Bontrager Chapter 6 Workbook

What is the name of the small prominence located on the posterolateral aspect of the medial condyle of the femur that is an identifying landmark to determine possible rotation of a lateral knee?

Adductor tubercle

Which anatomic structure on the posterior femur can be used to determine if a rotation error (over-rotation or under-rotation) is present on a lateral knee radiograph?

Adductor tubercle on posterolateral aspect of the medial femoral condyle

The most proximal aspect of the fibula is the ______________.

Apex or styloid process

What type of CR angulation is required for the PA axial weight-bearing projection (Rosenberg method)? A. None. CR is perpendicular B. 10 degrees caudad C. 10 degrees cephalad D. 5 to 7 degrees cephalad

B. 10-degree caudad

How much flexion is recommended for a lateral projection of the knee to best demonstrate the patellofemoral joint space? A. No flexion B. 20 to 30 degrees C. 30 to 35 degrees D. 45 degrees

B. 20 to 30 degrees

What is the recommended CR angulation for an AP projection of the knee for a patient with thick thighs & buttocks (i.e., measuring greater than 24 cm)? A. 3 to 5 degrees caudad B. 3 to 5 degrees cephalad C. CR perpendicular to IR D. CR perpendicular to patellar plane

B. 3 to 5 degrees cephalad

What is the recommended CR placement for a lateral knee position on a tall, slender male patient with a narrow pelvis (without support of the lower leg)? A. 5 to 10 degrees caudad B. 5 degrees cephalad C. CR perpendicular to IR D. CR perpendicular to patellar plane

B. 5 degrees cephalad

The calcaneus articulates with the: A. Navicular B. Cuboid C. Medial (first) cuneiform D. Lateral (third) cuneiform

B. Cuboid

With a true lateral projection of the ankle, the lateral malleolus is: A. Projected over the anterior aspect of the distal tibia B. Projected over the posterior aspect of the distal tibia C. Directly superimposed over the distal tibia D. Directly superimposed over the medial malleolus

B. Projected over the posterior aspect of the distal tibia

Situation: A radiograph of a mediolateral knee projection demonstrates that the medial femoral condyle is projected inferior to the lateral condyle. What can the technologist do to correct this problem during the repeat exposure?

By angling the CR 5 to 7 degrees cephalad, the medial femoral condyle will be superimposed with the lateral condyle. If CR angulation was used on the initial projection, increase the amount of angle with the repeat exposure. The technologist could also elevate the ankle & lower limb to same plane as the long axis of femur.

Which joint surface of the ankle is not typically visualized with a correctly positioned AP projection of the ankle? A. Medial aspect of joint B. Superior aspect of joint C. Lateral aspect of joint D. All of the listed aspects of the joint are visualized

C. Lateral aspect of joint

What is the best modality to examine ligament injuries to the knee? A. CT B. Nuclear Medicine C. MRI D. Ultrasound

C. MRI

The articular facets slope _________ degrees posteriorly in relation to the long axis of the tibia. A. 25 B. 45 C. 35 D. 10 to 20

D. 10 to 20

How much flexion of the knee is required for the PA axial weight-bearing projection (Rosenberg method)? A. 20 to 30 degrees B. 35 to 40 degrees C. 5 to 10 degrees D. 45 degrees

D. 45 degrees

Which projection of the ankle best demonstrates a possible fracture of the lateral malleolus & the base of the fifth metatarsal?

45-degree AP oblique with medial rotation

Where is the CR centered for an AP projection of the knee? A. 1/2 inch distal to apex of patella B. 1 inch proximal to apex of patella C. Midpatella D. Level of tibial tuberosity

A. 1/2 inch distal to apex of patella

Fill in the # of bones for the following: A. Phalanges B. Metatarsals C. Tarsals D. Total

A. 14 B. 5 C. 7 D. 26

How much part flexion is required for the following methods? A. Hughston method B. Settegast method

A. 55 degrees B. 90 degrees

List the 4 major ligament of the knee

A. Fibular (lateral) collateral B. Tibial (medial) collateral C. Anterior cruciate D. Posterior cruciate

A Lisfranc injury involves the: A. Foot B. Ankle C. Calcaneus D. Distal femur

A. Foot

What are two differences in the phalanges of the foot as compared with the phalanges of the hand?

A. Foot phalanges are smaller B. Joint movements are more limited in foot

Which of the following special projections of the knee best demonstrates the intercondylar fossa? A. Holmblad B. Merchant C. AP weight-bearing, bilateral projections D. Settegast

A. Holmblad

What are the other names for the patellar surface of the femur?

A. Intercondylar sulcus B. Trochlear groove

List the two arches of the foot

A. Longitudinal B. Transverse

What are the two palpable bony landmarks found on the distal femur?

A. Medial epicondyle B. Lateral epicondyle

List the correct terms for the following joints: A. Between the patella & distal femur B. Between the two condyles of the femur & tibia

A. Patellofemoral B. Femorotibial

List the three specific articular facets found in the middle of the subtalar/talocalcaneal joint.

A. Posterior B. Middle C. Anterior

Which of the following special projections of the knee must be performed erect? A. Rosenberg method B. Camp-coventry method C. Settegast method D. Hughston method

A. Rosenberg method

List the 2 bursae found in the knee joint

A. Suprapatellar bursa B. Infrapatellar bursa

Which large tendon attaches to the tuberosity of the calcaneus?

Achilles

Tarsal bone: Articulates with the second, third, and fourth metatarsal

Lateral (third) cuneiform

The extreme distal end of the fibula forms the _____________.

Lateral malleolus

Which projection places the foot into a more natural, true lateral position: mediolateral or lateromedial?

Lateromedial

Radiographic appearance: Osteoarthritis

Narrowed, irregular joint surfaces with sclerotic articular surfaces

Tarsal bone: Found on the medial side of the foot between the talus and the three cuneiforms

Navicular

Situation: A radiograph of a lateral patella shows that the patella is drawn tightly against the intercondylar sulcus. Which positioning modification should be performed to improve the quality of the image during the repeat exposure?

Decrease the amount of flexion of the knee to only 5 to 10 degrees

Radiographic appearance: Osteomalacia

Decreased bone density & bowing deformities of weight-bearing limbs

True/False: A 20-degree flexion of the knee forces the patella firmly against the patellar surface of the femur.

False

True/False: A kV range for digital imaging is typically lower as compared with analog kV ranges.

False

True/False: It is recommended that obese patients be allowed to wear pants for lower limb radiography.

False

True/False: The AP stress projections are performed to demonstrate stress fractures of the distal fibula.

False

True/False: The medial malleolus is approximately 1/2 inch posterior to the lateral malleolus.

False

True/False: The posterior surface of the patella is normally rough.

False

True/False: With careful & close collimation, gonadal shielding does not have to be used during lower limb radiograph.

False

True/False: The cuboid articulates with four bones of the foot.

False; 5

Structure to bone: Neck

Fibula

Structure to bone: Styloid process

Fibula

A small, triangular depression located on the tibia that helps form the distal tibiofibular joint is called the _______.

Fibular notch

Situation: A radiograph of an AP oblique with medial rotation of the knee to demonstrate the proximal fibula shows that there is total superimposition of the proximal tibia and the fibula. What must be modified to correct this projection?

The wrong oblique position of the knee was obtained. This description is that of a laterally or externally oblique position of the knee.

Structure to bone: Articular facets

Tibia

Structure to bone: Fibular notch

Tibia

Structure to bone: Intercondyloid eminence

Tibia

Structure to bone: Medial malleolus

Tibia

Structure to bone: Tibial plafond

Tibia

The articular facets of the proximal tibia are also referred to as the _____________.

Tibial plateau

What is the name of the large prominence located on the mid-anterior surface of the proximal tibia that serves as a distal attachment for the patellar tendon?

Tibial tuberosity

Why should AP, 45-degree oblique, & lateral ankle radiographs include the proximal metatarsals?

To demonstrate a possible fracture to the fifth metatarsal tuberosity (a common fracture site)

True/False: A foot with a high, anterior arch may require an increase of CR to 15 degrees posteriorly.

True

True/False: The AP stress projections of the ankle must have a physician or health care professional stress the ankle during exposures.

True

True/False: The patella acts as a pivot to increase the leverage of a large muscle found in the anterior thigh.

True

True/False: The recommended SID for lower limb radiography is 40 inches (102 cm).

True

True/False: The recommended SID is 48 inches (123 cm) to 72 inches (183 cm) for the tangential (bilateral Merchant) projection.

True

True/False: To place the interepicondylar line parallel to the IR for a PA projection of the patella, the lower limb must be rotated approximately 5 degrees internally.

True

True/False: With digital radiography, it is recommended that the anatomy should be centered to the IR.

True

Which tuberosity of the foot is palpable and is a common site of foot trauma?

Tuberosity @ the base of the 5th metatarsal

Dorsiflexion

decreasing the angle between the dorsum pedis and the anterior lower leg

What is the largest and strongest tarsal bone?

calcaneus

Reiter's syndrome

condition affecting the sacroiliac joints & lower limbs of young men, especially the posterosuperior margin of the calcaneus

Plantar flexion

extending the ankle or pointing the foot & toe downward

For which large muscle does the patella serve as a pivot to increase the leverage?

Quadriceps femoris muscle

Rotation can be determined on a radiograph of an AP foot projection by the near-equal distance between the __________ metatarsals.

Second to fifth

Situation: A radiograph obtained by using the PA axial (Camp-Coventry method) shows that the distal femoral condyles, articular facets, & intercondylar fossa are asymmetric. What possible positioning errors might have produced this distortion of the anatomy?

Rotation of the affected limb or incorrect CR angle to match the degree of flexion of the lower limb

Joint Classification or Movement Type: Ankle Joint

Saddle (sellar)

Joint Classification or Movement Type: Patellofemoral

Saddle (sellar)

Which calcaneal structure should appear medially & profiled on a well positioned plantodorsal (axial) projection?

Sustentaculum tali

Tarsal bone: Forms an aspect of the ankle joint

Talus

Tarsal bone: The most superior tarsal bone

Talus

Tarsal bone: The second largest tarsal bone

Talus

Which projection is best for demonstrating the sesamoid bones of the foot?

Tangential

Where are the sesamoid bones of the foot most commonly located?

plantar surface of the head of the 1st metatarsal

Osgood-Schlatter disease

inflammatory condition involving the anterior, proximal tibia

Gout

inherited type of arthritis that commonly affects males

Lisfranc joint injury

injury to a large ligament located between the bases of the first & second metatarsal

Inversion (varus)

inward turning or bending of ankle

Chondrosarcoma

malignant tumor of cartilage

What is the name of the joint found between the talus and calcaneus?

subtalar/talocalcaneal

Ewing's sarcoma

most prevalent primary bone malignancy in pediatric patients

The small opening, or space, found in the middle of the subtalar/talocalcaneal joint is called the

sinus tarsi/tarsal sinus

Eversion (valgus)

outward turning or bending of ankle

Tarsal bone: A tarsal found anterior to the calcaneus and lateral to the lateral (third) cuneiform

Cuboid

Tarsal bone: Articulates with the first metatarsal

Medial (first) cuneiform

Tarsal bone: The largest of the cuneiforms

Medial (first) cuneiform

For the AP oblique projection of the knee, the __________ rotation (medial [internal] or lateral [external]) best visualizes the lateral condyle of the tibia & the head & neck of the fibula.

Medial (internal)

Projection? Patient supine with 40-degree knee flexion & 30-degree caudad CR angle from horizontal

Merchant method

Which projections of the ankle require forced inversion & eversion movements?

AP stress projections

Joint Classification or Movement Type: Knee joint (femorotibial)

Bicondylar

Situation: A physician orders a bilateral, tangential projection of the patella & patellofemoral joint spaces. But the patient is restricted to a wheelchair & cannot lie on the radiographic table because of chronic pain. Which projection could be performed with the patient remaining in the wheelchair?

The superoinferior sitting tangential method is best suited for this patient. While remaining in the wheelchair, the patient's knees can be flexed, the IR can be positioned on a footstool, & the CR is placed vertically above the knees.

Radiographic appearance: Gout

Uric acid deposits in joint spaces

Radiographic appearance: Bone cyst

Well-circumscribed lucency

The three bones of the ankle joint surface form a deep socket into which the talus fits. This socket is called the

"open" mortise joint

Where is the CR placed for a mediolateral projection of the calcaneus?

1" inferior to medial malleolus

How much (if any) should the foot & ankle be rotated for an AP mortise projection of the ankle?

15 to 20 degrees medially

The foot should be dorsiflexed so that the plantar surface of the foot is ___________degrees from vertical for the sesamoid projection.

15-20

How much CR angle from the long axis of the femora is required for the tangential (Merchant method) bilateral projection?

30 degrees from horizontal

How should the CR be angled from the long axis of the foot for the plantodorsal axial projection of the calcaneus?

40 degrees cephalad

How much flexion of the lower leg is required for the PA axial projection (Camp-coventry method) when the CR is angled at 40 degrees caudad?

40-degree flexion

How much flexion of the knee is recommended for a lateral projection of the patella?

5 to 10 degrees

Why is it important to include the knee joint for an initial study of tibia trauma, even if the patient's symptoms involve the middle & distal aspect?

A fracture may also be present at the proximal tibia or fibula in addition to the distal portion.

Which special projection of the knee is best to evaluate the knee joint for cartilage degeneration or deformities?

AP or PA weight-bearing knee projections

The distal tibial joint surface forming the roof of the distal ankle joint is called the: A. Tibial plafond B. Articular facet C. Tibial plateau D. Ankle mortise

A. Tibial plafond

Which three bones make up the ankle joint?

A. tibia B. fibula C. talus

Paget's disease

AKA osteitis deformans

Which type of study should be performed to best evaluate the condition of the longitudinal arches of the foot?

AP & Lateral weight-bearing projections

What is the basic positioning routine for a study of the tibia & fibula?

AP & lateral projections

Situation: A patient with a possible Lisfranc joint injury comes to the radiology department. Which radiographic position(s) best demonstrate(s) this type of injury?

AP & lateral weight-bearing foot projections

Situation: A patient with a history of pain in the feet comes to the radiology department. The referring physician orders a study to evaluate the longitudinal arches of the feet. Which positioning routine should be used?

AP & lateral weight-bearing projections of the foot.

Which oblique projection of the foot best demonstrates the navicular & the first & second cuneiforms with minimal superimposition?

AP oblique with lateral rotation

Which oblique projection of the the foot best demonstrates the majority of the tarsal bones?

AP oblique with medial rotation

Joint Classification or Movement Type: Distal tibiofibular

Amphiarthrodial (syndesmosis type)

Situation: A patient with trauma to the medial aspect of the foot comes to the emergency room. A heavy object was dropped on the foot near the base of the first metatarsal. Basic foot projections do not clearly demonstrate this region. What other projections of the foot could be used to delineate this area better?

An AP lateral oblique projection with 30 degrees of external rotation will separate the bases of the first & second metatarsals & separate the first & second cuneiforms

Situation: A patient with a history of degenerative disease of the left knee joint comes to the radiology department. The orthopedic surgeon orders a radiographic study to determine the extent of damage to the joint space. Which projection(s) should be performed?

An AP or PA weight-bearing bilateral knee projections will best evaluate the joint spaces.

Situation: A radiograph of an AP knee projection demonstrates that the femorotibial joint space is not open at all. The patient is young & has no history of degenerative disease. What type of positioning modification may improve the outcome of this projection?

Angling the CR correctly to keep it parallel to the articular facets (tibial plateau)

Radiographic appearance: Reiter's syndrome

Asymmetric erosion of joint spaces with calcaneal erosion

Where is the CR centered for an AP oblique projection of the foot?

Base of 3rd metatarsal

Why must the central ray be angled 5 to 7 degrees cephalad for a lateral knee position?

Because the medial condyle extends lower or more distally than the lateral condyle of the femur

To include both joints for a lateral projection of the tibia & fibula for an adult, the technologist may place the IR __________ in relation to the part. A. Parallel B. Perpendicular C. Diagonal D. Transverse

C. Diagonal

How much knee flexion is required for the PA axial projection (Holmblad method)? A. 45 degrees B. 35 degrees C. 60 to 70 degrees D. None. Lower limb is fully extended

C. 60 to 70 degrees

Which basic projection of a knee best demonstrates the proximal fibula free of superimposition? A. True AP B. True lateral C. AP oblique, 45-degree medial rotation D. AP oblique, 45-degree lateral rotation

C. AP oblique, 45-degree medial rotation

The slightly raised area located on the posterolateral aspect of the medial femoral condyle is called the: A. Trochlear tubercle B. Anterior crest C. Adductor tubercle D. Tibial tuberosity

C. Adductor tubercle

Situation: A radiograph of an AP projection of the foot shows that the metatarsophalangeal joints are not open & the metatarsals are somewhat foreshortened. But there is equal spacing between the mid metatarsals. What positioning error was involved, & what modification should be made to improve this image on the repeat exposure?

CR is not angled correctly; adjust CR angle to keep it perpendicular to metatarsals (anterior arch of foot).

Tarsal bone: Common site for bone spurs

Calcaneus

Projection? Patient prone with 40- to 50-degree knee flexion & equal 40- to 50-degree caudad CR angle

Camp-coventry method

The formal name for "runner's knee" is

Chrondromalacia patellae

How much knee flexion is required for the horizontal beam lateral patella projection? A. 5 or 10 degrees B. 15 to 20 degrees C. 25 or 30 degrees D. None

D. None

What type of CR angle is required for the PA projection (Holmblad method)? A. 10 degrees caudad B. 10 degrees cephalad C. 15 to 20 degrees cephalad D. None. CR is perpendicular to IR

D. None. CR is perpendicular to IR

What type of CR angle is required for the superoinferior sitting tangential method for the patella? A. 40 degrees cephalad B. 5 to 10 degrees caudad C. Depends on degree of flexion D. None. CR is perpendicular to IR

D. None. CR is perpendicular to IR.

Structure to bone: Lateral epicondyle

Distal femur

Structure to bone: Patellar surface

Distal femur

Why are PA Axial projections for the intercondylar fossa recommended instead of AP axial projections (Beclere method)?

Distortion caused by poor CR to IR alignment & increased OID for AP axial projection

Radiographic appearance: Osgood-Schlatter disease

Fragmentation or detachment of the tibial tuberosity

Projection? IR is placed on a footstool to minimize the OID

Hobbs modification

Projection? Can be performed using a wheelchair or lowered radiographic table

Holmblad method (variation)

Projection? Patient prone with 55-degree knee flexion & 45-degree cephalic CR angle

Hughston method

Radiographic appearance: Ewing's sarcoma

Ill-defined area of bone destruction with surrounding "onion peel"

Which positioning error(s) is (are) present if the distal borders of the femoral condyles are not superimposed on a radiograph of a lateral knee on an average-sized knee (more than one answer possible)?

Improper angle of the CR or lack of support of the lower leg to keep entire lower limb in same place.

Situation: A radiograph of a plantodorsal (axial) projection of the calcaneus shows considerable foreshortening of the calcaneus. What type of positioning modification is needed on the repeat exposure?

Increase cephalad angle of the CR to correctly elongate the calcaneus

Projection? Patient supine with cassette resting on midthighs

Inferosuperior for patellofemoral joint

What is the name of the depression located on the posterior aspect of the distal femur?

Intercondylar fossa or notch

Situation: A patient with bony, loose bodies (or "joint mice") within the knee joint comes to radiology for a knee series. The AP & lateral knee projections fail to demonstrate any loose bodies. What additional knee projection can be taken to better demonstrate them?

Intercondylar fossa projections, including the PA axial projections (Holmblad, Rosenberg, &/or Camp-Coventry methods) demonstrate the entire knee joint intercondylar fossa region, which may be hiding "joint mice"

Which positioning line or plane is parallel to IR for an AP mortise projection of the ankle?

Intermalleolar line or plane

Tarsal bone: The smallest of the cuneiforms

Intermediate (second) cuneiform

The crescent-shaped fibrocartilage disks that act as shock absorbers in the knee joint are called

Medial & Lateral menisci

Why is the CR angled 10-15 degrees toward the calcaneus for an AP projection of the toes?

Opens up IP & MTP joint spaces

Why should the CR be perpendicular to the metatarsals for an AP projection of the foot?

Opens up metatarsophalangeal & certain intertarsal joints

Which positioning error is present if the posterior portions of the femoral condyles are not superimposed on a mediolateral knee radiograph?

Over-rotation (toward the IR) or under-rotation of the knee (away from the IR).

Situation: A radiograph of an AP oblique-medial rotation projection of the foot shows that the proximal third to fifth metatarsals are superimposed. What type of positioning error led to this radiographic outcome?

Over-rotation of foot (toward the medial direction)

Structure to bone: Base

Patella

What is the name of the largest sesamoid bone in the body?

Patella

Joint Classification or Movement Type: Proximal tibiofibular

Plane (gliding)

Joint Classification or Movement Type: Tarsometatarsal

Plane (gliding)

The general region of the posterior knee is called the ___________.

Popliteal region

Situation: A radiograph of an AP projection of the ankle shows that the lateral surface of the ankle joint is totally open. (It should not be open on a true AP projection.) The technologist is positive that the ankle was in the correct, true AP position with the long axis of the foot perpendicular to the IR. What else could have led to this joint space being open?

Possibly a spread of the ankle mortise caused by ruptured ligaments

Situation: A radiograph of an AP & lateral tibia & fibula shows that the ankle joint is not included on the AP projection, but both the knee & the ankle are included on the lateral projection. What should the technologist do in this situation?

Repeat the AP projection to ensure the ankle joint is demonstrated

What is another term for osteomalacia?

Rickets

Projection? Patient prone; requires 90-degree knee flexion

Settegast method

Radiographic appearance: Osteoid osteoma

Small, round/oval density with lucent center

Situation: A young male patient comes to the radiology department with a clinical history of Osgood-Schlatter disease. Which single projection of the basic knee series will best demonstrate this condition?

The lateral knee projection will best demonstrate any separation of the tibial tuberosity from the shaft of the tibia

Situation: A tangential (Inferosuperior) projection of the patellofemoral joint space shows that the patella is seated into the intercondylar sulcus & the joint space is not demonstrated. What possible positioning errors might have produced this radiographic outcome?

The most common error with the tangential (inferosuperior) projection is overflexion of the knee, which draws the patella into the intercondylar sulcus. Flexion of the lower limb should not exceed 45 degrees. Another possible error is that the CR is not parallel to the joint space.

Situation: A radiograph of a lateral recumbent knee shows that the posterior border of the medial femoral condyle (identified by the adductor tubercle) is not superimposed but is slightly posterior to the lateral condyle. The fibular head is also completely superimposed by the tibia. What type of positioning error led to this radiographic outcome?

Under-rotation of knee (excessive rotation of patella away from the IR)

Situation: A radiograph of an intended AP mortise projection shows that the lateral malleolus is superimposed over the talus, & the distal tibiofibular joint is not well demonstrated. What is the most likely reason for this radiographic outcome?

Under-rotation of the ankle (toward the medial direction). The described appearance is that of a true AP ankle with little or not obliquity.

Osteoid osteoma

benign bone lesion usually developing in teens or young adults

Exostosis

benign, neoplastic bone lesion cause by overproduction of bone at a joint

Bone cyst

benign, neoplastic bone lesion filled with clear fluid

The ankle joint is classified as a synovial joint with _______-type movement.

saddle (sellar)

The _________ is the weight-bearing bone of the lower leg.

tibia