1 / 87

Lower extremity

Lower extremity. Intended Learning Outcomes. The student should be able to recognize clinical radiographic technical principles of the lower limb. A-P Lower Leg. Measure: A-P at mid-lower leg Protection: Apron draped over pelvis SID: 40” Table top No Tube Angle

shiloh
Télécharger la présentation

Lower extremity

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Lower extremity

  2. Intended Learning Outcomes • The student should be able to recognize clinical radiographic technical principles of the lower limb.

  3. A-P Lower Leg • Measure: A-P at mid-lower leg • Protection: Apron draped over pelvis • SID: 40” Table top • No Tube Angle • Film: 7”x17 I.D. down or diagonal 14” x 17

  4. A-P Lower Leg • Patient lies on back on table. • Leg internally rotated 15° until in true A-P position • Film centered to include knee and ankle joints. The top of the film will be about 2” above knee. • Horizontal CR is centered to film

  5. A-P Lower Leg • Vertical CR: long axis of lower leg • Collimation top to bottom: From knee joint to ankle joint or slightly less than film size. • Collimation side to side: soft tissue of lower leg • Instructions: Remain still • Make exposure and let patient relax.

  6. A-P Lower Leg Film • Must include both knee and ankle articulations • No evidence of rotation • As with this example, the 14” x 17” cassette can be turned diagonally to get both joint spaces on film.

  7. Lower Leg Lateral • Measure: Lateral at mid lower leg • Protection: Apron draped over pelvis • SID: 40” Table Top • No Tube Angle • Film: 7” x 17” I.D. down or diagonal 14”x17” Regular

  8. Lower Leg Lateral • Patient lies on affected side with lower leg in lateral position. • Film centered under leg to get both knee joint and ankle joint on film. Top of film will be about 2” above knee joint. • Horizontal CR centered to film

  9. Lower Leg Lateral • Vertical CR: long axis of lower leg. • Collimation top to bottom: to include knee joint space and ankle joints • Collimation Side to side: soft tissues of lower leg.

  10. Lower Leg Lateral • Make sure that the knee and ankle are in lateral position. The condyles should be perpendicular to film and foot in lateral position. • Collimation Top to Bottom: include both knee joint space and ankle joints

  11. Lower Leg Lateral • Collimation Side to Side: soft tissues of lower leg. • Instructions: Remain still • Make exposure and let patient relax

  12. Lower Leg Lateral Film • Must include both knee and ankle joints. • Both joints should be in true lateral positions. • A 14” x 17” may be turned diagonally to get both joints on film.

  13. Ankle Radiography • Routine views at PCCW • AP • Mortise Oblique • Medial Oblique • Lateral • We do both oblique views for Dr. Scuderi • The mortise open the joints better • The medial oblique demonstrates Jones Fractures.

  14. A-P Ankle

  15. Ankle A-P • Measure: A-P at malleoli • Protection: lead apron • SID: 40” Table Top • No Tube Angle • Film: 1/2 of 12” x 10 extremity cassette I.D. up

  16. Ankle A-P • Patient is seated or lying on table. Leg is internally rotated until the leg is in a true A-P position position. • The foot is dorsiflexed until the plantar surface is perpendicular to film. • Horizontal CR: at level of talo-tibial joint or malleoli.

  17. Ankle A-P • Half of film is centered to Horizontal CR. • Vertical CR: Long axis of lower leg. • Collimation top to bottom: distal lower leg to soft tissue below calcaneus. Slightly less than film size.

  18. Ankle A-P • Collimation side to side: soft tissue of lower leg and ankle. • Patient Instructions: Remain still • Make exposure and let patient relax.

  19. Ankle A-P Film • A-P on left. • There should be no rotation as evidenced by the medial mortise joint being open. • The talotibial joint should also be open. • Soft tissue of plantar area of foot should be seen.

  20. Ankle Oblique ViewsMortise Medial

  21. Always take a medial obliqueMedial Oblique Lateral Oblique

  22. Ankle Medial Oblique • Measure: A-P at malleoli • Protection: lead apron • SID: 40” Table Top • No Tube Angle • Film: 1/2 of 12” x 10 extremity cassette I.D. up

  23. Ankle Medial Oblique • Patient is seated or lying on table. Leg is internally rotated 45° from true A-P position position. • The foot is dorsiflexed until the plantar surface is perpendicular to film. • Horizontal CR: at level of talo-tibial joint or malleoli.

  24. Ankle Medial Oblique • Half of film is centered to Horizontal CR. • Vertical CR: Long axis of lower leg. • Collimation top to bottom: distal lower leg to soft tissue below calcaneus. Slightly less than film size.

  25. Ankle Medial Oblique • Collimation side to side: soft tissue of lower leg and ankle. • Patient Instructions: Remain still • Make exposure and let patient relax.

  26. Ankle Medial Oblique Film • Oblique on right. • The lateral malleolus should be clear of the talus. • The medial mortise joint may be open • The talotibial joint should also be open. • The tarsal sinus will be open.

  27. Ankle Mortise Oblique • Measure: A-P at malleoli • Protection: lead apron • SID: 40” Table Top • No Tube Angle • Film: 1/2 of 12” x 10 extremity cassette I.D. up

  28. Ankle Mortise Oblique • Patient is seated or lying on table. Leg is internally rotated until the medial and lateral malleoli are parallel to the film , about 15 to 20 °. • The foot is dorsiflexed until the plantar surface is perpendicular to film. • Horizontal CR: at level of talotibial joint or malleoli.

  29. Ankle Mortise Oblique • Half of film is centered to Horizontal CR. • Vertical CR: Long axis of lower leg. • Collimation top to bottom: distal lower leg to soft tissue below calcaneus. Slightly less than film size.

  30. Ankle Mortise Oblique • Collimation side to side: soft tissue of lower leg and ankle. • Patient Instructions: Remain still • Make exposure and let patient relax.

  31. Ankle Mortise & Oblique Film • Oblique on right., Mortise on left • The lateral malleolus should be clear of the talus. • The medial mortise joint must be open • The talotibial joint should also be open.

  32. Lateral Ankle

  33. Ankle Lateral • Measure: Lateral at malleoli • Protection: Lead Apron • SID: 40” Table Top • No Tube Angle • Film: 8” x 10” I.D. up

  34. Ankle Lateral • Patient lies on the affected side with lower leg aligned with table center line. • Foot dorsa-flexed to form a 90° angle with lower leg. • Plantar surface of foot is perpendicular to film and malleoli are perpendicular to film.

  35. Ankle Lateral • Horizontal CR: medial malleolus • Vertical CR: medial malleolus and long axis of lower leg. • Collimation top to bottom: distal tibia to soft tissue below calcaneus

  36. Ankle Lateral • Collimation side to side: to include soft tissue around calcaneus and lower leg. • Instructions: Remain still • Make exposure and let patient relax.

  37. Ankle Lateral Film • Must include distal tibia, talus and calcaneus. • The talus domes must be superimposed. • The fibula should overlie the distal tibia. • The talotibial joint should be open. • Note wrong I.D. location

  38. Calcaneus Axial View • Measure: Lateral at calcaneus • Protection: Lead Apron • SID: 40” Table Top • Tube Angle: 40° cephalad • Film: 1/2 of 8”x10” Extremity Cassette

  39. Calcaneus Axial View • Patient lies or sits on table with affected leg centered to table. • Lower leg in true A-P position and foot dorsiflexed until the plantar surface is perpendicular to film. • A strap or tape may be used for the patient to hold foot in dorsiflexion.

  40. Calcaneus Axial View • Horizontal CR: 1.5 to 2” up the calcaneus tuberosity • Film centered to Horizontal CR. • Vertical CR: long axis of foot. • Collimation top to bottom: to include all of calcaneus and adjacent soft tissues

  41. Calcaneus Axial View • Collimation Side to Side: soft tissue of foot or slightly less than 1/2 of film. • Instructions: Remain still • Make exposure and let patient relax.

  42. Calcaneus Axial View Film • The calcaneus tuberosity will be seen free of distortion. • The Calcaneal-Talus joint space should be seen. • If the foot is not properly dorsiflexed, the joint space will be closed and the tuberosity foreshortened.

  43. Calcaneus Lateral View • Measure: Lateral at calcaneus • Protection: Lead Apron • SID: 40” Table Top • No Tube Angle • Film: 1/2 of 8”x10” Extremity Cassette

  44. Calcaneus Lateral View • Patient lies on table on affected side with affected leg centered to table. • Lower leg in true lateral position and foot dorsiflexed. • Horizontal CR: 1.5 to 2” up the calcaneus tuberosity • Film centered to Horizontal CR.

  45. Calcaneus Lateral View • Vertical CR: through medial malleoli • Collimation top to bottom: to include all of calcaneus and adjacent soft tissues • Collimation Side to Side: soft tissue of foot or slightly less than 1/2 of film.

  46. Calcaneus Lateral View • Instructions: Remain still • Make exposure and let patient relax.

  47. Calcaneus Lateral Film • The calcaneus, talus and ankle should be demonstrated in a true lateral position. • The domes of the talus will be superimposed. • Soft tissues adjacent to the calcaneus and ankle should be visualized.

  48. Foot Radiography • Fractures are characterized by involvement of the subtalar joint (75%) and not involving the subtalar joint. • Stress fractures are common in runners but typically not seen on radiographs. • Stress fractures , plantar fascitis or heel spurs are common repetitive use conditions.

  49. Foot or Heel Radiography • Views of the foot and calcaneus are totally different. • If a heel injury is suspected, take heel views and not foot views. • A 30 degree medial oblique view can be useful. The oblique and lateral will demonstrate the subtalar joint.

  50. Foot Radiography • Foot view must include the tarsal bones, metatarsals and phalanges. • A tube angle is used to open the tarsal bone articulations on the A-P view. • If the patient is flat footed, no tube angle would be needed.

More Related