Podcast
Questions and Answers
What are the three borders that form the ankle mortise?
What are the three borders that form the ankle mortise?
Which ligaments are part of the lateral ankle ligaments?
Which ligaments are part of the lateral ankle ligaments?
Achilles injuries rarely occur during sports activities.
Achilles injuries rarely occur during sports activities.
False
What is the purpose of weight-bearing views in ankle imaging?
What is the purpose of weight-bearing views in ankle imaging?
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What type of fracture involves both the lateral and medial malleolus?
What type of fracture involves both the lateral and medial malleolus?
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A dislocation of the ankle does not usually involve a fracture.
A dislocation of the ankle does not usually involve a fracture.
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What is Avascular Necrosis (AVN)?
What is Avascular Necrosis (AVN)?
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The operation to fix a dislocated ankle is called _________.
The operation to fix a dislocated ankle is called _________.
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What is the kVp setting for an AP ankle x-ray?
What is the kVp setting for an AP ankle x-ray?
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Match the types of ankle fractures to their description:
Match the types of ankle fractures to their description:
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______ is a metabolic disease where the body absorbs old bone and forms new, abnormal bone.
______ is a metabolic disease where the body absorbs old bone and forms new, abnormal bone.
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What is the tube angle for the PA Oblique Thumb?
What is the tube angle for the PA Oblique Thumb?
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What is the central ray location for the lateral thumb?
What is the central ray location for the lateral thumb?
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What is the recommended kVp for a thumb X-ray?
What is the recommended kVp for a thumb X-ray?
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Artifacts such as jewelry should be removed from the field of view before imaging.
Artifacts such as jewelry should be removed from the field of view before imaging.
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What distance should be maintained during a thumb X-ray?
What distance should be maintained during a thumb X-ray?
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Which of the following describes the anatomy that should be included in the collimation for the lateral thumb?
Which of the following describes the anatomy that should be included in the collimation for the lateral thumb?
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Before performing a thumb X-ray, the patient prep requires the removal of __________.
Before performing a thumb X-ray, the patient prep requires the removal of __________.
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What should be ensured about the finger positioning for proper lateral thumb X-ray?
What should be ensured about the finger positioning for proper lateral thumb X-ray?
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What is the grid requirement for the thumb X-ray?
What is the grid requirement for the thumb X-ray?
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What is the required posture for a PA Chest X-ray?
What is the required posture for a PA Chest X-ray?
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What is the central ray location for a PA Chest X-ray?
What is the central ray location for a PA Chest X-ray?
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What is the kVp range for an adult PA Chest X-ray?
What is the kVp range for an adult PA Chest X-ray?
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You are allowed to image another classmate in the laboratory.
You are allowed to image another classmate in the laboratory.
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What must be done before exposing radiation in the lab?
What must be done before exposing radiation in the lab?
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What is the tube angle for the Lateral Chest X-ray?
What is the tube angle for the Lateral Chest X-ray?
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What is the recommended distance for both PA and Lateral Chest X-rays?
What is the recommended distance for both PA and Lateral Chest X-rays?
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What should be included in the collimation for an AP Abdomen X-ray?
What should be included in the collimation for an AP Abdomen X-ray?
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What angle should the thumb be for PA Oblique Hand positioning?
What angle should the thumb be for PA Oblique Hand positioning?
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Markers are not necessary on X-ray images.
Markers are not necessary on X-ray images.
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For a PA Hand X-ray, the patient must hold still to avoid _____ artifacts.
For a PA Hand X-ray, the patient must hold still to avoid _____ artifacts.
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What is the central ray for a PA Finger X-ray?
What is the central ray for a PA Finger X-ray?
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For an AP Thumb X-ray, what should the patient do with their hand?
For an AP Thumb X-ray, what should the patient do with their hand?
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What type of clothing is required in the laboratory?
What type of clothing is required in the laboratory?
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Study Notes
Ankle Anatomy
- The ankle joint is a synovial hinge joint (dorsiflexion/plantar flexion).
- The mortise joint is a gliding joint between the distal ends of the tibia and fibula and the proximal end of the talus.
- The ankle mortise is formed by three borders:
- Articular facet of the lateral malleolus
- Articular facet of the medial malleolus
- Inferior articular surface of the tibia and superior margin of the talus
- The ankle includes the tibiotalar joint, subtalar joint, and distal tibiofibular joint (syndesmosis).
Ankle Ligaments
- The ankle has three main sets of ligaments:
- Medial: Deltoid ligament
- Lateral: PTFL, ATFL, and CFL
- Syndesmotic ligament
- Achilles injuries often occur during sports.
Ankle Fat Pads
- Kager fat pads are normally lucent on lateral radiographs.
- Obliteration or distortion of the fat pad borders may indicate posterior ankle pathology.
Ankle Imaging
- Potential indications for ankle imaging include trauma, pain, lumps, swelling, foreign body, deformity, loss of function, reduced range of motion, and infections.
- For ankle radiographs, remove shoes, socks, and jewelry (anklets, toe rings, etc.).
- Standard ankle radiographs include:
- AP ankle
- AP mortise oblique ankle
- Lateral ankle
- 45-degree oblique ankle
- Horizontal beam lateral ankle
Ankle Radiographic Projections
AP Ankle
- The central ray should be directed midway between the medial and lateral malleoli at the level of the malleoli.
- The cassette should be parallel to the long axis of the ankle.
- The foot should be dorsiflexed to place the long axis of the foot in a vertical position.
AP Mortise Oblique Ankle
- The central ray should be directed midway between the medial and lateral malleoli at the level of the malleoli.
- The cassette should be parallel to the long axis of the ankle.
- From the AP position, rotate the entire lower leg 15-20 degrees internally, placing the intermalleolar plane parallel to the image receptor.
Lateral Ankle
- The central ray should be directed over the medial malleolus.
- The cassette should be parallel to the long axis of the ankle.
- Roll the patient laterally onto the affected side.
Ankle Radiographic Evaluation
AP Ankle Evaluation Criteria
- Regional anatomy included (talus, proximal metatarsals, 1/3 distal tibia and fibula, including soft tissue)
- Tibiotalar joint space open
- Medial aspect of mortise joint free of superimposition
- Joint not open laterally (some overlap of fibula with tibia and talus)
- Density and contrast optimal to visualize bone and soft tissue, no motion
AP Mortise Oblique Ankle Evaluation Criteria
- Regional anatomy included (proximal metatarsals, 1/3 distal tibia and fibula, including soft tissue)
- Entire mortise joint in profile
- Lateral and medial talarmalleolar joint free of overlap
- The base of the 5th metatarsal is shown well (common fracture site)
- Density and contrast optimal to visualize bone and soft tissue, no motion
Lateral Ankle Evaluation Criteria
- Regional anatomy included (proximal metatarsals, 1/3 distal tibia and fibula, including soft tissue)
- Fibular superimposing posterior half of tibia
- Tibiotalar joint open
- Talar domes superimposed
- Lateral malleolus superimposes talus
- Calcaneus in profile
- Density and contrast optimal to visualize bone and soft tissue, no motion
Ankle Trauma
- Ankle fractures include uni-malleolar, bi-malleolar, and tri-malleolar.
- An ankle dislocation usually occurs with a fracture.
- Ankle dislocations are described by the talus displacement.
Ankle Stress Views
- Stress views assess the integrity of the syndesmosis and deltoid ligament.
- The ankle is placed into inward (inversion stress) and then outward (eversion stress) positions while in AP position.
Ankle Syndesmosis Treatment
- Syndesmosis injuries may be treated with fixation.
Avascular Necrosis (AVN) of the Ankle
- AVN can occur following an ankle fracture or dislocation.
- It is the death of bone tissue due to a loss of blood supply.
- Also known as osteonecrosis.
Ankle Surgery
- Arthroplasty = joint replacement
- Arthrodesis = joint fusion
Tibia and Fibula Anatomy
- The tibia includes the tibial plateaus, intercondylar eminences, medial and lateral tibial condyles, tibial tuberosity, and medial malleolus.
- The fibula includes the apex, head, neck, and lateral malleolus.
- The talus is also included as it articulates with the tibia and fibula.
Tibia and Fibula Joints
- The tibia and fibula articulate at the proximal and distal tibiofibular joints.
- The tibia also articulates with the femur at the medial and lateral femorotibial joints.
Tibia and Fibula Imaging
- Potential indications for imaging include trauma, acute sporting injury, pain, lumps, swelling, foreign body, infections, and previous surgery.
- Standard tibia and fibula radiographs include:
- AP tib/fib
- Lateral tib/fib
Tibia and Fibula Radiographic Projections
AP Tib/Fib
- The central ray should be directed to the mid-shaft of the lower leg proximally to include the knee joint and distally to include the ankle joint.
- The image receptor should be positioned so that both the knee and ankle joints are included.
- The patient should be supine with both legs extended and the femoral condyles parallel to the image receptor.
Lateral Tib/Fib
- The central ray should be directed to the mid-shaft of the lower leg.
- The patient should be supine with the affected leg extended.
- The patient should be rolled towards the affected leg with the knee flexed to ensure a true lateral position.
Tibia and Fibula Radiographic Evaluation
AP Tib/Fib Evaluation Criteria
- Regional anatomy included (distal femur to talus, including soft tissue)
- Ankle and knee joints included and in AP position
- Tibiotalar joint space open
- Femoral and tibial condyles should appear symmetrical
- Patella superimposed on midline of femur
- Proximal and distal fibula slightly superimposed on tibia
- Density and contrast optimal to visualize bone and soft tissue
Lateral Tib/Fib Evaluation Criteria
- Regional anatomy included (distal femur to talus, including soft tissue)
- Femoraltibial joint space
- Tibiotalar joint space
- Femoral and tibial condyles should be superimposed
- Fibular distally superimposing posterior half of tibia
- Lateral Malleolus superimposes talus
- Density and contrast optimal to visualize bone and soft tissue
Tibia and Fibula Trauma
- Fractures of the tibia and fibula are best evaluated with two views at 90 degrees to each other.
Tibia and Fibula External Fixation
- External fixation is used for:
- Complex fractures
- Temporary stabilization prior to surgical treatment
- Pediatric cases where pins could damage the growth plate
Tibia and Fibula Internal Fixation
- Internal fixation techniques include:
- Intramedullary nailing
- Pin and plate ORIF
Paget's Disease
- Paget's disease is a metabolic bone disease where the body resorbs old bone and forms abnormal new bone.
- It affects the pelvis, skull, femur, tibia, and spine.
- On imaging:
- Thickened cortex
- Coarsened trabeculae
Exostosis
- Exostosis is a benign bone tumor or developmental anomaly.
- It is an overgrowth of bone and cartilage extending from the surface.
- Often an incidental finding in teenagers.
- Grows from the epiphyseal plate parallel to the long bone.
Ewing's Sarcoma
- Ewing's sarcoma is a malignant tumor.
- Occurs in young patients (10-20 years old)
- Arises in the medullary cavity or bone marrow of long bones.
- On imaging:
- Moth-eaten
- Destructive
- Lucent lesions in the shaft of long bones
- Wide zone of transition
- Poorly defined margin
- Soft tissue component
UON X-Ray Lab Rules
- Wear TLD badges when attending labs
- Protective clothing required including UON placement uniform and enclosed footwear,
- Eating, drinking or smoking prohibited
- Only authorised personnel permitted in the lab
- Adherence to School of Health Sciences OH&S regulations
Radiation Rules
- Obtain lab tutor approval before exposing during first lab
- Never image other students
- Ensure the door is closed prior to exposure
- Ensure no students are present before exposing
- Always follow the guidance of your laboratory supervisor
PA Chest
- Posture: Erect
- Positioning: Facing upright bucky, shoulders rolled forward, head straight
- Tube Angle: Straight tube (perpendicular to anatomy)
- Central Ray: Mid-sagittal plane at level of T7 (inferior angle of scapulae)
- Distance: 180cm
- Collimation: Include lung apices to costophrenic angles, laterally to skin border
- IR (Receptor): 35x43cm Portrait or Landscape
- kVp: Adult 90-110 kVp
- mAs: Both lateral cells of AEC Estimate: 1.2 mAs
- Grid: Yes
- Instructions: Breath in and hold your breath
- Breathing: Suspended (inspiration)
PA Chest Criteria
- Collimation: Include from the apices to costophrenic angles. Include the anterior and posterior soft tissues
- Alignment: No rotation. Clavicles should be equidistant from sternum. Correct angulation places medial ends of clavicles at level of T3 vertebra
- Anatomy: Lungs, including apices, tracheal air shadow, heart, great vessels, diaphragm, costophrenic angles, bony thorax
- Density: Vertebral bodies of thoracic spine just visible through cardiac shadow
- Contrast: Lung detail clearly visualised. Soft tissue borders should be seen
- Markers: Side marker evident
- Identity: Image has appropriate identification or deliberately anonymised
Lateral Chest
- Posture: Erect
- Positioning: Left side to upright bucky, hands on head
- Tube Angle: Straight tube (perpendicular to anatomy)
- Central Ray: Mid-coronal plane at level of T7 (inferior angle of scapulae)
- Distance: 180cm
- Collimation: Include lung apices to costophrenic angles, laterally to skin border
- IR (Receptor): 35x43cm Portrait
- kVp: 90-110 kVp
- mAs: Central cell of AEC Estimate: 4 mAs
- Grid: Yes
- Instructions: Breath in and hold your breath
- Breathing: Suspended (inspiration)
Lateral Chest Criteria
- Collimation: Include from the apices to costophrenic angles. Include the anterior and posterior soft tissues
- Alignment: No rotation. Posterior ribs superimposed
- Anatomy: Lungs, trachea, heart, great vessels, diaphragm, posterior costophrenic angles, bony thorax
- Density: Vertebral bodies of thoracic spine just visible through cardiac shadow
- Contrast: Lung detail clearly visualised. Soft tissue borders should be seen
- Markers: Side marker evident
- Identity: Image has appropriate identification or deliberately anonymised
AP Abdomen
- Posture: Supine
- Positioning: Pt on back, on xray table or trolley. No rotation, with shoulders and hips equidistant from table/trolley
- Tube Angle: Straight tube (perpendicular to anatomy)
- Central Ray: Mid-sagittal plane at level of iliac crests
- Distance: 100-110cm
- Collimation: Include lung apices to costophrenic angles, laterally to skin border
- IR (Receptor): 35x43cm Portrait (landscape may be required in bariatric patients to include all relevant anatomy)
- kVp: Adult 75-80 kVp
- mAs: Lateral cells of AEC Estimate: 30-35+ mAs
- Grid: Yes
- Instructions: Breath in, breath out and hold it.
- Breathing: Suspended (expiration)
AP Abdomen Criteria
- Collimation: Superior to the diaphragm, inferiorly to the inferior pubic rami, laterally to the abdominal skin edge
- Alignment: No rotation. Ribs, crests and obturator foramen symmetrical
- Anatomy: Abdomen from diaphragm to inferior pubic rami. Liver, spleen, kidneys, gastric bubble, bowel gas, bladder, bony anatomy of lumbar spine and pelvis
- Density: Gas, soft tissue and bone adequately demonstrated
- Contrast: Soft tissue and bony contrast visualised
- Markers: Side marker evident
- Identity: Image has appropriate identification or deliberately anonymised
PA Hand
- Posture: Seated
- Positioning: Patient seated at end of xray table with legs at right angle to table, hand on image receptor
- Tube Angle: Straight tube (perpendicular to anatomy)
- Central Ray: 3rd MCP joint
- Distance: 100-110cm
- Collimation: Four sides of collimation seen to include skin edges of hand
- kVp: 50kVp
- mAs: 2mAs
- Grid: No
- Instructions: Hold still
- Breathing: N/A
PA Hand Criteria
- Collimation: Include all of required anatomy including skin edges
- Alignment: No rotation. Symmetry of phalanges and metacarpals
- Anatomy: Tips of digits to distal radius and ulna
- Density: Cortical outline and bony trabecular pattern adequately demonstrated
- Contrast: Soft tissue and bony interfaces visualised
- Markers: Side marker evident
- Identity: Image has appropriate identification or deliberately anonymised
PA Oblique Hand
- Posture: Seated
- Positioning: Patient seated at end of xray table with legs at right angle to table, hand on image receptor. Thumb side of hand raised 45 degrees
- Tube Angle: Straight tube (perpendicular to anatomy)
- Central Ray: 3rd MCP joint
- Distance: 100-110cm
- Collimation: Four sides of collimation seen to include skin edges of hand
- kVp: 50kVp
- mAs: 2mAs
- Grid: No
- Instructions: Hold still
- Breathing: N/A
PA Oblique Hand Criteria
- Collimation: Include all of required anatomy including skin edges
- Alignment: 45 degrees rotation with elevation of radial aspect of hand elevated (thumb up). Midshafts of third, fourth and fifth metacarpals should not overlap, however some overlap of distal metacarpal heads
- Anatomy: Tips of digits to distal radius and ulna
- Density: Cortical outline and bony trabecular pattern adequately demonstrated
- Contrast: Soft tissue and bony interfaces visualised
- Markers: Side marker evident
- Identity: Image has appropriate identification or deliberately anonymised
Lateral Hand
- Posture: Seated
- Positioning: Patient seated at end of xray table with legs at right angle to table, hand on image receptor. From oblique position, rotate hand to 90 degrees. Thumb is parallel to image receptor. Fingers can be superimposed or fanned to see each digit
- Tube Angle: Straight tube (perpendicular to anatomy)
- Central Ray: Level of MCP joint
- Distance: 100-110cm
- Collimation: Four sides of collimation seen to include skin edges of hand
- kVp: 55kVp
- mAs: 2.5mAs
- Grid: No
- Instructions: Hold still
- Breathing: N/A
Lateral Hand Criteria
- Collimation: Include all of required anatomy including skin edges
- Anatomy: Tips of digits to distal radius and ulna
- Density: Cortical outline and bony trabecular pattern adequately demonstrated
- Contrast: Soft tissue and bony interfaces visualised
- Markers: Side marker evident
- Identity: Image has appropriate identification or deliberately anonymised
AP Ball Catcher’s Hands
- Posture: Seated
- Positioning: Patient seated at end of xray table with both hands on the image receptor. Both hands are positioned with palms up and 45 degrees oblique rotation. Elevate radial aspect of the hands (thumbs up)
- Tube Angle: Straight tube (perpendicular to anatomy)
- Central Ray: Between hands at level of MCP joints
- Distance: 100-110cm
- Collimation: Four sides of collimation seen to include skin edges of hand
- kVp: 55kVp
- mAs: 2.5mAs
- Grid: No
- Instructions: Hold still
- Breathing: N/A
AP Ball Catcher’s Hands Criteria
- Collimation: Include all of required anatomy of both hands including skin edges
- Positioning: Midshafts of 2nd-5th metacarpals and base of phalanges should not be superimposed. MCP joints open. Thumb free of superimposition
- Anatomy: Tips of digits to distal radius and ulna
- Density: Cortical outline and bony trabecular pattern adequately demonstrated
- Contrast: Soft tissue and bony interfaces visualised
- Markers: Side markers evident
- Identity: Image has appropriate identification or deliberately anonymised
PA Finger (Digits 2-5)
- Posture: Seated
- Positioning: Patient seated at end of xray table with legs at right angle to table, hand flat on image receptor
- Tube Angle: Straight tube (perpendicular to anatomy)
- Central Ray: Level of joint in focus (PIPJ or DIPJ)
- Distance: 100-110cm
- Collimation: Four sides of collimation seen to include skin edges of finger and adjacent digits, including CMC joint
- kVp: 50kVp
- mAs: 2mAs
- Grid: No
- Instructions: Hold still
- Breathing: N/A
PA Oblique Finger Criteria
- Collimation: Include all of digit of interest including skin edges
- Anatomy: Tip of digit to distal metacarpal
- Density: Cortical outline and bony trabecular pattern adequately demonstrated
- Contrast: Soft tissue and bony interfaces visualised
- Markers: Side marker evident
- Identity: Image has appropriate identification or deliberately anonymised
Lateral Finger (Digits 2-5)
- Posture: Seated
- Positioning: Patient seated at end of xray table with legs at right angle to table
- Tube Angle: Straight tube (perpendicular to anatomy)
- Central Ray: Level of joint in focus (PIPJ or DIPJ)
- Distance: 100-110cm
- Collimation: Four sides of collimation seen to include skin edges of finger
- kVp: 50kVp
- mAs: 2mAs
- Grid: No
- Instructions: Hold still
- Breathing: N/A
Lateral Finger Criteria
- Collimation: Include all of digit of interest including skin edges
- Anatomy: Tip of digit to distal metacarpal
- Density: Cortical outline and bony trabecular pattern adequately demonstrated
- Contrast: Soft tissue and bony interfaces visualised
- Markers: Side marker evident
- Identity: Image has appropriate identification or deliberately anonymised
AP Thumb
- Posture: Seated
- Positioning: Patient seated at end of xray table. Internal rotation of hand so that thumb is AP and in contact with the image receptor
- Tube Angle: Straight tube (perpendicular to anatomy)
- Central Ray: 1st MCP Joint
- Distance: 100-110cm
- Collimation: Four sides of collimation seen to include skin edges of thumb
- kVp: 50kVp
- mAs: 2mAs
- Grid: No
- Instructions: Hold still
- Breathing: N/A
AP Thumb Criteria
- Collimation: Include all of digit of interest including skin edges
- Anatomy: Tip of thumb to trapezium
- Density: Cortical outline and bony trabecular pattern adequately demonstrated
- Contrast: Soft tissue and bony interfaces visualised
- Markers: Side marker evident
- Identity: Image has appropriate identification or deliberately anonymised
PA Oblique Thumb
- Posture: Seated
- Positioning: Patient seated at end of xray table. Hand flat on image receptor, thumb slightly abducted
- Tube Angle: Straight tube (perpendicular to anatomy)
- Central Ray: 1st MCP Joint
- Distance: 100-110cm
- Collimation: Four sides of collimation seen to include skin edges of thumb
- kVp: 50kVp
- mAs: 2mAs
- Grid: No
- Instructions: Hold still
- Breathing: N/A
PA Oblique Thumb Criteria
- Collimation: Include all of digit of interest including skin edges
- Anatomy: Tip of thumb to trapezium
- Density: Cortical outline and bony trabecular pattern adequately demonstrated
- Contrast: Soft tissue and bony interfaces visualised
- Markers: Side marker evident
- Identity: Image has appropriate identification or deliberately anonymised
Lateral Thumb
- Posture: Seated
- Positioning: Patient seated at end of xray table. Hand pronated, then arch fingers slightly to rotate thumb into lateral position
- Tube Angle: Straight tube (perpendicular to anatomy)
- Central Ray: 1st MCP Joint
- Distance: 100-110cm
- Collimation: Four sides of collimation seen to include skin edges of thumb
- kVp: 50kVp
- mAs: 2mAs
- Grid: No
- Instructions: Hold still
- Breathing: N/A
Lateral Thumb Criteria
- Collimation: Include all of digit of interest including skin edges
- Anatomy: Tip of thumb to trapezium
- Density: Cortical outline and bony trabecular pattern adequately demonstrated
- Contrast: Soft tissue and bony interfaces visualised
- Markers: Side marker evident
- Identity: Image has appropriate identification or deliberately anonymised
Hand Ball-Catcher View
- A specific radiographic projection used to visualize the hand
- Captures potential fractures in the hand, particularly the scaphoid bone
- Patient position: Elbow flexed at 90 degrees with forearm pronated and hand positioned like catching a ball
- Central ray: Perpendicular to the hand, directed to the scaphoid bone
Hand Oblique View
- A versatile radiographic projection of the hand to examine different structures based on the angle used
- Helps visualize specific bones and joints within the hand
- Patient position: Hand placed on the cassette, rotated in varying degrees for different sections of the hand
- Central ray: Perpendicular to the cassette, adjusted based on the desired angle
Abdominal X-Ray
- A common diagnostic tool used in radiology to examine the abdominal organs
- Involves exposing the abdomen to a controlled dose of radiation
- Produces images of the internal organs, including the intestines, stomach, liver, spleen, and kidneys
- Helps identify abnormalities like gas or fluid buildup, tumors, or blockages
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Description
Test your knowledge on ankle anatomy, including joint types, ligaments, and imaging techniques. This quiz covers essential aspects like the mortise joint structure, key ligaments, and indicators for imaging. Perfect for students and professionals in anatomy and sports medicine.
