Radiographic Procedures II: Unit 1 WB
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What two metatarsal bases appear overlapped in the image of the AP oblique projection, medial rotation
1 and 2
Name the tarsal bones that articulate with metatarsals
1,2,and3 cuneiforms and cuboid
*AP projection of the Leg The placement of the top border of the IR should extend at least __ inches above the knee joint to avoid being projected off by beam divergence.
1-1 1/2
processes on proximal tibia
condyles
two prominent processes on the proximal end of the tibia
condyles
abnormal twisting of the foot, usually inward and downward
congenital
known as the anterior border of the of the tibia
crest
lateral tarsal bone
cuboid
which tarsal bone is lateral from the cuneiforms
cuboid
which tarsal bone is located between the calcaneous and the fourth and fifth metatarsals
cuboid
where is the intercondylar fossa located
distal end of posterior femur between the condyles
With reference to the lower leg, how should the foot be positioned for the lateral projection?
dorsiflex the foot from 90 degree angle with the lower leg
What other projection term refers to the AP foot projection?
dorsoplantar
For the lateral projection of the fifth toe, the pt should lie in a lateral recumbent position on the unaffected side. (T/F)
false
The central ray should enter the dorasal surface of the foot for the axial projection
false
The foot should be plantar-flexed to place the long axis of the foot parallel to the IR. (T/F)
false
The lateral projection demonstrates the patella with slight overlapping with the femoral condyles. T/F
false
The patellofemoral articulation is seen in slight overlap with the anterior surfaces of the femoral condyles. T/F
false
The pt should slightly flex both knees to max the knee joint space. T/F
false
list the articulations of the tibia
femorotibial proximal tibiofibular distal tibiofibular tibiotalar
largest bone of lower limb
femur
name the largest bone of the lower limb
femur
Lateral bone of the leg
fibula
name the lateral bone of the leg
fibula
name the smaller of the bones of the leg
fibula
The plantar surface of the foot should be in conttact with the IR for the axial projection
flase
What positioning maneuver relaxes the muscles and shows the max volume of the joint cavity
flexing the knee 20-30 degrees
What types of movement do the interphalangeal joints permit?
flexion and extension
How should the pelvis be positioned to demonstrated the proximal femur
from true lateral, the pelvis should be rolled posteriorly about 10-15 degrees
hereditary form of arthritis where uric acid is depostied in joints
gout
superior, lateral process of femur
greater trochanter
To what level of the pt should the IR or collimated field be centered?
half in below the apex
What type of jiont is an interphalangeal joint?
hinge
How should the femoral neck appear in the AP projection of the proximal femur
in profile
sharp projection between the two superior articular surfaces
intercondylar eminence
what other term refers to the tibial spine
intercondylar eminence
between femoral condyles on posterior aspect
intercondylar fossa
The PA axial projection, first described by Holmblad in 1937, requires the pt to assume a __ position
kneeling
For pt comfort, which side of the foot(medial or lateral) should be placed in contact with the IR for the lateral projection
lateral
What projection of the patella should be preformed before the tangential projection is attempted
lateral
location of fibula in lower leg
lateral
which tibial condyle has a facet for articulation with the head of the fibula
lateral
Enlarged distal end of the fibula
lateral malleolus
Which projection of the calcaneus best demonstrates the sinus tarsi
lateral view
process on distal end end of tibia and fibula
malleolus
*Lateral Knee 1.The central ray should enter the pt 1 in distal to the __
medial epicondyle
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 the foot and lower leg be rotated?
medially
In which direction(medially or laterally) should the foot be rotated for the AP oblique projection to best demonstrate the cuboid and its related articulations?
medially
cushions between tibia and femur
menisci
bones of the forefoot
metatarsals
For the lateral projection of the great toe, the central ray should enter at the __ joint of the great toe.
metatarsophalangeal
Where on the medial surface of the foot should the central ray enter the calcaneus for the lateral projection
midportion of the calcaneus
alternate name of the ankle joint
mortise
If a radiographer positions the lower limb very carefully to ensure that the femoral condyles are physically superimposed, but they do not appear to be well superimposed on the radiograph, what could have cause the image to appear that way?
natural divergence of the ray
tarsal located between talus and cuneiforms
navicular
which tarsal bone is located between the talus and the cuneiforms
navicular
specifically, where is the tibial tuberosity located
on the anterior surface of the tibia, inferior from the condyles
incomplete separation or avulsion of the tibial tuberosity
osgood-schlatter disease
benign bone tumor projection with a cartilaginous cap
osteaochondroma
Lucent lesion in the metaphysis, usually at the distal femur
osteoclastoma
a benign lesion of cortical bone
osteoid osteoma
softening of the bones due to a vitamin D deficiency
osteomalacia
Where should the distal fibula be seen in images of the lateral projection of the foot?
overlapping over the posterior portion of the tibia
thick, soft bone marked by bowing clubfoot and fractures
paget disease
sesamoid that protects knee jiont
patella
What is the name of the "kneecap" and the bone classification
patella and sesamoid
For the lateral projection of the leg, how should the patella be positioned with reference to the plane of the IR-perpendicular or parallel?
perpendicular
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 degrees so that the toes are elevated above a horizontally placed IR?
perpendicular
With reference to the plane of the IR, the plantar surface of the foot should be __ for the axial projection
perpendicular
where and how should the CR by directed
perpendicular to the patellofemoral joint space
Describe how and where the central ray should be directed
perpendicular to the tib/fib at the center of the IR, entering the posterior knee
toe bones
phalanges
Identify by individual name or group the bones found in each section of the foot. Forefoot: Midfoot: Hindfoot:
phalanges and metatarsals 1,2,3 cuniform and cuboid talus and calcaneous
articular surfaces on superior tibia
plateau
avulstion fracture of the medial malleolus with the loss of the ankle mortise
pott fracture
What procedure should the radiographer perform if the leg is too long to demonstrate the knee and the ankle joint with the same exposure?
preform two AP projections to ensure that the entire lower limb is demonstrated
Describe three ways the pt can be positioned on a radiographic table for the tangential projection
prone, lateral recumbent, and standing
With what do the heads of the metatarsals articulate?
proximal phalanx
How should the lower limb be adjusted to place the patella parallel with the IR
rotate the heel 5-10 degrees laterally
How are the metatarsals identified within the foot?
starting from medial to lateral numbered 1-5
what can be done to alleviate the pressure on the patella caused by the pts weight
supports under the thigh and leg
most superior tarsal bone
talus
which tarsal bone articulates superiorly on the calcaneus
talus
which tarsal bone forms part of the ankle joint
talus
What structures and articulation should be in view in the image of AP oblique ankle
talus distal tibia distal fibula tibiofibular articulation
How many degrees and in which direction should the lower limb by rotated to demonstrate the proximal femur?
10-15 degrees medially
What is the central ray orientation if the joint spaces of the toes are of primary interest?
15 degrees posteriorly
AP oblique projection(medial rotation) of the ankle for demonstrating mortise joint From the supine position, how many degrees should the lower limb and foot be rotated to position the ankle for this projection
15-20 degrees
List names of the tarsal bones
1st/medial cuniform 2nd/intermediate cuniform 3rd/lateral cuniform navicular/scaphoid cuboid talus/astragulus calcaneous/ os calcis
Which individual toes are best demonstrated using the AP oblique projection with the foot rotated laterally?
3,4,5
Less than 18 cm 18-24 cm 25 cm or more
3-5 caudad Perpendicular 3-5 cephalic
How many bones are found in the lower limb?
30
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 degrees
How many degrees of rotation are needed to properly rotate the foot for the AP oblique projection of toes?
30-45 degrees
How many degrees and in which direction should the central ray be directed for the axial projection
40 degrees cephalic
When demonstrating the distal femur and including the knee, how many degrees should the knee be flexed
45 degrees
*AP oblique projection(medial rotation) of the ankle How many degrees and in what direction should the leg and foot be rotated?
45 degrees medially
How many degrees and in what direction should the central ray be directed in a lateral knee
5-7 degrees
Which metatarsal has a tuberosity that is prominent at its base?
5th
Identify by group name and quantity the bones found in the foot and ankle.
7 tarsals 5 metatarsals 14 phalanges
What angle should be formed between the femur and the place of the IR when the pt is correctly positioned?
70 degrees
How many interphalangeal articulations does one foot have?
9
For lateral projections of the toes, what be be done to prevent the superimposition of toes?
tape all the toes above the affected toe into a flexed position
Gonadal shielding should not be used because it may superimposed the femoral head. T/F
Flalse
With reference to the knee where is the centering point used for positioning the IR or centering the collimated field to the knee
Half inch below apex of patrlla
For lateral projections of the lesser toes, the central ray should enter at the __ jiont
Proximal interphalangeal
List three factors that should be considered when deciding whether or not to use a grid for AP projections
Size of pts knee, radiologists preference, radiographers preference
Where will the patella be located in a correctly positioned AP projection of the knee
Slightly off center to the medial side of the femur
All phalanges should be seen in the image. (T/F)
True
The bony detail of the femoral condyles should be demonstrated. T/F
True
The lateral projection should demonstrate some interosseous space between the shafts of the fibula and tibia. T/F
True
The lateral(mediolateral) projection should demonstrate the fibula over the posterier half of the tibia.(T/F)
True
The talofibular joint space should be demonstrated in profile without any bony superimposition. (T/F)
True
The AP projection should demonstrate the lateral and medial malleoli. (T/F)
Ture
Which physical condition affecting knees is often the reason that weight-bearing AP projections are performed?
arthritis
Why is the PA projection preferred over the AP projection
better recorded detail
Describe how the lesser trochanter should appear in the AP projection of the proximal femur
beyond the medial border of the femur, small portion
fluid filled cyst with a wll of fibrous tissue
bone cyst
which is the largest of the tarsal bones
calcaneous
which tarsal bone comprises the heel of the foot?
calcaneous
largest tarsal bone
calcaneus
What could occur if the pt with a healing fracture flexes the knee more than the recommended number of degrees?
the fracture may separate causing a fragment to displace
*AP oblique knee 1. How many degrees should the leg be rotated? 2. How many degrees and in what direction should the central ray be directed if the pt measures between 19-24 cm from the ASIS to tabletop 3. More than 24 cm 4. less than 19 cm 5. Where on the knee should the CR enter?
1. 45 2. perpendicular 3. 3-5 cephalic 4. 3-5 caudad 5. half in inferior to patellar apex
*Prosimal or Distal 1. trochanters 2. fibular apex 3. fibular head 4. tibial plateau 5. femoral neck 6. femoral head 7. tibial condyles 8. trochlear groove 9. tibial tuberosity 10. lateral malleolus 11. medial malleolus 12. femoral condyles 13. intercondylar fossa 14. femoral epicondyles 15. intercondylar eminence
1. P 2. P 3. P 4. P 5. P 6. P 7. D 8. D 9. P 10. D 11. D 12. D 13. D 14. D 15. P
*Medial or Lateral Oblique Rotations 1. tibial plateaus should be visualized 2. knee joint should be open and seen 3. soft tissue around the knee should be seen 4. medial femoral and tibial condyles should be demonstrated 5. lateral femoral and tibial condyles should be demonstrated 6. fibula should be superimposed over the lateral half of the tibia 7. tibia and fibula should be separated at their proximal articulation 8. bony detail of the distal femur and proximal tibia should be demonstrated 9. margin of patella should project slightly beyond the edge of the femoral lateral condyle 10. margin of the patella should project slightly beyond the edge of the femoral medial condyle
1. both 2. both' 3. both 4. lateral 5. medial 6. lateral 7. medial 8. both 9. lateral 10. medial
*Located on what leg bone 1. Apex 2. Head 3. Condyles 4. Tuberosity 5. Trochanters 6. Trochlear Groove 7. Medial malleolus 8. lateral malleolus 9. intercondylar fossa 10. intercondylar eminence
1. fibula 2. femur and fibula 3. femur and tibia 4. tibia 5. femur 6. femur 7. tibia 8. fibula 9. femur 10. tibia
*Articulations 1. Knee 2. Ankle 3. Intertarsal 4. Interphalageal 5. Tarsometatarsal 6. Distal tibiofibular 7. Prosimal tibiofibular 8. metatarsophalangeal
1. flexion, extension 2.flexion, extensin 3. gliding 4. flexion, extension 5. flexion, extension, abduction, adduction 6. syndesmosis 7. gliding 8. flexion, extension, abduction, adduction
*Femur 1. large, rounded eminence on the superior end 2. constricted portion just inferior from the head 3. two large eminences on the distal end 4. shallow, triangular area on the anterior surface between the condyles 5. large, prominent process superior and lateral on the shaft 6. deep depression between the condyles
1. head 2. neck 3. condyles 4. pateller surface 5. greater trochanter 6. intercondylar fossa
*Lateral Projection 1. With reference to the plane of the IR, the patella should be __ 2. The knee should be flexed __ degrees 3. When a new or healing fracture is present, the knee should be flexed no more than __ degrees
1. perpendicular 2. 20-30 3. 10
*AP axial: camp-coventry method 1. What pt body position should be used when performing this projection? 2. Approximately how many degrees should the knee be flexed? 3. What should the radiographer do to make maintaining the proper flexion of the knee more comfortable for the pt? 4. The CR should be directed perpedicular to the long axis of the __ 5. How many degrees and in what direction should the CR be directed 6. What factor determines the number of degrees the CR should be angled
1. prone 2. 40 or 50 3. rest pt foot on a support 4. leg(tibia) 5. 40-50 caudad 6. the mat of knee flexion
Describe the three ways pts can be positioned.
1. standing with flexed affected knee relaxing horizontal on IR 2. pt standing with affected knee flexed and in contact with vertical IR 3. kneeling on radiographic table with affected knee of IR
The knee should be flexed no more than __ degrees
10
How should the central ray be directed to best demonstrate tarsometatarsal joints with a dorsoplantar projection?
10 degrees posteriorly
What projection of the foot best demonstrates the lateral tarsals with the least superimposition of sructures?
AP oblique projection, medial rotation
What projection for toes noramally does not demonstrate open interphalangeal joints?
AP projection of the toes with the central ray directed perpendicular
On an image of a correctly positioned AP projection of the knee, the patella should be demonstrated where
Completely superimposed on the femue
What determines the number of degrees the central ray is angled
Degree of flexion of the knee
A radiograph of the lateral (mediolateral) malleolus free from superimposition by the talus
False
The AP projection of the leg should demonstrate the fibula without any overlapping with the tibia. T/F
False
The bases of metatarsals should be included within the image for AP oblique projections. (T/F)
False
What procedure should the radiographer perform if the pt is unable to turn from the supine position toward the affected side to position the fractured leg on the IR for the lateral projection?
a cross table lateral by placing IR between the pts leg and directing CR horizontal to the leg
What might occur if the pt flexes the knee more than the recommended number of degrees
a reduction in the femoropatellar joint space
Concerning the IR placement field location. a) to what level on the pt should the upper border of an IR or collimated field be placed when demonstrating the proximal femur, and b) to what level of the pt should the lower border of the IR or collimated field be placed when demonstrating the distal femur
a)level of ASIS b) 2 inches below knee
Concerning the placement of the unaffected limb, a) where should it be placed when demonstrating the proximal femur, and b) where should it be placed when demonstrating the distal femur
a)posterior to affected theigh b)anterior
Describe how the IR should be placed
against the anterior surface of the knee and centered to the patellar apex
What portion of an orthopedic appliance should be demonstrated on the radiograph
all of it
How do images indicate that a pt has a torn ligament affectin the ankle?
an increase in joint space on the side of the injury indicates a torn ligament
Assuming that the ASIS to tabletop measurement for the pt is greater than 24 cm describe how you believe the central ray was directed to produce the image.
angled 3-5 degrees cephalad
conical projection at the head of the fibula
apex
With reference to the position of the pts leg an 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
Why is it preferable to place the pt in the prone position for the tangential projection
the knee can usually be flexed to a greater degree and immobilization is easier
How can the pt hold the foot in the stress position during AP stress studies?
the pt may be instructed to pull and strip bandage that is looped around the foot
For AP oblique projections, the central ray should enter the foot at the __ joint
third metatarsophalangeal
medial lower leg bone
tibia
the larger of the two bones of the leg
tibia
name the two bones of the leg.
tibia and fibula
two joints in the lower leg
tibiofibular
Why should the lower limb be rotated
to place in anatomic position and put the femoral neck in view
Why is dorsiflexion of the foot required for the lateal projection?
to prevent lateral roatation of the ankle
Why is the central ray cephalic for a lateral projection
to prevent the joint space from being obscured by magnified shadow of femoral condyle
TO what point of the foot should the central ray be directed toward for AP and AP axial projections?
to the base of the third metatarsal
State the purpose of performing AP stress studies of the ankle
to verify the presence of a ligamentous tear
Both knees should be demonstrated without rotation. T/F
true
For the lateral projection of the great toe, the pt should lie in a lateral recumbent position on the unaffected side. (T/F)
true
Interphalangeal and metatarsophalangeal joint spaces should appear open. (T/F)
true
The femoral condyles should appear superimposed. T/F
true
The lateral side of the affected knee should be in contact with the table or IR. T/F
true
The patella should be seen in profile. T/F
true
The tuberosity and base of the fifth metatarsal should be demonstrated as a lateral projection radiograph of the ankle. (T/F)
true
How should the pelvis be positioned to demonstrate the distal femur
true lateral
two peaklike processes arising from the intercondylar eminence
tubercles
prominent process on the anterior surface of the tibia; just below the condyles
tuberosity
What should the radiographer do to demonstrate a complete calcaneous if the anterior portion of the calcaneus is not seen in the image without it causing excessive radiographic density to the posterior portion when the calcaneus is demonstrated in the axial projection
two images performed to completely demonstrate the entire calcaneus
