In which of the following positioning projections will the talocalcaneal joint be visualized

the benign, neoplastic bone lesions filled with clear fluid that most often occur near the knee joint in children and adolescents.

malignant tumors of the cartilage that usually occur in the pelvis and long bones of men older than 45 years

common primary malignant bone tumor that arises from bone marrow in children and young adults; symptoms are similar to those of osteomyelitis, with low-grade fever and pain; "onion-peel" look on radiographs 

Form of arthritis that may be hereditary in which uric acid appears in excessive quantities in the blood and may be deposited in the joints and other tissues; common initial attacks occur in the first MTP joint of the foot. 

large band that spans the articulation of the medial cuneiform and the fist and second metatarsal base. 

Range from sprains to fracture-dislocations of the bases of the first and second metatarsals. 

Involves inflammation of the bone and cartilage of the anterior proximal tibia, is most common in boys 10 to 15 years old

• AKA degenerative joint disease (DJD)
• Noninflammatory joint disease that is characterized by gradual deterioration of the articular cartilage with hypertrophic bone formation.
• Most common type of arthritis and is considered part of the normal aging process
  

Literally means "bone softening". This disease is caused by lack of bone mineralization secondary to a deficiency of calcium, phosphorus, or vitamin D in the diet or an inability to absorb these minerals

Paget's disease (Osteitis deformans)

One of the most common diseases of the skeleton. It is the most common in midlife and is twice as common in men as in women. It is a non-neoplastic bone disease that disrupts new bone growth, resulting in over-production of very dense yet soft bone. 

Which diseases cause exposure factors to be decreased?

• Osteoarthritis
• Osteomalacia (rickets)
  

Which diseases cause exposure factors to be increased?

• Lisfranc joint injury
• Paget's disease

What is the evaluation criteria for Ap Proj. of the toes?

• Digits and minimum of distal 1/2 of metatarsal demonstrated
• No overlap of soft tissues
• IP and MTP joints appear open
• No rotation-- more concavity on side rolled away from

What is the CR for AP Toes?

• Angle CR 15 degrees toward calcaneus
• If a 15 degree wedge is placed under the foot for parallel part-film alignment, the CR is perpendicular to the IR
• Center CR to MTP joint in question

What is the evaluation criteria for AP oblique projection-- medial or lateral rotation toes?

• Digits and minimum of distal 1/2 of metatarsal demonstrated
• IP and MTP joints appear open
• Increase concavity on the side of shaft
• heads of metatarsals not overlapped

Where is the CR for AP Oblique projection-- medial or lateral rotation: toes? 

CR perpendicular to IR, directed to MTP joint in question

Where is the CR directed for a tangential proj: Toes-- sesamoids

CR perpendicular to IR, directed tangentially to posterior aspect of first MTP joint -- depending on amount of dorsiflexion of foot, may need to angle CR slightly for a true tangential projection

Evaluation criteria for tangential projection: toes-- sesamoids?

• sesamoids free of superimposition
• Min of 3 metatarsals seen

Where is the CR directed for a laeral-mediolaeral or lateromedial proj : toes?

• CR directed to interphalangeal joint for first digit and to proximal interphalangeal joint for second to fifth digits
  
• 1st, 2nd, 3rd digits -- lateromedial
• 4th & 5th-- mediolateral

Evaluation criteria for lateral-mediolateral or lateromedial projections: toes?

• Digits presented in lateral position
• IP and MTP joints appear open
• Digit free of superimposition

How far do you rotate the leg and foot for an AP oblique projection-- medial or lateral rotation: toes?

Rotate the leg and foot 30 to 45 degrees medially for the first, second, and third digits and laterally for the fourth and fifth digits 

How far should you dorsiflex the foot for a tangential projection: toes-- sesamoids

Dorsiflex the foot so that the plantar surface of the foot forms about a 15 to 20 degree angle from vertical 

Another name for the tangential projection-- patient prone

Lewis-- Rest great toe on IR in a dorsiflexed position (15-20 degree angle from vertical) 

Another name for an Alternative projection-- patient supine; of tangential projection: toes-- sesamoid

Evaluation criteria for AP Projection: foot -- dorsoplantar proj.

• Entire foot visualized
• No rotation of metatarsals
• MTP joints generally open

Evaluation Criteria for AP Oblique proj-- medial rotation: foot 

• Entire foot visible
• third through fifth metatarsal bases are free of superimposition
• tuberosity demonstrated at base of 5th metatarsal
• BEST DEMONSTRATES SINUS TARSI

What may cause a greater or lesser CR angle during an AP Proj: Foot-- dorsoplantar proj

• A high arch requires a greater angle (15 degrees) and a low arch nearer 5 degrees to be perpendicular to the metatarsals
  
• For foreign body, CR should be perpendicular to IR with no CR angle

Where is the CR directed for an AP projection: foot dorsoplantar proj

• Angle CR 10 degrees posteriorly (toward heel) with CR perpendicular to the metatarsals
• Direct CR to base of third metatarsal

What should the part be angled for an AP oblique projection-- medial rotation-- foot 

Rotate foot medially to place plantar surface 30 to 40 degrees to the plane of the IR 

Where is the CR directed for an AP oblique projection -- medial rotation: foot

Cr perpendicular to IR, directed to base of third metatarsal 

Why do some text recommend 40 to 45 degrees on an AP oblique projection-- medial rotation: foot 

To demonstrate tarsals and proximal metatarsals best relatively fee of superimposition for the foot with an average transverse arch 

Where is the CR directed for a lateral-mediolateral or lateromedial proj-- foot

CR perpendicular to IR, directed to medial cuneiform (At level of base of third metatarsal (3rd MTP)

Part Position (Mediolateral Proj) of the foot

• Flex knee of affected limb about 45 degree; place opposite leg behind the injured limb to prevent over-rotation of affected leg
• Place support under leg and knee as needed so that plantar surface is perpendicular to IR. DO NOT over-rotate foot
• Center mid area of base of metatarsals to CR

Evaluation Criteria for Lateral-mediolateral or lateromedial proj: foot

• Entire foot visualized
• Tibiotalar joint demonstrated
• Metatarsals superimposed

Alternative Lateromedial Projection of the foot

Lateromedial projection may be taken as an alternative lateral. This position can be more uncomfortable or painful for the patient, but it may be easier to achieve a TRUE LATERAL

Optional Lateral Oblique: AP Oblique Projection-- foot 

• rotate the foot laterally 30 degrees (less oblique required because of the natural arch of the foot)
• a lateral oblique BEST DEMONSTRATES the space between first and second metatarsals and between first and second cuneiforms. The navicular also is well visualized on the lateral oblique

What are the Clinical Indications for a Lateral Weight-bearing foot

Demonstrate the bones of the feet to show the condition of the longitudinal arches under the full weight of the body 

Where is the CR angled for an AP weight-bearing proj-- foot

Angle CR 15 degree posteriorly to midpoint between feet at level of base of metatarsals 

Evaluation Criteria: Lateral Weight bearing Projection-- Foot

• Entire foot demonstrated
• Plantar surfaces of MTs superimposed

Evaluation Criteria AP weight-bearing projections: foot

• Bilateral feet demonstrated
• No rotation

Where is the CR directed for a Lateral Weight-Bearing Projections: Foot

Direct CR HORIZONTALLY to level of base of third metacarpals 

What do you angle for a plantodorsal (axial) proj-- calcaneus

Angle CR 40 degrees cephalad from long axis of foot 

What is the evaluation criteria for a plantodorsal (axial) proj-- calcaneus

• Entire calcaneus visualized
• No rotation

What are the clinical indications for the lateral-mediolateral proj-- calcaneus

• Bony lesions involving calcaneus, talus, and talocalcaneal joint
• Demonstrate extent and alignment of fractures

Where is the CR directed for a lateral-mediolateral proj-- calcaneus 

CR perpendicular to IR, directed to a point 1 inch inferior to medial malleolus (mid calcaneus)

Where is the CR directed for plantodorsal (axial) projection- calcaneus

• Direct CR to base of third metatarsal to emerge at a level just distal to lateral malleolus

What is the evaluation criteria for a lateral-mediolateral proj--- calcaneus

• Calcaneus and talus visualized
• No rotation

True or False-- For a lateral-mediolateral proj-- calcaneus you should position the ankle and foot for a true lateral

TRUE-- the lateral malleolus should be about 1 cm posterior to the medial malleolus 

Where should the CR be directed for an AP proj-- ankle?

CR perpendicular to IR, directed to a point midway between malleoli

Clinical Indications for the plantodorsal (axial) proj.- calcaneus

• Pathologies or fractures with medial or lateral displacement

What is the evaluation criteria for an AP proj- ankle?

• Distal 1/3 of tibia and fibula demonstrated
• Proximal 1/2 of metatarsals included
• Medial and superior aspect of ankle joint open

How should the foot and ankle be positioned for an AP proj-- ankle?

Adjust the foot and ankle for a true AP projection

Clinical Indications for an AP weight-bearing proj-- foot

• Demonstrate the bones of the feet to show the condition of the longitudinal arches under the full weight of the body
  
• May demonstrate injury to structural ligaments of the foot such as a Lisfranc joint injury

How is the part positioned for an AP mortise proj-- 15 to 20 degree medial rotation-- ankle

Internally rotate entire leg and foot about 15 to 20 degrees until intermalleolar line is parallel to IR

Where is the CR directed for an AP mortise projection-- 15 to 20 degree medial rotation-- ankle

CR perpendicular to IR, directed midway between malleoli

What is the evaluation criteria for an AP mortise projection- 15 to 20 degree medial rotation-- ankle 

• Entire ankle mortise open
• distal 1/3 of tibia and fibula demonstrated
• proximal 1/2 of intertarsals included

How is the patient positioned for an AP oblique projection-- 45 degree medial rotation-- ankle

Flex knee of affected limb about 45 degrees; place support under knee as needed to place leg and foot in a true lateral position 

Where is the CR directed for an AP oblique proj-- 45 degree medial rotation-- ankle

CR perpendicular to IR, directed to medial malleolus 

What is the evaluation criteria for an AP oblique projection-- 45 degree medial rotation-- ankle

• distal tibulofibular joint open
• distal 1/3 of tibia and fibula
• proximal 1/2 of metatarsals
  

LOOK AT HANDOUT FOR AP OBLIQUE ANKLE

Where is the CR directed for a lateral-mediolateral projection-- Ankle

Cr perpendicular to IR, directed to a point midway between malleoli

How do you position the part for a lateral-mediolateral projection-- ankle 

Rotate leg and foot medially 45 degrees 

What is the evaluation criteria for a lateral-mediolateral projection-- ankle

• entire talus and calcaneus visualized
• lateral malleolus superimposed over posterior half of tibia
  

Clinical indications for AP Stress Projections: ankle

Pathology involving ankle joint separation secondary to ligament tear or rupture 

Where is the CR directed for AP stress projections-- ankle

CR perpendicular to IR, directed to a point midway between malleoli

What is the evaluation criteria for an AP stress projection- ankle

• distal aspect of tibia and fibula demonstrated
• ankle joint to center of collimation field

How do you position the part for an AP stress Projection-- Ankle

Center and align ankle joint to CR and to long axis of portion of IR being exposed

What are the clinical indications for an AP projection-- leg

Pathologies involving fractures, foreign bodies, or lesions of the bone 

How is the part positioned for an AP Projection-- Leg

Adjust pelvis, knee, and leg into true AP with no rotation 

Where is the CR directed for an AP projection-- leg 

Cr is perpendicular to IR, and directed to midpoint of leg 

What is the evaluation criteria for an AP Projection--- Leg

• Entire tibia and fibula demonstrated
• knee and ankle joints demonstrated
• partial superimposition of fibula and tibia at proximal and distal ends

AP OBLIQUE LOW LEG MEDIAL AND LATERAL ROTATION ON SEPARATE HANDOUT!

Where is the Cr directed for a lateral-mediolateral projection: Leg-- tibia and fibula

CR perpendicular to IR, directed to midpoint of leg 

Evaluation criteria for lateral-mediolateral projection: Leg- tibia and fibula 

• Entire fibula and tibia demonstrated
• knee and ankle joints demonstrated
• proximal head of fibula superimposed by tibia
• distal fibula superimposed over posterior half of tibia

Where is the CR directed for an AP Knee

• variable depending on anterior superior iliac spine (ASIS) to table top measurement
• <19 cm = 3-5 degrees caudad
• 19-24 cm= perpendicular
• >24 cm= 3-5 cephalad

Where is the CR directed for an AP Knee

• Align CR parallel to articular facets (tibial plateau); for average-size patient, CR is perpendicular to IR
• Direct CR to a point 1/2 inch distal to apex of patella

Evaluation Criteria for an AP Knee

• femorotibial joint space open
• knee joint entered to collimation field
• articular facets profiled

How is the patient positioned for an AP Oblique Proj- Medial (Internal) Rotation-- Knee

Rotate entire leg internally 45 degrees

Where is the CR directed for an AP Oblique proj: medial (internal) rotation-- knee

• Angle CR 0 degrees on an average patient
• Direct CR to midpoint of knee at a level 1/2 inch distal to apex of patella

Evaulation criteria for an AP Oblique porjec-- lateral and medial rotation -- knee

• proximal tibiofibular joint open (medial oblique)
• fibula superimposed over midtibia (lateral oblique)

How is the patient positioned for an AP Oblique proj-- lateral rotation: knee

Rotate entire leg externally 45 degrees 

Where is the CR directed for an AP Oblique proj- lateral rotation-- knee

• Angle CR 0 degrees on average patient
• Direct CR to midpoint of knee at a level 1/2 inch distal to apex of patella

How is the part positioned for a lateral-mediolateral proj-- knee

Flex knee 20 to 30 degrees for lateral recumbent projection. 

Where is the CR directed for a lateral-mediolateral projection- knee

• Angle CR 5 to 7 degrees cephalad for lateral recumbent projection
• Direct CR to a point 1 inch distal to medial epicondyle

Evaluation criteria for a lateral-mediolateral projection-- Knee

• Femoral condyles superimposed
• patella in profile (no rotation)
• patellofemoral joint space open
• fibular head and tibia slightly overlap

Where is the CR directed for an AP weight-bearing bilateral knee projection-- knee

CR perpendicular to IR (average-sized patient), or 5 to 10 degrees caudad on thin patient, directed to midpoint between knee joints at a level 1/2 inch below apex of patella

Evaluation criteria for an AP weight-bearing bilateral knee projection-- knee

• Knee joints centered to collimation field
• No rotation of knees
• Joint spaces open
• Optimal exposure factors
• if using phototiming make sure proper AEC is set
• 2 outside cells

PA axial projection-- tunnel view: knee- intercondylar fossa (Prone- Camp conventry method)

• Flex knee 40 to 50 degrees; place support under ankle
• center IR to knee joint, considering projection of CR angle-- center to popliteal crease -- CR perpendicular to lower leg

PA axial projection- tunnel view: knee- intercondylar fossa (kneeling- Holmblad method)

• With patient kneeling on "all fours," place IR under affected knee and center IR to popliteal crease
• Ask patient to lean forward slowly 20 to 30 degrees and to hold that position (results in 60 to 70 degree knee flexion)

Evaluation criteria for Camp-Coventry 

• Intercondylar fossa in profile
• No superimposition by patella
• No rotation
• Articular facets and intercondylar eminence well visualized

Part positioning for AP Axial projection: knee- Intercondylar fossa (Beclere Method)

Flex knee 40 to 45 degrees, and position support under IR as needed to place IR firmly against posterior thigh and leg-- MORE OID WITH THIS PORJECTION

Where is the CR directed for an AP Axial Proj: knee-- intercondylar fossa (Beclere Method)

• Direct CR perpendicular to lower leg (40 to 45 degrees cephalad)
• Direct CR to a point 1/2 inch distal to apex of patella

Evaluation criteria for AP Axial Proj: Knee- intercondylar fossa (Beclere Method)

• Same as PA Axial or Camp-Conventry
• Magnification (More OID)

Where is the CR directed for an PA Proj-- Patella

• CR is perpendicular to IR
• Direct CR to midpatella area (approx at the midpopliteal crease)

Evaluation Criteria for a PA proj-- patella

• Patella centered to collimation
• No rotation

Part Position for Lateral-mediolateral proj-- patella 

Flex knee only 5 to 10 degrees 

Where is the CR directed for a lateral-mediolateral projection: patella

• CR is perpendicular to IR
• Direct CR to midfemoropatellar joint

Evaluation Criteria for lateral-mediolateral proj- patella 

• Patella and knee joint in center of collimation field
• patella in true lateral
• femoropatellar joint space open

SID Factors for Tangential (Axial or Sunrise/skyline) proj- patella (Merchant Bilateral Method)

SIDE- 48 to 72 inch (increase in SID reduces magnification)

Patient position for Merchant bilateral method (tangential- axial, sunrise/skyline)-- patella

place patient in the supine position with knees flexed 40 degrees over the end of the table (ASRT SAYS 45 DEGREES)

CR directed for Merchant bilateral method (tangential- axial, sunrise/skyline)-- patella

• Angle CR caudad, 30 degrees from horizontal
• Direct CR to a point midway between patellae

Evaluation criteria for all tangential proj-- patella

• Intercondylar sulcus and patella visualized
• femoropatellar joint spaces open

Patient position for inferosuperior Projection (supine)-- patella

Place patient in supine position, legs together, with sufficient size support placed under knees for 40 to 45 degree knee flexion 

Cr directed for an Inferosuperior projection-- patella

Direct CR inferosuperiorly, at 10 to 15 degree angle from lower legs to be tangential to femoropatellar joint

Patient position for Hughston Method (prone)-- patella 

This projection may be done bilaterally on one IR. Place patient in prone position, with IR placed under knee; slowly flex knee 55 degrees

Where is the CR aligned for a Hughston Method?

• Align CR approximately 15 to 20 degrees from long axis of lower leg (tangential to femoropatellar joint)
• Direct CR to midfemoropatellar joint

Rule out transverse fracture of patella before attempting these projections of the patella

• Hughston
• merchant
• Settegast

Patient position for Settegast Method

Place patient in prone position, with IR under knee; slowly flex knee to a minimum of 90 degrees

Where is the CR directed for the Settegast Method

• Direct CR tangential to femoropatellar joint space (15 to 20 degrees from lower leg)
• Minimum SID is 40 inches

Where is the CR directed for the Hobbs Modification Superoinferior Sitting Tangential Method?

• Align CR to be perpendicular to IR
• Direct CR to midfemoropatellar joint
• Minimum SID is 48 to 50 inches to reduce magnification because of increased OID

What joints have Plane or gliding movement?

• Tarsometatarsal joints
• Intertarsal joints
• Proximal tibiofibular joint

What joints have Ginglymus or hinge movement?

What joints have modified ellipsoidal or condyloid movement?

metatarsophalangeal joints

What joints have sellar or saddle movement?

• Ankle Joint
  
• Patellofemoral

What joints have bicondylar movement?

ALL JOINTS OF THE LOWER LIMB EXCEPT DISTAL TIBIOFIBULAR are classified as what and have what type of mobility?

• Synovial
• Diarthrodial

What is the distal tibiofibular joint classified as and waht type of mobility does it have?

• Fibrous
• Amphiarthrodial

How many phalanges are in the foot?

How many metatarsals are in the foot?

How many tarsals are in the foot?

How many bones are in the foot all together?

What area of the metatarsals should be well visualized on radiographs?

The proximal portion of the fifth metatarsal, including the tuberosity, because it is readily visible on radiographs and is a COMMON TRAUMA SITE. 

What is the largest sesamoid bone in the body?

Where are sesamoid bones illustrated on the foot?

The plantar surface at the head of the first metatarsal near the first MTP joint (tibial sesamoid is on the medial side and fibular sesamoid is on the lateral side)

What is the largest and strongest bone of the foot?

Where is the tuberosity of the foot located?

• The most posterior-inferior part of the calcaneus
  
• Common site for bone spurs, which are sharp outgrowth of bone that can be painful on weight-bearing

What is the largest tendon that is attached to the rough and striated process of the calcaneus?

What bones does the calcaneus articulate with?

Anteriorly with the cuboid and superiorly with the talus 

What is the second largest tarsal bone?

What does the talus articulate with?

Superiorly with the tibia and fibula, inferiorly with the calcaneus, and anteriorly with the navicular 

What does the navicular articulate with?

posteriorly with the talus and anteriorly with the three cuneiforms

What are the three cuneiforms called from most medial to most lateral?

• Medial Cuneiform
• Intermediate cuneiform
• and lateral cuneiform

What does the medial cuneiform articulate with?

• navicular proximally
• first and second metatarsals distally
• intermediate cuneiform laterally

What does the intermediate cuneiform articulate with?

• the navicular proximally
• the second metatarsal distally
• medial and lateral cuneiforms on each side

What does the lateral cuneiform articulate with?

• the navicular proxiamally
• the second, third, and fourth metatarsals distally
• intermediate cuneiform medially
• cuboid laterally

What does the cuboid articulate with?

• The calcaneus proximally
• lateral cuneifomr medially
• fourth and fifth metatarsals distally
• occasionally articulates with the navicular

What do the longitudinal and transverse arches provide?

A strong, shock-absorbing support for the weight of the body 

In which of the following positions projections will the Talocalcaneal joint be visualized?

Which of the following projections of the ankle would best demonstrate the distal tibiofibular joint?

What projection will best demonstrate the talo fibular joint?

Which projection of the ankle will open up the distal tibiofibular joint?