Radiographic Projection Techniques Quiz

Questions and Answers

What is the correct central ray (CR) orientation for the Isherwood Method in the lateromedial oblique projection?

10 degrees cephalad

5 degrees anterior

Perpendicular to the image receptor (correct)

15 degrees caudal

Which position is recommended for the patient when performing the AP axial oblique projection?

Prone

Standing

Supine

Seated or semi-lateral recumbent (correct)

What is the degree of medial rotation for the foot in the lateromedial oblique projection?

45 degrees (correct)

15 degrees

60 degrees

30 degrees

In the AP axial oblique projection, what is the required angle for dorsiflexion of the foot?

Dorsiflexed Signup and view all the answers

What anatomical structure is primarily visualized in the lateromedial oblique projection?

Anterior subtalar articulation Signup and view all the answers

What characterizes Pott’s fracture?

Avulsion fracture of the medial malleolus. Signup and view all the answers

What is the primary indicator of Gout?

Uric acid deposition in joints. Signup and view all the answers

Chondromalacia Patellae is often referred to as?

Runner's knee. Signup and view all the answers

What is the central ray direction (CR) for the Broden method's lateral rotation projection?

15 degrees cephalad Signup and view all the answers

Which projection uses a 15° posterior angulation for the central ray?

AP/AP axial projection. Signup and view all the answers

In the Broden method's medial rotation setup, how should the foot be positioned?

Dorsiflexed with a 45-degree medial rotation Signup and view all the answers

What is the purpose of the lateral projection for the ankle?

To provide a true lateral view of the joint Signup and view all the answers

What is the primary feature of Hallux Valgus?

Congenital deviation of the great toe. Signup and view all the answers

What is the suggested positioning of the leg for the AP axial oblique projection in the Broden method?

Supine with leg and foot rotated 45 degrees medially Signup and view all the answers

What is the main goal of performing the Kite method for congenital clubfoot?

Visualize ossification centers of tarsals. Signup and view all the answers

What type of injury characterizes a Lisfranc Injury?

Abnormal separation of the metatarsals. Signup and view all the answers

What anatomy is projected in the Broden method at 20-30 degrees cephalad?

Sustentaculum tali articulation Signup and view all the answers

During an AP projection of the ankle, how is the patient's leg positioned?

Supine with foot vertical and rotated 5 degrees medially Signup and view all the answers

What does the lateral projection primarily visualize?

Entire foot in profile. Signup and view all the answers

What is the recommended relationship between the central ray (CR) and the ankle joint in the AP projection?

CR should be perpendicular to the ankle joint Signup and view all the answers

Which projection is specifically useful for localizing foreign bodies in the foot?

AP/AP axial projection. Signup and view all the answers

What specific area is assessed when performing the lateromedial projection of the ankle?

Medial surface of the foot Signup and view all the answers

In which method is the foot medial border positioned perpendicular to the IR?

Holly method. Signup and view all the answers

What is indicated by the term 'Joint Effusion'?

Fluid accumulation in the joint cavity. Signup and view all the answers

What angle is specifically noted in the evaluation of Bohler’s critical angle?

20-40° Signup and view all the answers

Which injury is predominantly associated with the base of the fifth metatarsal?

Jones fracture. Signup and view all the answers

What is the required position for performing a medial rotation AP oblique projection of the ankle?

Supine, leg rotated 45 degrees medially Signup and view all the answers

What is the central ray (CR) direction for a lateral projection of the ankle?

Perpendicular to ankle joint Signup and view all the answers

What is demonstrated in the SS for AP oblique projection with medial rotation?

Mortise joint and distal ends of tibia and fibula Signup and view all the answers

Which projection is effective for evaluating ligamentous tears and joint separation?

Stress method AP projection Signup and view all the answers

In the weight-bearing method, what is the positioning of the feet?

Heels against the IR, toes toward the x-ray tube Signup and view all the answers

For lateral projections of the leg, what positioning is required regarding the femoral condyles?

Condyles parallel to the IR Signup and view all the answers

How much should the leg and foot be rotated for a lateral rotation ankle projection?

45 degrees laterally Signup and view all the answers

What is the main purpose of performing the AP projection of the leg?

To visualize the tibia and fibula as well as the knee and ankle joints Signup and view all the answers

For which reason is the intermalleolar line positioned parallel to the image receptor in the medial rotation projection?

To demonstrate the mortise joint effectively Signup and view all the answers

What is the reference point (RP) for the lateral projection of the ankle?

Midway between the malleoli Signup and view all the answers

What is the purpose of rotating the knee 45-55 degrees medially during the PA oblique projection?

To free the medial portion of the patella from the femur Signup and view all the answers

In the lateral projection, how should the knee be positioned to maximize the volume of the joint cavity?

Flexed 20-30 degrees Signup and view all the answers

What is the recommended central ray angle for the Hughston Method?

45 degrees cephalad Signup and view all the answers

Which projection involves elevating the hip 2-3 inches while the knee is rotated 35-40 degrees laterally?

Kuchendorf Method Signup and view all the answers

What angle should the knee be flexed to when performing the Sunrise Method?

40-45 degrees Signup and view all the answers

What is a disadvantage of the Settegast Method?

Requires acutely flexing the knee Signup and view all the answers

Which position should the patient be in for the lateral projection of the femur?

Lateral recumbent with affected side against IR Signup and view all the answers

In the AP projection of the femur, what degree of internal rotation is recommended for the proximal femur?

10-15 degrees inward Signup and view all the answers

What is the central ray orientation when performing the PA axial oblique projection using the Kuchendorf Method?

25-30 degrees caudad Signup and view all the answers

What is the primary focus during the Merchant Method?

Assessing patellar disorders Signup and view all the answers

What should the patient's leg look like in the translateral projection?

Vertically against the medially placed IR Signup and view all the answers

For which method is flexing the knee until the patella is perpendicular to the IR specifically indicated?

Settegast Method Signup and view all the answers

What anatomical structure is primarily visualized in the lateral projection of the knee?

Patellofemoral joint space Signup and view all the answers

Study Notes

Pathology

Congenital Clubfoot (Talipes equinovarus): Abnormal foot twisting usually inward and downward.
Pott’s Fracture: Avulsion fracture of the medial malleolus resulting in loss of ankle mortise.
Jones Fracture: Avulsion fracture at the base of the fifth metatarsal.
Gout: Hereditary arthritis characterized by uric acid deposition in joints.
Osgood-Schlatter Disease: Incomplete separation or avulsion of the tibial tuberosity.
Giant Cell Tumor (Osteoclastoma): Lucent lesion in the metaphysis, commonly at the distal femur.
Chondromalacia Patellae: Also known as "runner's knee," involves softening of cartilage under the patella.
Joint Effusion: Accumulation of fluid in a joint cavity.
Lisfranc Injury: Abnormal separation between the base of the 1st and 2nd metatarsals and cuneiform.
Reiter Syndrome: Causes erosions in the sacroiliac joints and lower limbs.
Hallux Valgus: Congenital deformity leading to lateral deviation of the great toe.

Routine Imaging

Various imaging views used for bony injuries (AP, APOblique, Lateral), bony pathology, and foreign body localization.

Divisions of the Foot

Hindfoot: Comprises calcaneus and talus.
Midfoot: Includes cuboid, navicular, and cuneiform bones.
Forefoot: Metatarsals and phalanges.

Projections for Toes

AP/AP Axial Projection: Dorsiflexion with 15° wedge under foot; CR directed perpendicular or 15° posteriorly for improved visualization of joint spaces.
PA Projection: Prone position; CR perpendicular, enhancing visibility of IP joint spaces.
AP Oblique Projection: Rotated medially 30-45°; CR is perpendicular to show joint spaces of 2nd-5th MTP joints.
Lateral Projection: True lateral position with open IP joint spaces.

Sesamoid Projections

Lewis Method: Tangential projection focused on the phalanges and sesamoids via dorsiflexed great toe.
Holly Method: Similar to Lewis but with seated position and toe flexion.
Causton Method: Shows sesamoids by utilizing a lateral recumbent position.

Foot Imaging

AP/AP Axial Projection: Supine position with foot flat on the IR; CR perpendicular or 10° posteriorly shows the entire foot and TMT joints.
AP Oblique Projection: Leg rotated 30° medially, visualizing lateral foot components.
Lateral Projection: Provides a profile view of the entire foot.

Weight-Bearing Methods

Longitudinal Arch (Lateral Projection): Upright position; assesses pes planus and Bohler's critical angle (20-40°).
AP Axial Projection: Evaluates MT and tarsals, particularly assessing hallux valgus and Lisfranc injury.

Congenital Clubfoot Imaging (Kite Method)

AP Projection: Displays relationships of bones and ossification centers; 15° CR helps visualize forefoot adduction and inversion.
Lateral Projection: Follow-up to ensure proper positioning of the foot in infants.

Calcaneus Imaging

Axial Projection: Plantodorsal view emphasizes calcaneus and subtalar joint; CR directed cephalad at 40°.
Dorsoplantar Projection: Provides a caudal view, highlighting the calcaneus, subtalar joint, and sustentaculum tali.

Subtalar Joint Views

PA Axial Oblique Projection: Visualizes the subtalar joint with a double angle for clearer imagery of the sinus tarsi.
Isherwood Method: Focuses on subtalar articulation through medial rotation.

Ankle Imaging

AP Projection: Vertical placement of the leg and foot with an equidistant position of malleoli; CR perpendicular.
Lateral Projection: Mediolateral view gives comprehensive visualization of the lower leg, ankle joint, and potential injuries.### Ankle Projections
Superior to lateral malleolus uses a perpendicular central ray to the ankle joint.
Lateral projection shows the lower third of tibia & fibula, the ankle joint, and tarsals.

AP Oblique Projection (Medial Rotation)

Position: Supine, leg & foot rotated 45° medially.
Dorsiflex the foot to visualize bony structures.
Intermalleolar line should be parallel to the image receptor (IR) for mortise joint demonstration.
Central ray (CR): Perpendicular to ankle joint.
Structures shown: Distal ends of tibia, fibula, talus, tibiofibular articulation, and mortise joints.

Mortise Joint Evaluation

Medial rotation is performed with the leg and foot rotated 15-20° to align the intermalleolar plane with the IR.
CR directs perpendicular to the ankle joint.

Lateral Rotation Projection

Position: Supine, leg & foot rotated 45° laterally, with dorsiflex foot.
RP: Midway between malleoli.
CR: Perpendicular to ankle joint.
Structures shown: Superior aspect of calcaneus and useful for detecting fractures.

Stress Method (AP Projection)

Position: Seated, foot forcibly turned toward the opposite side.
Purpose: Evaluate ligament tears & joint separation.
RP: Ankle joint, with CR perpendicular.

Weight-Bearing Method (AP Projection)

Position: Upright, heels against the IR, toes toward the x-ray tube.
CR: Horizontal, midway at ankle joint level.
Purpose: Identify narrowing of ankle joint space and side-to-side joint comparison.

Leg Radiography

AP Projection: Supine, with femoral condyles parallel to IR; foot in vertical position. RP at midshaft; CR is perpendicular. Visualizes tibia, fibula, ankle, and knee joints.
Lateral Projection (Mediolateral): Supine, rotated versions with patella perpendicular to IR; femoral condyles should also be parallel.

Knee Projections

AP Projection: Supine, femoral epicondyles parallel to IR, leg 5° inward for correct alignment. RP is 0.5 inches inferior to patellar apex. CR angulates based on ASIS to tabletop distance.
PA Projection: Prone position, similar alignment, with CR 5-7° caudad.
Lateral Projection: Flexed knee with femoral epicondyles perpendicular to IR; focuses on patella and joint space.

Oblique and Tangential Knee Projections

PA Oblique (Medial Rotation): Knee flexed 5-10°, 45-55° medial rotation; CR perpendicular.
Hughston Method (Tangential): Prone, knee flexed 50-60°, CR directed cephalad at 45°. Useful to show patellar subluxation & conditions.
Merchant Method (Tangential): Supine with knees flexed 30-90°, CR 30° caudad from horizontal for patellofemoral joint visualization.
Sunrise Method (Tangential): Knee flexed 40-45°, CR 30° from horizontal focusing on joint space.

Femur Projections

AP Projection: Supine, leg rotated (5° for distal, 10-15° for proximal) for accurate anatomical positioning. CR perpendicular.
Lateral Projection (Mediolateral): Lateral recumbency with affected side down; knee flexed to visualize the entire femur and adjacent joints.
Translateral Projection: Dorsal decubitus with IR against the femur; horizontal CR for patients unable to assume standard lateral positions.

Weight-Bearing Method for Hips, Knees, Ankles

Standing position facing the upright grid unit, CR perpendicular to IR, showing the entire limb from hip to ankle joint.

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Description

Test your knowledge on the Isherwood Method and related radiographic projections. This quiz covers central ray orientations, patient positioning, and foot rotation angles essential for accurate imaging. Answer questions related to lateral and axial oblique projections.