adduction
Joint Movements: tarsometatarsal Gliding, flexion, extension, abduction, adduction, circumduction, rotational (around a single axis), syndesmosis (slight movement)
Flexion, extension, abduction, adduction
Which individual toes are best demonstrated using the A&P oblique projection with the foot rotated laterally
Fourth and fifth sometimes third
Joint Movements: Intertarsal Gliding, flexion, extension, abduction, adduction, circumduction, rotational (around a single axis), syndesmosis (slight movement)
Gliding
Joint Movements: proximal tibiofibular Gliding, flexion, extension, abduction, adduction, circumduction, rotational (around a single axis), syndesmosis (slight movement)
Gliding
Which type of joint is the proximal tibiofibular joint?
Gliding
Hereditary form of arthritis in which uric acid is deposited in joints
Gout
Femur - large prominent process superior and lateral on the shaft
Greater trochanter
Superior lateral process of femur
Greater trochanter
Femur - large round in Eminence on the superior and
Head
What is the most distal part of a metatarsal?
Head
What type of joint is an interphalangeal joint?
Hinge
Which type of joint is the ankle joint?
Hinge
For the lateral projection of the great toe the CR should enter at the _________joint of the great to
IP
How do you images indicate that the patient has a torn ligament affecting the ankle in the AP stress study
Increased joint space on the side of the injury indicates a torn ligament
Tib/fib-Sharp projection between the two superior articular surfaces
Intercondylar eminence
What other term refers to the tibial spine
Intercondylar eminence
Between the moral condyle's on posterior aspect
Intercondylar fossa
Femur - deep depression between the condyles
Intercondylar fossa
Which articulation of the foot is a gliding type joint?
Intertarsal
A. Anterior cruciate ligament B. Lateral meniscus C. Fibular collateral ligament D. Trochlear groove E. Posterior cruciate ligament F. Medial meniscus G. Tibial collateral ligament H. Fibula
Knee joint A. Anterior aspect with knee flexed B. Posterior aspect
A. Medial meniscus B. Anterior cruciate ligament C. Articulate cartilage D. Posterior cruciate ligament E. Lateral meniscus F. Femur G. Synovial fluid H. Meniscus I. Patella J. Tibia
Knee joint A. Superior surface of tibia B. Sagittal section
For patient comfort, which side of the foot medial or lateral should be placed in contact with the IR for the lateral projection
Lateral
Which projection of the calcaneus best demonstrates the sinus tarsi
Lateral
Which tibial condyle has a facet for articulation with the head of the fibula
Lateral
Which bone articulate mediately with the cuboid?
Lateral Cuneiform
Where on the femur is the greater trochanter located?
Lateral and superior
1. Medial and lateral Talor domes are not super imposed. Fibula is to posterior to the tibia 2. The toes should have been elevated more to place the plantar surface parallel with the IR and superimpose the malleoli better.
Lateral ankle with improper positioning 1. Why does this image not meet evaluation criteria? 2. How would you correct this error?
A. Right tibia B. Talus C. Calcaneus D. Navicular E. Medial cuneiform F. First metatarsal G. Sesamoid bones H. Phalanges I. Metatarsals J. Tarsals
Lateral aspect of a foot Define:
A. Tuberosity B. Anterior crest C. Tibial body D. Lateral condyle E. Apex F. Head of the fibula G. Fibular body H. Medial malleolus I. Lateral malleolus
Lateral aspect of a tibia and fibula
1. Talus and tibiotalar joint are not included in the collimated field 2. Collimated field should have been 1 inch above medial malleolus
Lateral foot with error 1. Why does this projection not meet criteria? 2. How should this have been corrected?
1. Perpendicular-magnified shadow of the medial femoral condyle obscures the femorotibial joint space 2. A,B,E
Lateral knee with improper positioning 1. What CR and elation was most likely use to make this image? 2 circle the three evaluation criteria for lateral projection that this image does not meet A. The femoropatellar space should be open. B. The femoral condyles should be superimposed. C. The knee should be flexed approximately 20 to 30°. D. The fibular head and to be a should be slightly superimposed. E. The joint space between femoral condyles and tibia should be open.
Enlarged distal end of the fibula
Lateral malleolus
Which projection of the foot should demonstrate the metatarsals nearly superimposed on each other?
Lateral projection
Which projection of the knee best demonstrates the femoropatellar space open?
Lateral projection
Which projection of the knee should be used to demonstrate the patella in profile?
Lateral projection
For which lower limb projection should the pelvis be rotated 10 to 15° from true lateral?
Lateral projection of the proximal femur
With which structure does the head of the fibula articulate?
Lateral tibial condyle
For AP oblique projections, the CR should enter the foot at the ________ joint
MTP
Which cuneiform is the largest cuneiform?
Medial
Where on the femur is the lesser trochanter located?
Medial and posterior
What are the names of the tarsal bones?
Medial cuneiform, intermediate cuneiform, lateral cuneiform, navicular, cuboid, Talus, calcaneus
Large process at the distal end of the tibia
Medial malleolus
Name the large bony process that extends both medially and inferiorly from the distal end of the tibia
Medial malleolus
For the AP oblique projection demonstrating all of the toes, which way (medially or laterally) should be foot and lower leg be rotated?
Medially
In which direction (mediately or laterally) should the foot be rotated for the AP oblique projection for best demonstration of the cuboid and it's related articulations
Medially
Cushions between tibia and femur
Menisci
Bones of the forefoot
Metatarsals
Which bones articulate distally with the three cuneiforms?
Metatarsals
Forefoot bones:
Metatarsals and phalanges
Which articulation is an ellipsoid-type joint?
Metatarsophalangeal
Alternative name of the ankle joint
Mortise
Lateral projection leg: if a radiographer positions the lower limb very carefully to ensure that the femoral condyle's are physically superimposed but they do not appear to be well superimposed on the image what could have caused the image to appear that way
Natural divergence of the beam may prevent the femoral condyle's from appearing superimposed
Tarsal located between talus and Cuneiforms
Navicular
Which tarsal bone is located between the talus and the cuneiforms?
Navicular
Which tarsal bone is located on the medial side of the foot between the talus and the three cuneiforms?
Navicular
Which bones comprise the midfoot?
Navicular, cuboid, and cuneiforms
Femur -constricted portion just inferior from the head
Neck
How many interphalangeal articulations does 1 foot have?
Nine
Can you see the interphalangeal joints? How was the central ray angled?
No Perpendicular (joint spaces are not clearly seen) Image of the toes
How are metatarsals identified within the foot?
Numbered 1-5 from medial to lateral
Where specifically is the tibial tuberosity he located?
On the anterior surface of the tibia, just inferior from the condyles
Incomplete separation or avulsion of the tibial tuberosity
Osgood-Schlatter disease
Benign bone tumor projection with a cartilaginous cap (exostosis)
Osteochondroma
Lucent lesion in the metaphysics, usually at the distal femur
Osteoclastoma (giant cell tumor)
A benign lesion of cortical bone
Osteoid osteoma
Softening of the bones (rickets) as a result of a vitamin D deficiency
Osteomalacia
Where should the patella be demonstrated on the image of the AP oblique projection of the knee with lateral rotation?
Over the lateral femoral condyle
Where should the patella be demonstrated on the image of the AP oblique projection of the knee with medial rotation?
Over the medial condyle of the femur
Which of the following projections of the knee best demonstrates the intercondylar fossa?
PA axial projection (Holmblad method)
Axial (plantodorsal) calcaneus A. Sustenacalulum tali B. Trochlear process C. Plantar process D. Tuberosity
Projection and bones?
Lateral ankle A. Tibia B. Fibula C. Tibiotalar (MORTISE) joint D. Talus E. Navicular F. Cuboid G. Calcaneus
Projection and bones?
Lateral calcaneus A. Tibiotalar joint (MORTISE) B. Sinus tarsi C. Tuberosity D. Talus E. Navicular F. Systentaculum tali
Projection and bones?
Lateral foot A. Phalanges B. Metatarsals C. Fibula D. Tibia E. Tibiotalar joint (MORTISE joint) F. Navicular G. Talus H. Sinus tarsi I. Calcaneus J. Tarsals
Projection and bones?
Lateral tibia and fibula A. Patella B. Femur C. Tibia D. Fibula
Projection and bones?
AP knee A. Femur B. Patella C. Lateral epicondyle D. Lateral condyle E. Lateral tibial plateau F. Intercondyle eminence G. Head of fibula H. Fibula I. Medial epicondyle J. Medial condyle K. Medial tibial plateau L. Tibia 1. 3-5 degrees cephalad
Projection and bones? 1. Assuming that the ASIS to table top measurement for this patient is greater than 10 inches (24cm), how was the central ray Ingold in this image?
AP oblique knee 45 degree medial rotation A. Patella B. Medial femoral condyle C. Lateral femoral condyle D. Medial tibial plateau E. Lateral tibial plateau F. Medial tibial condyle G. Lateral tibial condyle H. Tibiofibular articulation I. Fibula J. Tibia
Projection and define?
Pa axial intercondylar fossa A. Patella B. Lateral femoral condyle C. Intercondyle fossa D. Medial femoral condyle E. Medial tibial spine F. Lateral tibial spine G. Tibia H. Fibula
Projection and define?
Proximal or distal; Femoral head
Proximal
Proximal or distal; Intercondylar eminence
Proximal
Proximal or distal; fibular Apex
Proximal
Proximal or distal; fibular head
Proximal
Proximal or distal; tibial condyles
Proximal
Proximal or distal; tibial plateau
Proximal
Proximal or distal; tibial tuberosity
Proximal
Proximal or distal; trochanters
Proximal
With what do the heads of metatarsals articulate?
Proximal phalanges
Where in the foot is the tuberosity that is easily palpable?
Proximal portion of the fifth metatarsal
Where are the tibial plateaus located?
Proximal tibia
Where is the intercondylar eminence located?
Proximal tibia
Which joint is formed by the articulation of the head of the fibula with the lateral condyle of the tibia?
Proximal tibiofibular
Which positioning maneuver should be performed to place the femoral neck in profile for the AP projection of the proximal femur?
Rotate the lower limb medially 10 to 15°
Which positioning maneuver should be performed to prevent the femoral neck from appearing for-shortened in the AP projection of the proximal femur?
Rotate the lower limb medially 10 to 15°
Which bone classification are tarsals?
Short
What part of the patella is the base?
Superior border
Joint Movements: distal tibiofibular Gliding, flexion, extension, abduction, adduction, circumduction, rotational (around a single axis), syndesmosis (slight movement)
Syndesmosis
Which articulation should be seen in profile with the AP oblique projection (medial rotation) of the ankle?
Talofibular
It's tarsal bone articulates superiorly on the calcaneus?
Talus
Most superior tarsal bone
Talus
What tarsal bone is the most superior tarsal bone?
Talus
Which bone articulates with the superior surface of the calcaneus?
Talus
Which tarsal bone forms part of the ankle joint
Talus
With what bone does the undersurface of the tibia articulate?
Talus
Which two tarsal bones articulate with each other by way of three facets?
Talus in calcaneus
Location: medial malleolus Femur, tibia, fibula?
Tibia
Location: tuberosity Femur, tibia, fibula?
Tibia
Medial lower leg bone
Tibia
Tib/fib-The larger of the two bones of the leg
Tibia
Name the two bones of the lower leg
Tibia and fibula
Two joints in the lower leg
Tibiofibular
Why is Dorsiflexion Of the foot required for the lateral (mediolateral) projection of the ankle
To prevent lateral rotation of ankle
Where should the central ray be directed for the AP oblique projection of the foot?
To the base of the third metatarsal
What is the purpose of performing AP stress studies of the ankle when pertaining to AP projections stressed method
To verify a presence of a ligamentous tear
Where should the central ray be directed for the lateral projection of the calcaneus?
Toward the midpoint of the calcaneus
Which part of the talus articulates with the distal tibia?
Trochlea
Lateral projection leg: True or false the lateral projection should demonstrate some interosseous space between the shafts of the fibula and tibia
True
Mortise joint: True or false the Talofibular joint space should be demonstrated in profile without any super in position with the AP oblique projection medial rotation
True
True or false ankle-the lateral (mediolateral) projection should demonstrate the fibula over the posterior half of the tibia
True
True or false for the lateral projection of the great toe the patient should lie in the lateral recumbent position on the unaffected side
True
True or false interphalangeal and metatarsophalangeal joint spaces should appear open
True
True or false the AP projection should demonstrate the joint space between the medial malleolus and the talus without any overlapping of structures in the AP projection of the ankle
True
True or false the tibiotalar joint must be seen in the lateral projection of the foot
True
True or false the tuberosity and base of the fifth metatarsal should be demonstrated as a lateral projection image of the ankle
True
True or false. All phalanges should be seen in the image of AP oblique projection
True
For the lateral projection of the femur, how should the pelvis be positioned to demonstrate only the knee joint with the distal femoral shaft?
True lateral
Which of the following evaluation criteria indicates that the knee is properly positioned for a lateral projection?
Tthe femoral condyles are superimposed
Tib/fib-Two peak like processes are rising from the intercondylar eminence
Tubercles
Prominent process on the anterior surface of the tibia; just below the condyles
Tuberosity
Which term refers to the prominent process on the anterior surface of the proximal tibia that is just inferior to the condyles?
Tuberosity
Where are the tibial plateaus located? a. Distal tibia b. Distal femur c. Proximal tibia d. femur
c. Proximal tibia
1. Lateral proximal femur A. Femoral head B. Femoral neck C. Lesser trochanter D. Ischial tuberosity E. Femoral body 3. From true lateral, the pelvis should be rolled posteriorly about 10 to 15° 4. True lateral 5. At the level of the ASIS 6. 2 inches below the knee
1. Projection 2. Define 3. How should the pelvis be positioned to demonstrate the proximal femur? 4. How should the pelvis be positioned to demonstrate the distal femur? 5. What level on the patient should the upper border of an IR or collimated field be placed when demonstrating the proximal femur? 6. What level of the patient should the lower border of the IR/collimated field be placed when demonstrating the distal femur?
1. Tangential patella, Settegast method. 2. Define A. Patella B. Patellofemoral articulation C. Lateral femoral condyle D. Medial femoral condyle E. Fibula
1. Projection? 2. Define
1. AP proximal femur A. Acetabulum B. Femoral head C. Greater trochanter D. Femoral neck E. Lesser trochanter F. Femoral body 3. Not foreshortened (in profile) 4. The lesser trochanter should not to be seen beyond the medial border of the femur or only a very small portion of the lesser trochanter should be seen.
1. Projection? 2. Define 3. How should femoral neck appear in the AP projection of the proximal femur? 4. How should the lesser trochanter appear in the AP projection of the proximal femur?
1. PA axial intercondylar fossa, camp-Coventry method 2. Prone 3. 40-50 degrees 4. The amount of knee flexion 5. perpendicular to the long axis of the tibial(leg)
1. Projection? 2. Which PT body position should be used when performing this projection? 3. How may degrees should knee be flexed? 4. What factor determines the number of degrees the CR should be angled? 5. How should the CR be directed?
1. PA patella 2. Pa projection provides greater recorded detail because OID is closer than AP. 3. Use supports under the patients thigh and leg to remove pressure from the patella 4. Rotate the heel 5 to 10° laterally
1. Projection? 2. Why is the PA projection preferred over the AP projection? 3. What can be done to alleviate the pressure of the patella caused by PT's weight? 4. How should the lower limb be adjusted to place the patella parallel with the IR?
1. The Femorotibial joint space is not fully open 2. Angulation of central ray is not correct probably angled perpendicular or more than 3-5 degrees cephalad
1. What is wrong with this image? 2. How did the positioning procedure effect this image?
Which of the following projections for toes normally does NOT demonstrate open interphalangeal joint A. AP projection of the toes with the central ray directed perpendicular B. AP axial projection of the toes with a CR angulation of 15° C. AP axial projection of the toes with a 15° foam wedge in the central ray directed perpendicular
A. AP projection of the toes with the CR directed perpendicular
1) Moderate overlapping of the talus with the distal tibia, which obscures the MORTISE (tibiotalar) joint. Some overlap of medial talomalleolar articulation 2) foot was plantar flexed rather than dorsiflexed (evidenced by the appearance of the tarsals and the bases of the metatarsals)
AP ankle with improper positioning 1. Why does image not meet evaluation criteria? 2. What position in error most likely produced this image?
Which projection of the foot best demonstrates the cuboid and it's articulations?
AP oblique (medial rotation)
1. The talofibular joint (mortise) is not open most likely too much internal rotation of the lower leg.
AP oblique ankle, medial rotation, improper positioning. 1. why does this not meet evaluation criteria?
Which projection of the ankle best demonstrates the talofibular joint space free from bony superimposition?
AP oblique projection (medial rotation)
Which projection of the foot best demonstrates most of the tarsals with the least amount of superimposition?
AP oblique projection (medial rotation)
Which projection of the foot best demonstrates the bases of the fourth and fifth metatarsals free from superimposition?
AP oblique projection (medial rotation)
Which projection of the foot best demonstrates the sinus tarci?
AP oblique projection (medial rotation)
Which projection of the knee best demonstrates the proximal tibiofibular articulation without bony superimposition?
AP oblique projection (medial rotation)
The toes are not separated from each other
AP oblique toes with improper positioning
Which projection of the knee should be used to demonstrate the patella completely superimposed on the femur?
AP projection
For which lower limb projection should the lower limb be rotated medially 10 to 15°?
AP projection of the proximal femur
Which projection of the ankle should be performed for the best demonstration of a ligamentous tear?
AP projection with inversion
Which projection of the knee best demonstrates the femorotibial joint space open if the patient measures more than 10 inches (24cm) between the ASIS and tabletop?
AP projection with the central ray angled 3 to 5° cephalad
Yes 15 degrees posteriorly ( toward the toes)
AP toes Are the IP joints open? What degree was the central ray angled?
On which border of the tibia is the Crest located?
Anterior
A. Neck B. Lesser trochanter C. Body D. Medial epicondyle E. Medial condyle F. Head G. Greater trochanter H. Lateral epicondyle I. Lateral condyle J. Trochlear groove
Anterior aspect of a femur
Anterior aspect of the foot A. Phalanges B. Metatarsals C. Tarsals D. Medial cuneiform E. Intermediate cuneiform F. Lateral cuneiform G. Navicular H. Cuboid I. Talus J. Calcaneus K. DIP Joint second digit right foot L. PIP joint third digit right foot M. Distal phalanx fifth digit N. Middle phalanx fifth digit O. Proximal phalanx fifth digit P. MTP joint (metatarsophalangeal joint) Q. Tuberosity fifth metatarsal right foot R. Sesamoid bones right foot
Anterior aspect of the foot Define:
Conical projection at the head of the fibula
Apex
What structure is located on the proximal end of the fibula?
Apex
What term refers to the inferior tip of the patella?
Apex
Which structure is located on the head of the fibula?
Apex
Where exactly is the intercondylar fossa located
At the distal end of the posterior femur between the condyle's
Where should the central ray enter for the lateral projection of the ankle?
At the medial malleolus
Where on the medial surface of the foot should be central ray enter the calcaneus for the lateral projection
At the mid portion of the calcaneus 1 inch distal to the medial malleolus
Which to projections comprise the typical series that best demonstrates the calcaneus?
Axial (plantodorsal) and lateral projections
At which level on the plantar surface should the central ray enter the foot for the axial (plantodorsal) projection of the calcaneus?
Base of the third metatarsal
Where in the foot are the cuneiforms are located?
Between the navicular and the metatarsals
Fluid - filled cyst with a wall of fibrous tissue
Bone cyst
Which is the largest of the tarsal bones?
Calcaneus
Which tarsal bone is the largest of the tarsal bones?
Calcaneus
How can the patient hold the food in the stress position during AP stress studies
Call on a strip of bandage that's looped around the foot
For a patient prone on the radiographic table with the knee centered to the midline and the knee flexed until the lower leg forms a 40° angle with the table, how should the central ray be directed to demonstrate the femoral intercondylar fossa?
Caudally 40°
Hind foot bones
Chalice and calcaneus
Processes on proximal tibia
Condyle's
Femur - two large eminences on the distal end
Condyles
Which femoral structures articulate with the tibia?
Condyles
To prominent processes on the proximal end of the tibia
Condyls
Abnormal twisting of the foot, usually in word and down word
Congenital
Known as the anterior border of the tibia
Crest
Which term refers to the sharp ridge on the anterior border of the tibia?
Crest
Which tarsal bone is lateral from the cuneiforms?
Cuboid
Which tarsal bone is located on the lateral side of the foot between the calcaneus and the fourth and fifth metatarsal?
Cuboid
Name the tarsal bones that articulate with metatarsals
Cuneiforms and cuboid
How many degrees and in what direction should the central ray be directed for the AP axial projection of the toes? A. 10° caudad (towards the toes) B. 10 degrees cephalad (toured the heel) C. 15 degrees caudad (toward the toes) D. 15 degrees cephalad (toward the heel)
D. 15° cephalad (toward that heel)
What projection of the foot best demonstrates the lateral tarsals with the least superimposition of structures A. AP projection B. AP axial projection C. AP oblique projection - lateral rotation D. AP oblique projection - medial rotation
D. AP oblique projection - medial rotation
With which structure does the head of the femur articulate? A. Condyles B. Tubercles C. Trochanters D. Acetabulum
D. Acetabulum
Where is the fovea capitis located? A. Distal tibia B. Distal femur C. Proximal tibia D. Proximal femur
D. Proximal femur
Define DIP TMT MTP IP
DIP- distal interphalangeal TMT - tarsometatarsal MTP - metatarsophalangeal IP - interphalangeal
A. Phalanges B. Sesamoid C. Metatarsals D. DIP joint E. distal phalanx F. Middle phalanx G. PIP joint H. Proximal phalanx I. MTP (metatarsophalangeal joint)
Define
AP oblique knee 45 degree lateral rotation A. Femur B. Patella C. Medial femoral condyle D. Lateral femoral condyle E. Lateral tibial plateau F. Medial tibial plateau G. Medial tibial condyle H. Fibula I. Tibia
Define and projection?
Lateral knee A. Femur B. Femoral condyle C. Patella D. Tibial plateau E. Tibia F. Fibula
Define and projection?
Which positioning factor determines the number of degrees the central ray should be angled for the tangential projection (Settegast method) to demonstrate the patella?
Degree of knee flexion
What should be done to prevent the knee joint space from being obscured by the magnified shadow of the medial femoral condyle when the lateral projection of the knee is performed?
Direct the central ray 5-7° cephalad
Proximal or distal; Intercondylar fossa
Distal
Proximal or distal; femoral condyle's
Distal
Proximal or distal; femoral epicondyles
Distal
Proximal or distal; lateral malleolus
Distal
Proximal or distal; medial malleolus
Distal
Proximal or distal; trochlear groove
Distal
Where is the Intercondylar fosse located?
Distal femur
Where is the lateral malleolus located in the leg?
Distal fibula
Where is the medial malleolus located in the leg?
Distal tibia
With reference to the lower leg how should the foot be positioned for the lateral projection
Dorsiflex The foot to form a 90° angle with the lower leg
What other projection term refers to the AP projection A. Axial B. Plantodorsal C. Dorsoplantar
Dorsoplantar
What other projection term refers to the AP projection of the foot?
Dorsoplanter
What procedural compensation is required for the plantodorsal axial projection of the calcaneus when the patient cannot dorsiflex the foot sufficiently to place the plantar surface vertical?
Elevate the leg on sandbags to achieve the correct position
Regardless of the condition of the patient, which positioning maneuver should be performed to position the foot for the lateral projection?
Ensure that the plantar surface is perpendicular to the IR
True or false. The basis of metatarsals should be included within the image for AP oblique projection's
False - distal and should be seen
True or false an image of the lateral (mediolateral) ankle projection should demonstrate the lateral malleolus free from superimposition by the talus
False - distal fibula will appear superimposed with the Telus
True or false the plantar surface of the foot should be in contact with the IR for the axial plantodorsal projection
False - heel in contact with IR
AP projection leg: True or false the leg should demonstrate the fibula without any overlapping with the tibia
False - proximal and distal articulations of tibia and fibula should have moderate overlapping
Mortise joint: AP oblique projection medial rotation True or false the foot should be plantar flexed to place the long axis of the foot parallel with the IR
False -. Foot should be dorsiflexed with long axis perpendicular to IR
True or false the CR should enter the dorsal surface of the foot for the axial Plantodorsal projection
False Dash CR should enter plantar surface
True or false the AP projection of the ankle should demonstrate the distal third of the fibula without super imposition with the talus or tibia
False-Some overlapping of the distal fibula with talus and tibia is expected
Which structure of the knee is best demonstrated with the PA axial projection (the Holmblad method)?
Femoral intercondylar fossa
For which projection of the knee should the patient be prone on the table, with the knee flexed until the leg forms an angle of 40° with the table, and the central ray directed perpendicular to the long axis of the leg, entering the back side of the knee?
PA axial projection (camp-Coventry method)
Which of the following projections of the knee best demonstrates the femoral intercondylar fossa?
PA axial projection (camp-Coventry method)
Which projection of the knee can be accomplished with the patient upright, the affected knee flexed and its anterior surface in contact with a vertically placed IR, and the horizontally directed central ray entering the posterior aspect of the knee?
PA axial projection (holmblad method)
For lateral projections on the lesser toes the CR should enter at the _______ joint
PIP
Thick, soft Bone marked by bowing club foot and fractures
Paget disease
With reference to the plane of the IR, how should the malleoli be positioned for the AP oblique projection of the ankle for the best demonstration of the mortise joint spaces open?
Parallel
Sesamoid that protects need joint
Patella
Which structure of the knee is best demonstrated with the tangential projection?
Patella
What is the name of the kneecap and it's bone classification?
Patella, sesamoid
Femur - shallow, triangular area on the anterior surface between the condyles
Patellar surface
Lateral projection leg: what procedure should the radiographer perform if the patient is unable to turn from the supine position toward the affected side deposition a fractured leg on the IR for the lateral projection
Perform a cross table lateral projection by placing an IR vertically between the patients legs and directing the CR horizontally to the leg
For the AP projection of the femur on typical adults, what should be done to ensure that both joints of the femur are demonstrated?
Perform a second exposure with another IR
AP projection leg: what should the radiographer do if the leg is too long to demonstrate the knee and the ankle joint with the same exposure
Perform two AP projections to ensure that the entire lower limb is demonstrated
How should the central ray be directed to demonstrate toes when the plantar surface of the affected foot is in contact with a foam wedge, which should be inclined 15° so that the toes are elevated above a horizontally placed IR?
Perpendicular
Lateral projection leg: should the patella be positioned perpendicular or parallel with reference to the plane of the IR
Perpendicular
How and toward what centering point should the central ray be directed for the AP oblique projection to demonstrate all five toes?
Perpendicular to the third metatarsophalangeal joint
How should the central ray be directed for the AP projection of the femur?
Perpendicularly
How should the central ray be directed for the bilateral weight-bearing AP projection of the knees?
Perpendicularly
Articular surfaces on superior tibia
Plateaus
Which area of the knee should the central ray enter for the PA axial projection (Holmblad method)?
Posterior
A. Greater trochanter B. Head C. Neck D. Lesser trochanter E. Body F. Lateral epicondyle G. Lateral condyle H. Medium epicondyle I. Medial condyle J. Intercondylar fossa
Posterior aspect of a femur
Avulsion fracture of the medial malleolus with the loss of the ankle mortise
Pott fracture
AP ankle A. Fibula B. Tibiotalar (MORTISE) joint C. Lateral malleolus D. Tibia E. Medial malleolus F. Talus
Projection and bones?
AP axial foot A. MTP joint first phalanx B. TMT (tarsometatarsal) joint C. Medial cuneiform D. Navicular E. Phalanges F. Metatarsals G. Tarsals H. Cuboid
Projection and bones?
AP oblique ankle, medial rotation A. Fibula B. Lateral malleolus C. Tibia D. Medial malleolus E. Tibiotalar (MORTISE) joint F. Talus
Projection and bones?
AP oblique foot, medial rotation A. Medial cuneiform B. Intermediate cuneiform C. Metatarsals D. Tuberosity of the fifth metatarsal E. Lateral cuneiform F. Cuboid G. Calcaneus H. Navicular I. Talus J. Sinus tarsi
Projection and bones?
AP tibia and fibula A. Femur B. Knee joint C. Head of fibula D. Fibula E. Tibia F. Lateral malleolus
Projection and bones?
From the following list define the structures and articulation that should be demonstrated in the image of the AP oblique ankle A. Talus B. Cuboid C. Calcaneus D. Distal tibia E. Distal fibula F. Tibiofibular articulation G. Femorotibial articulation H. Metatarsophalangeal articulation I. Talofibular articulation
Talus, distal tibia, distal fibula, tibiofibular articulation
For lateral projections of the toes what can be done to prevent the super imposition of toes
Tape all toes above the affected toe into a flexed position
Toward what point of the foot should the CR be directed for AP and AP axial projections
The base of the third metatarsal
Where should the distal figure I'd be seen in images of the lateral projection of the foot?
The distal fibula should overlap the posterior portion of the tibia
Which of the following evaluation criteria indicates that the knee is properly positioned for the AP projection?
The femorotibial joint space is open
Mortise joint: with reference to the position of the patient's leg and foot during the procedure how is it determined that the leg has been rotated the correct number of degrees
The intermalleolar plane should be parallel with the IR
When performing the axial (plantodorsal) projection, what should the radiographer do to demonstrate a complete calcaneus if the anterior portion of the calcaneus is not seen in the image with the same brightness as the posterior portion?
Two images should be taken to demonstrate the entire calcaneus completely
Location: Intercondylar eminence Femur, tibia, fibula?
tibia
