Radiographic Positioning PDF

4/26/2019 RADIOGRAPHIC POSITIONING Upper limbs/ Upper extremities 1. Hand 2. Fo...

4/26/2019 RADIOGRAPHIC POSITIONING Upper limbs/ Upper extremities 1. Hand 2. Forearm 3. Arm 4. Shoulder girdle RAGIOGRAPHIC POSITIONING Philip DC Benzal, RRT RADIOGRAPHIC POSITIONING DIGITS Carpals’ other terms  2nd through 5th -PA -Lateral -oblique CR:PIP jt 1ST CMC JT  1st digit Robert method (AP projection) -AP -similar to AP of 1st digit but CR -PA is directed to CMC jt -Lateral -PA oblique CR: MCP jt 1  4/26/2019 BURMAN METHOD (AP PROJECTION) FOLIO METHOD BILATERAL PA PROJECTION -Hyperextend the hand -For UCL rupture AKA:?? -abduct the thumb -hand rotate medially until thumb lies flat on IR CR: midway level of 1st MCPs CR: 45 deg entering 1st CMC toward elbow SS: concavoconvexity of 1st CMC RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 1. PA HAND Procedures: 1. PA 2. PA oblique 3. Lateral 4. Ball Catcher’s position LATERAL PROJECTION RADIOGRAPHIC POSITIONING 2. PA oblique (w/ wedge & w/o wedge) Post. and ant. displacement of metacarpals CR: 3rd MCP 3 ways Lateromedial Mediolateral Fan lateral CR: 2nd MCP Note: -Thumb abducted -Done in extension or in flexion 2  4/26/2019 RADIOGRAPHIC POSITIONING 4. Bilateral AP Oblique (Norgaard) Brewerton method aka?? Another method for determining RA -early detection of RA -45 deg internal rotation of hand CR: midway at level of MCP jts RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING WRIST Procedures: 1. PA 1. PA 2. AP 3. Lateral  Proximal metacarpals 4. PA Oblique  Distal radius and ulna 5. AP Oblique 6. PA Ulnar Flexion 7.PA Radial Flexion 8. PA Axial (Stecher’s Method) 9. Carpal Canal Tangential 10. Carpal Bridge Tangential 11. Clements Nakayama Method RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 2. AP 3. Lateral / Lateromedial - more open carpal interspaces than PA -thumb adducted - Barton’s, Colles, Smith - Ant. & Post. Fxs. Fiolle suggest w/ palmar Flexion Burman lat of scaphoid 3  4/26/2019 RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 4. PA Oblique 5. AP Oblique -Lat. side carpal bones -medial side carpal bones - Trapezium & Scaphoid -entire pisiform, Triquetrum & Hamate RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 6. PA with Ulnar Flexion/deviation - lat. side of carpal spaces CR ┴ to scaphoid 7. PA with Radial Flexion/deviation Ss: prevent foreshortening of scaphoid - medial side carpal spaces SCAPHOID SCAPHOID SERIES (RAFERT-LONG METHOD) Ulnar deviation with 4 shots 8. PA Axial (Stecher) CR: 0-10-20-30 deg toward elbow - Cassete inclined - C.R angulation - Clenched fist SS: prevent self superimposition 4  4/26/2019 RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 9. Gaynor-Hart (carpal canal) 10.Tangential projection (Carpal Bridge) Tangential proj. (inferosuperior) -aka Lentino method - hyperextend the wrist - fractures of the scaphoid - 250-300 long axis of the hand - lunate dislocation - best view to demons. fx hamate’s hamulus - calcification & FB - R/O abnormal calcification in the carpal sulcus - chip fractures in dorsal aspect of carpals - carpal tunnel syndrome CR: 45 deg caudally to wrist RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 11. Clements Nakayama Method - PA Oblique with Ulnar Flexion FOREARM (Antebrachium) - C.R 45 distally - demonstrates trapezium and it’s articulations Procedures: 1. AP Note: if Pt cant execute ulnar flexion, hands 2. Lateral long axis must be deviated 200 laterally away the CR’s axis RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 1. AP 2. Lateral -lean laterally for less strain -true AP makes radial head,neck & tuberosity superimposed over ulna 5  4/26/2019 RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING ELBOW Procedures: 1. AP 2. Lateral 3. AP Oblique (Medial Rotation) 1. AP 4. AP Oblique (Lateral Rotation) - ⊥ to elbow jt 5. AP Partial Flexion (proximal forearm) and (Distal humerus) - Elbow jt, PF, DH 7. AP Acute Flexion / Jones method 8. Lateral (Lateromedial rot.) Radial Head 9. coyle method (coronoid and radial head) RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 3. AP Oblique (Medial Rotation) 2. Lateral - hand pronated -griswold 90 deg flex - coronoid process & elbow jt - lateral epicondyles a. Olecranon Process b. Fat Pads *soft tissue injury deg. Flexion?? RADIOGRAPHIC POSITIONING COYLE METHOD-AXIAL LATEROMEDIAL PROJ 4. AP Oblique (Lateral Rotation) - radial head, neck & tuberosity For Trauma pt Similar to elbow lat but hands in prone For Radial Head -flex elbow 90 deg -45 deg toward the shoulder For coronoid process -flex elbow 80 deg -45 deg away from shoulder 6  4/26/2019 RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 5. AP Partial Flexion (distal humerus) 6. AP Partial Flexion (Proximal Forearm) - fot trauma pt - ⊥ to the humerus traversing the elbow joint RADIOGRAPHIC POSITIONING RADIAL HEAD 8. Lateral Proj. (Lateromedial rotation) 7. AP Acute Flexion (Jones Method) - 4 positions series - 2’’ superior or distal to the OP - Flex the elbow 900 * supinate hand and rotate externally * hand in true lateral position (Thumbs up) * hand pronate * rotate hand internally (Thumbs down) PA AXIAL PROJECTION PA AXIAL PROJECTION For distal humerus For olecranon process -rest elbow on IR with supinated forearm -45-50 deg flex elbow - flex elbow 75 deg -CR: a.) ⊥ to demons. Dorsum of OP -CR: perpendicular b.) 20 deg toward to ulnar sulcus the wrist to demons -for detection of articular margin & tennis elbow curved extremity of OP 7  4/26/2019 RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING HUMERUS 1. AP Projection Procedures: A. Recumbent 1. AP 2. Lateral RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 2. Lateral (Lateromedial) B. Upright 1. AP Projection 2. Lateromedial 3. Transthoracic Lateral Position / Lawrence Method RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 2. Lateral 1. AP 8  4/26/2019 RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 3. Transthoracic Lateral Projection / Lawrence SHOULDER / PECTORAL GIRDLE Method -for trauma pt 1. Clavicle -unaffected arm raise forearm resting on head - S-shaped -full inspiration to improve the contrast - last bone to completely ossify at the age 21 CR ┴ to IR, level of surgical neck -WHAT IS THE OTHER TERM OR NAME FOR CLAVICLE? RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 2. Scapula SHOULDER JOINTS Procedures: - upper margin of the scapula 1. AP External Rotation Rotator cuff series * 2nd thoracic vertebra 2. AP Neutral Rotation 3. AP Internal Rotation - lower margin of the scapula 4. Transthoracic Lateral Projection/ * 7th thoracic vertebra Lawrence Method 5. Inferosuperior Axial Projection 6. Inferosuperior Axial Projection (Rafert Modification) RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 7. Inferosuperior Axial Projection (West Point Method) 8. Inferosuperior Axial Projection (Clements Modification) 9. Superoinferior Axial Projection ROTATOR CUFF SERIES 10. AP Axial Projection 1.AP External Rotation 11. Tangential Projection 12. PA Oblique (RAO&LAO) (Scapular Y) - hand is supinated 13. AP Apical Oblique Axial Projection (RPO&LPO) - epicondyles are parallel to IR (Garth Method) 14. AP Oblique Projection (Grashey Method) - to demons. greater tuberosity 15. AP Axial Projection ( Stryker “Notch” Method *humerus in true AP 16. Apple Method 9  4/26/2019 RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 3. AP Internal Rotation 2. AP Neutral - hand rotated internally - palm of the hand against the hip - epicondyles should be perpendicular to IR - epicondylar plane is 45 degrees to the plane of - humerus in true lat the film - to demonstrate lesser tuberosity - greater tubercle partially superimposes the humeral head RADIOGRAPHIC POSITIONING CR- I inch inferior to CP 4. Transthoracic Lateral Projection (Lawrence Method) SS:  External rot- insertion site of supraspinatus tendon  Neutral rot- profiles small calcific deposit  Internal rot- insertion site of subscapularis tendon RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 5. Inferosuperior Axial / Lawrence 6. Inferosuperior Axial Proj. (Rafert Mod) - supine - exaggerated external rotation, thumb - abduct the arm 90 deg pointing downward & posteriorly 450 - arm external rotation - best for hill sachs CR: horizontally through -CR same but medial angulation the axilla to the AC jt. of 15 deg 10  4/26/2019 RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 7. Inferosuperior Axial Projection / West point 8. Inferosuperior Axial Projection (Clements - prone Modification) - lateral recumbent on the unaffected side - arm abducted at 900, forearm hanged - abduct the affected arm @ 900 pointing pointing downward the ceiling - C.R. 25AM - horizontally to the midcoronal - CR 5-150 medially RADIOGRAPHIC POSITIONING 9. Superoinferior Axial Projection Cleaves method-rolled film axial position - extend the shoulder - flex the elbow 900 - 5-150 towards the elbow - relationship of the prox. end of humerus & glenoid cavity RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 11. PA Oblique (Scapular Y) AP Axial Projection (Stryker “Notch” Method) -affected side in contact -useful in identifying the cause of shoulder - MCP 45-600 dislocation -arms hanging at side - flex/abduct the arm forwardly beyond 900 and place the hand on top of the head CR: ┴ vertebral border passing glenohumeral jt. SS: subacromial & subcoracoid dislocation 11  4/26/2019 RADIOGRAPHIC POSITIONING NEER METHOD- TANGENTIAL PROJECTION SUPRASPINATUS OUTLET RAO/LAO, affected side in contact - CR 100 Rotate body 45-60 deg - coracoid process CR- 10-15 deg caudally passing superior margin of humeral head  SS: coracoacromial arch for supraspinatus outlet region RADIOGRAPHIC POSITIONING BLACKET-HEALY METHOD 12. Tangential Projection (Fisk Method)  Teres minor insertion (PA projection) - standing -prone - flex the elbow and place the cassette -elbow flex over the supinated forearm -forearm resting on back - lean forward to place the humerus 10-150 from vertical  CR: ⊥ to the head of the humerus -CR is ⊥ GLENOID CAVITY  Subscapularis insertion (AP projection) 13. AP oblique Proj. (Grashey Method) -supine - rotate the body 35-450 towards the -arm slightly abducted affected side (when standing) -forearm rotated internally - scapula is parallel to the IR -dorsum touches the hip - abduct the arm slightly using internal rotation - palm of the hand in the abdomen CR:⊥ to the shoulder joint, entering the CP 12  4/26/2019 RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING - CR: ⊥ 2 iM * to demonstrate the SPACE bet. humeral head and glenoid cavity 14. AP Oblique Proj. (Apple Method) - this is similar to Grashey, but uses weighted abduction for demons. loss of articular cartilage in the SHj RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 15. AP Axial Oblique (Garth Method) ACROMIOCLAVICULAR ARTICULATIONS - for acute shoulder trauma - posterior dislocation of shoulder Procedures: - Hill-Sach defect 1. AP Projection (Bilateral) (Pearson -apical view Method) -rotate body 450 towards affected side 2. AP Axial Projection (Alexander - flex the elbow & place arm across the chest Method) - CR 450 to SHj 3. PA Axial Oblique Projection (RAO/LAO) (Alexander Method) RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 1. Bilateral AP Proj. (Pearson Method) 2. AP Axial Projection (Alexander Method) -2 exposure w/o weights & w/ weights - equal weights (5-8 lbs) - 150↑ to the CP * make the shoulder muscle contract - ACj projected - demons. dislocation/separation of joints superiorly 13  4/26/2019 RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 3. PA Axial Oblique Proj. (Alexander Method) -affected side in contact CLAVICLE / COLLAR BONE -body rotated 45-600 -arm across chest Procedures: - 150 to ACj 1. AP Projection 2. PA Projection 3. AP Axial (Tangential Projection) 4. PA Axial Projection 5. Tangential (Tarrant) RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 1. AP Projection AP - used to prevent additional injury CR: midshaft RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 2. PA Projection 3. AP Axial Projection - reduce magnification & improve recorded - lordotic position detail - 0-15 degrees if upright - 15- 30 degrees if supine - exact axial image of the clavicle is seen C.R ┴ to the midshaft SS: entire clavicle with slight superimposition 14  4/26/2019 TANGENTIAL RADIOGRAPHIC POSITIONING -supine 4. PA Axial Projection -IR supported to stand slantedly touching the - Prone affected shoulder -15-30 deg. to the supraclavicular region CR: passing bet. Clavicle and chest wall ┴ to IR -25-400 from the horizontal Note: add 15-250 laterally If medial third is in question RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING SCAPULA 5. Tangential Projection (Tarrant) Procedures: - useful in pt. who have multiple injuries 1. AP Projection and can’t assume the lordotic or recumbent 2. Lateral Projection(RAO/LAO) 3. PA Oblique Projection (RAO/LAO) - C.R. 25-350 Anterior & inferior midclavicle (Lorenz and Lilienfield Method) RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 2. Lateral Projection -(RAO/LAO) affected side in contact 1. AP Projection - rotate the body 45-600 (similar to Scapular Y) - Abduct 900 to draw the scapula laterally - For body of scapula - flex the elbow and supinate the hand - extend the arm upwards and rest the - 2“ inferior to the coracoid process forearm on the head - quiet breathing - for Acromion and Coracoid process - -flex the elbow and rest dorsum of the * to blurr the lung detail hand on the back. CR: ⊥ medial border of protruding scapula 15  4/26/2019 PA Oblique Proj. (Lorenz and Lilienfeld Method) RADIOGRAPHIC POSITIONING -pt in lateral recumbent AP Oblique Projection LORENZ - rotate the shoulder 15-250 away from - afftected side arm at right angle to the body the affected side - elbow flex hand beneath the patient’s head LILIENFELD - extend the arm of the affected side obliquely upward (1350) CR: ⊥ IR, bet. Chest wall and scapula SS: demons. the oblique image of the scapula RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING SCAPULAR SPINE 1. Tangential Proj. (Laquerriere-Pierquin Method) Procedures: - supine 1. Tangential Projection - CR 450 to (Laquerriere-Pierquin Method) posterosuperior region 2. Tangential Projection (Prone) of shoulder - 350 for obese pt. RADIOGRAPHIC POSITIONING CORACOID PROCESS 2. Tangential Projection (Prone)  AP Axial proj - hand of the affected side in supination -supine - 450 cephalad exit anterosuperior CR: 15-45 deg cephalad to CP 30 deg ceph suggested SS: inferosuperior view of CP 16  4/26/2019 RADIOGRAPHIC POSITIONING TOES AP/ AP Axial/ PA LOWER LIMB / LE CR: ⊥ or 150 posteriorly to 3rd MTPj Bones of the lower limbs are divided into 4 groups 1. Foot 2. Leg 3. Femur 4. Hip SESAMOID RADIOGRAPHIC POSITIONING 1. Tangential Proj. (Lewis and Holly Method) 2. Tangential Proj. (Causton Method) - prone (Holly-supine) - lateral recumbent on the unaffected side - dorsiflex the toes - 400 towards the heel to 1st MTPj prominence -CR: ⊥ & tangential to 1st MTPj RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING Procedures: FOOT 1. AP axial Proj. (Dorsoplantar) 1. AP Projection (Dorsoplantar) 2. AP Oblique Proj. (Medial Rotation) for general study- CR is ⊥ 3. Lateral Proj. (Mediolateral) for joint space/foreshoretening of MT 4. Lateral Proj. (Weight Bearing) -100 posteriorly/ towards the ankle 5. AP Axial Proj. (Weight Bearing) CR: base of the 3rd MT 6. AP Axial Proj. (Weight Bearing Composite Dorsoplantar Projection) 17  4/26/2019 RADIOGRAPHIC POSITIONING  AP Oblique Lateral rotation 2. AP Oblique Projection (Medial Rotation) -300 laterally from IR - dorsum horizontal with table top - foot is 300 * demonstrate intertarsal joints SS: medial side structure particularly on lateral side CR: ┴ base of the 3rd MT PA OBLIQUES (GRASHEY METHOD) RADIOGRAPHIC POSITIONING For medial structure 3. Lateral Projection (Mediolateral) -rotate 300 toward the medial side - plantar surface at right angles - degree of ant. and post. For lateral structure displacement of fxs. -rotate 200 toward lateral side CR: level of base of 3rd MT CR: ⊥ base of the 3rd MT RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 6. AP Axial Proj. (Weight Bearing Composite 4. Lateral Projection (Weight Bearing) Dorsoplantar) - demonstrated pes planus / status of the - exp 1 150 posterior angulation longitudinal arch - exp 2 250 anterior angulation - Bohler’s/tuber angle SS: entire foot free of superimposition from leg *lines are drawn tangent to the ant. and post. aspects of the superior surface of calcaneus forming an angle * 20-400 angle normally 18  4/26/2019 RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING CONGENITAL CLUBFOOT - Talipes equinovarus Procedures: 1. Kite Methods Shows 3 deviations: A. AP 1. Plantar flexion and inversion of the calceneus or EQUINUS B. Lateral 2. Medial displacement of the forefoot or 2. Kandel Method ADDUCTION A. Axial Projection (Dorsoplantar) 3. Elevation of the medial border of the foot or SUPINATION RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING CALCANEUS / OS Calcis 1. PA Axial Proj. (Plantodorsal) Procedures: - dorsiflexion - plantar surface at right angles CR: 400 to base of 3rd MT SS: *sustentaculum tali *calcaneal tuberosity *trochlear process RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 3. Weight Bearing (Coalition Position axial Proj.) Lilienfeld method 2. AP Axial Proj. (dorsoplantar) - demonstrate calcaneotalar fusion - prone -unaffected foot 1 step forward - 400 to posterior ankle - 450 anteriorly to the posterior surface Level of base of 5th MT 19  4/26/2019 RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 4. Lateral Projection Procedures: - 1” inferior to the medial malleolus POSTERIOR SUBTALAR RADIOGRAPHIC POSITIONING BRODEN METHOD A. AP Axial Oblique Proj. (Medial Rotation) - 4 central ray angulations - dorsiflex the foot RP: 2-3 cm caudoanteriorly to lat. malleolus -plantar surface at right angle to IR SS: posterior articulation - rotate the leg and foot medially 450 RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING B. Isherwood method 2. AP Axial Oblique Proj.(Medial Rotation Ankle) - method used to demons. 3 articulation of the talocalcaneal joint separately - from plantar right angle to IR, rotate 300 medially 1. Lateromedial Oblique Projection (Medial Rotation Foot) CR:100 1 DA to lateral malleolus -plantar flat on IR,then rotate 450 medially SS: middle subtalar joint CR:⊥ 1 DA to the lateral malleolus SS: anterior subtalar joint 20  4/26/2019 RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING ANKLE 3. AP Axial Oblique Proj. (Lateral Rotation Ankle) from plantar right angle to IR, rotate 300 Procedures: laterally CR:100 1 D to medial malleolus SS: posterior subtalar joint RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING ANKLE Procedures: 1. AP - plantar surface vertically positioned CR: ⊥ to ankle joint to a point midway between malleoli SS: distal tib.fib. and proximal talus RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING B. Mortise view 2. Oblique -plantar surface vertically positioned A. Bony Structure - rotate leg & foot 150 to 200 medially -plantar surface vertically positioned CR:⊥ to ankle joint - rotate leg & foot 450 medially SS: mortise joint free of superimposition CR: ⊥ midway between the malleoli also demons. jones fx SS: for bony study of distal tibia & fibiola & their joint 21  4/26/2019 RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 4. AP stressed studies (forced inversion and 3. Lateral (mediolateral) forced eversion) CR: ┴ to the ankle jt. entering the medial - to evaluate the joint separation and malleolus ligament tear or rupture note: articulation (jt. space) bet. talus and fibula is not demonstrated RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING LEG Procedures: TIBIA - shin bone (anterior crest or border) FIBULA - calf bone RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 1. AP Projection 2. Lateral Projection 22  4/26/2019 RADIOGRAPHIC POSITIONING KNEE AP Oblique Procedures: Medial rotation- 45 deg -SS: open proximal tibiofibular Lateral rotation – 45 deg - SS: superimposed tibia and fibula - CR: for both, perpendicular midshaft RADIOGRAPHIC POSITIONING Knee joint: 1. AP Projection  Femorotibial jt - rotate 3-50 internally until the  Patellofemoral jt interepicondylar line is parallel to IR - ½“ below the apex of the patella - 5-70 SS: distal femur, proximal leg VARIATION- ASIS TO TABLETOP PA PROJECTION  CR: 50 caudad -because tibia & fibula are slightly inclined, CR will be parallel to tibial plateau 23  4/26/2019 RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 3. AP Oblique Internal Rotation 2. Lateral Projection (mediolateral) - rotate the leg 450 internally - turn toward the affected side -flexion 20-300 relaxes the muscle and show the maximum volume of the joint cavity - CR 5-70 cephalad RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 4. AP Weight Bearing (AHLBACK) 6. AP Oblique Lateral Rotation - DJD, knee joint spaces, varus and valgus - rotate the leg 450 externally deformity -narrowing of the joints space RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 5. PA Proj, weight bearing (Rosenberg) INTERCONDYLOID FOSSA - flex knee to place the femur at angle of 450 Procedures: dCR:⊥ to leg/CR 100 24  4/26/2019 RADIOGRAPHIC POSITIONING 8. PA Axial Projection (Camp-Coventry Method) 7. PA Axial Projection (Holmblad Method) - intercondyloid fossa - intercondylar fossa * prone 3 pos. * femur in contact on table 1. Standing,knee resting on stool * flex knee 40-500 2. Standing, knee on vertically placed cassette CR: ⊥ to long axis of leg entering 3. Kneeling popliteal - Femur must be 700 to the long axis of leg - to demonstrate the knee joint space and reveal a - CR: ⊥ to long axis of leg entering popliteal LOOSE BODY within the joint RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 9. AP Axial Projection (Beclere Method) PATELLA - supine, IR under popliteal - knee is flexed so that femur forms - knee cap 600 to the long - biggest sesamoid bone axis of leg CR: ⊥ to long axis of Leg entering knee RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 1. PA Projection - heel rotated 5-100 laterally Procedures: - midpopliteal depression 25  4/26/2019 RADIOGRAPHIC POSITIONING PA OBLIQUE -MEDIAL & LATERAL ROTATION Rotate the knee 45-550 2. Lateral Projection - flex not more than 100 (5-100) * to prevent fragments separation in new or unhealed patellar fractures. - demons. patella, patello femoral joint, tibiofemoral joint RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 3. PA Axial Oblique Projection (Kuchendorf Procedures: Method) -prone - rotate the knee laterally so that patella and medial Condyle will both rest on table (35-400) - flex knee by 100 to relax the muscle CR 25-300 patella SS: most of patella free of superimposition RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 4. Tangential Projection (Hughston Method) -Aka?? 5. Tangential Projection (Merchant Method) - prone -mountain view -leg elevated resting on the tube - sitting/supine - flex the knee 50-600 - flex knee 40 - CR 450 - CR 300 from horizontal - patellofemoral joint * demons. patellafemoral disorders - demons. Patellar subluxation & femoral -uses “Axial viewer device” condyles 26  4/26/2019 RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 6. Tangential Projection (Settegast Method) - prone 7. Settegast method (inferosuperior) - acute flexion (≥900) - sitting / supine - perpendicular to the joint space - flex knee 40-450 usually 15-200 cephalad - CR 10-150 from lower leg * vertical fracture RADIOGRAPHIC POSITIONING RADIOGRAPHIC POSITIONING 1. AP Projection FEMUR - if distal femur, no rotation - if proximal femur (hip), rotate the leg by 10-150 internally Procedures: RADIOGRAPHIC POSITIONING 2. Lateral Projection If distal femur -proximal femur -lateral (affected side on IR), then draw the -supine, then rotate body toward affected side unaffected thigh forward -adjust the pelvis 10-150 post. to prevent Superimposition -flex affected knee 450 27  4/26/2019 SHAPE OF PELVIS RADIOGRAPHIC POSITIONING  Android PELVIS  Gynecoid Procedures:  Platypelloid  anthrapoid ILIAC CREST WIDER FLAIR NARROWER COCCYX MORE STRAIGHT MORE CURVED PUBIC ARCH >900