number of phalanges in the foot
number of metatarsals in the foot
number of tarsals in the foot
total number of bones in the foot
What are the 2 differences in the phalanges of the foot as compared with the phalanges of the hand?
1) phalanges of the foot are smaller, 2) joint movements of the foot are more limited
Which tuberosity of the foot is palpable and a common site of foot trauma?
Tuberosity of base of the 5th metatarsal
Where are the sesamoid bones of the foot most commonly located?
Plantar surface of the foot near the first MTP joint
What is the largest and strongest tarsal bone?
What is the name of the joint found between the talus and calcaneus?
subtalar or talocalcaneal
List the 3 specific articular facets found in the subtalar/talocalcaneal joint.
posterior facet, middle facet, anterior facet
The small opening found in the middle of the subtalar/talocalcaneal joint is called the:
sinus tarsi or tarsal sinus
tarsal bone that forms an aspect of the ankle joint
smallest of the cuneiforms
found on the medial side of the foot between the talus
the largest of the cuneiforms
tarsal bone that articulates with the 2nd, 3rd, and 4th metatarsal
the most superior tarsal bone
tarsal bone that articulates with the 1st metatarsal
tarsal bone that is a common site for bone
spurs
a tarsal found anterior to the calcaneus and lateral to the lateral cuneiform
the second largest tarsal bone
TF: The cuboid articulates with the 4 bones of the foot.
The calcaneus articulates with the talus and the ___.
List the two arches of the foot.
Which 3 bones make up the ankle joint?
The three bones of the ankle form a deep socket into which the talus fits. This socket is called the ___.
The distal tibial joint surface forming the roof of the distal ankle joint is called the ___.
TF: The medial malleolus is approximately 1/2 inch posterior to the lateral malleolus.
The ankle joint is classified as a synovial joint with ___ type movement.
The ___ is the weight-bearing bone of the lower leg.
What is the name of the large prominence located on the midanterior surface of the proximal tibia that serves as a distal attachment for the patellar tendon?
What is the name of the small prominence located on the posterolateral aspect of the medial condyle of the femur that is an identifying landmark to determine possible rotation of a lateral knee?
A small, triangular depression located on the tibia that helps form the distal tibiofibular joint is called the ___.
The articular facets of the proximal tibia are also referred to as the ___.
The articular facets (of the tibial plateau) slope ___ degrees posteriorly.
The most proximal aspect of the fibula is the ___.
The extreme distal end of the fibula forms the ___.
What is the name of the largest sesamoid bone in the body?
What are 2 other names for the patellar surface of the femur?
intercondylar sulcus, trochlear groove
What is the name of the depression located on the posterior aspect of the distal femur?
intercondylar fossa or notch
Why must the CR be angled 5*-7* cephalad for a lateral knee position?
Because the medial condyle extends lower than the lateral condyle of the femur.
The slightly raised area located on the posterolateral aspect of the medial femoral condyle is called the:
What are the two palpable bony landmarks found on the distal femur?
medial epicondyle, lateral epicondyle
The general region of the posterior knee is called the ___.
TF: Flexion of 20* of the knee forces the patella firmly against the patellar surface of the femur.
TF: The patella acts like a pivot to increase the leverage of a large muscle found in the anterior thigh.
TF: The posterior surface of the patella is normally rough.
For which large muscle does the patella serve as a pivot to increase the leverage?
quadriceps femoris muscle
Name of the joint located between the patella and distal femur.
Name of the joint located between the 2 condyles of the femur and tibia.
The 4 major ligaments of the knee.
1) fibular (lateral) collateral, 2) tibial (medial) collateral, 3) anterior cruciate, 4) posterior cruciate
The crescent-shaped fibrocartilage disks that act as shock absorbers in the knee joint are called ___.
medial and lateral menisci
The two bursae found in the knee joint.
suprapatellar bursa, infrapatellar bursa
Tibial plafond is found on which bone?
Medial malleolus is found on which bone?
Lateral epicondyle is found on which bone?
Patellar surface is found on which bone?
Articular facets are found on which bone?
Fibular notch is found on which bone?
Styloid process is found on which bone?
Base is found on which bone?
Intercondyloid eminence is found on which bone?
Neck is found on which bone?
Ankle joint is what type of joint?
Patellofemoral is what type of joint?
Proximal tibiofibular is what type of joint?
Tarsometatarsal is what type of joint?
Knee joint (femorotibial) is what type of joint?
Distal tibiofibular is what type of joint?
amphiarthrodial (syndesmosis type)
What type of movement is inward turning or bending of the ankle?
What type of movement is decreasing the angle between the dorsum pedis and anterior lower leg?
What type of movement is extending the ankle or pointing the foot and toe downward?
What type of movement is outward turning or bending of the ankle?
TF: The recommended SID for lower limb radiography is 40 inches.
TF: To reduce scatter radiation during table top procedures, the Bucky tray should be positioned over the lower limb being radiographed.
TF: With careful and close collimation, gonadal shielding does not have to be used during lower limb radiography.
TF: A kV range between 50 and 70 should be used for film-screen lower limb radiography.
TF: kV range for CR and digital radiography is typically lower as compared with film-screen ranges.
Why is the CR angled 10* to 15* toward the calceneus for an AP projection of the toes?
Opens up the IP and MTP joints
Where is the CR centered for an AP oblique projection of the foot?
base of the 3rd metatarsal
Which projection is best for demonstrating the sesamoid bones of the foot?
The foot should be dorsiflexed so that the plantar surface of the foot is ___ degrees from vertical for the sesamoid projection.
Why should the CR be perpendicular to the metatarsals for an AP projection of the foot?
opens up the MTP and certain intertarsal joints
If a foreign body is lodged in the plantar surface of the foot, which type of CR angle should be used for the AP projection?
None; use a perpendicular CR
Rotation can be determined on a radiograph of an AP foot projection by the near-equal distance between the ___ metatarsals.
Which obligue projection of the foot best demonstrates the majority of the tarsal bones?
AP oblique with medial rotation
Which oblique projection of the foot best demonstrates the navicular and the 1st and 2nd cuneiforms with minimal superimposition?
AP oblique with lateral rotation
Which projection tends to place the foot into a truer lateral position: mediolateral or lateromedial?
Which type of study should be performed to best evaluate the condition of the longitudinal arches of the foot?
AP and lateral weight-bearing projections
How should the CR be angled from the long axis of the foot for the plantodorsal axial projection of the calcaneus?
Which calcaneal structure should appear medially on a well-positioned plantodorsal projection?
Where is the CR placed for a lateral projection of the calcaneus?
1.5 inches (4 cm) from the medial malleolus
Which joint surface of the ankle is not typically visualized with a correctly positioned AP projection of the ankle?
Why should AP, 45* oblique, and lateral ankle radiographs include the proximal metatarsals?
To demonstrate a possible fracture of the 5th metatarsal tuberosity (a common fracture site)
How much (if any) should the foot and ankle be rotated for an AP mortise projection of the ankle?
Which projection of the ankle best demonstrates a possible fracture of the lateral malleolus?
45* AP oblique with medial rotation
With a true lateral projection of the ankle, the lateral malleolus is:
projected over the posterior aspect of the distal tibia
Which projections of the ankle require forced inversion and eversion movements?
What is the basic positioning routine for a study of the tibia and fibula?
AP and lateral projections
Why is it important to include the knee joint for an initial study of tibia trauma, even if the patient's symptoms involve the middle and distal aspect?
A fracture may also be present at the proximal fibula in addition to the distal portion.
To include both joints for a lateral projection of the tibia and fibula for an adult, the technologist may place the cassette ___ in relation to the part.
What is the recommended CR angulation for an AP projection of the knee for a patient with thick thighs and buttocks (ie measuring greater than 24 cm)?
Where is the CR centered for an AP projection of the knee?
1/2" distal to apex of patella
Which basic projection of a knee best demonstrates the proximal fibula free of superimposition?
AP oblique, 45* medial rotation
For the AP oblique projection of the knee, the ___ rotation best visualizes the lateral condyle of the tibia and the head and neck of the fibula.
What is the recommended CR placement for a lateral knee position on a tall, slender male patient with a narrow pelvis?
How much flexion is recommended for a lateral projection of the knee?
Which positioning error is present if the distal borders of the femoral condyles are not superimposed on a lateral knee radiograph?
Which positioning error is present if the posterior portions of the femoral condyles are not superimposed on a lateral knee radiograph?
overrotation or underrotation of the knee
Which anatomic structure of the femur can be used to determine which rotation error (overrotation or underrotation) is present on s slightly rotated lateral knee radiograph?
adductor tubercle on posterolateral aspect of the medial femoral condyle
Which special projection of the knee best evaluates the knee joint for cartilage degeneration or deformities?
AP or PA weight-bearing knee
AP knee stress projections are performed to demonstrate:
medial or collateral ligament damage
Which special projection of the knee best demonstrates the intercondylar fossa?
How much flexion of the lower leg is required for the Camp Coventry projection when the CR is angled 40* caudad?
Why is the PA axial projection for the intercondylar fossa recommended instead of an AP axial projection?
Distortion caused by CR angle and increased OID for AP axial projection.
How much knee flexion is required for the PA axial projection (Holmblad method)?
What type of CR angle is required for the PA axial (Holmblad method)?
None. CR is perpendicular to the IR.
TF: To place the interepicondylar line parallel to the IR for a PA projection of the patella, the lower limb must be rotated approximately 5* internally.
How much part flexion is recommended for a lateral projection of the patella?
How much part flexion is required for the Settegast method?
What type of CR angle is required for the superoinferior sitting tangential method for patella?
None. CR is perpendicular to the IR.
The ___ method can be performed using a wheelchair or lowered radiographic table.
The ___ method can be performed with the patient prone and requires 90* knee flexion.
The ___ method can be performed with the patient prone with a 40* to 50* knee flexion and with equal 40* to 50* caudad CR angle.
The ___ projection is performed with patient supine and with cassette resting on midthighs.
inferosuperior axial for patellofemoral joint
A radiograph of an AP projection of the foot reveals that the MTP joints are not open and the metatarsals are somewhat foreshortened. What was the positioning error involved, and what modification should be made to improve this image on the repeat exposure?
CR not angled correctly. Adjust CR angle to keep it perpendicular to the metatarsals.
A radiograph of an AP oblique-medial rotation projection of the foot reveals that the proximal 3rd to 5th metatarsals are superimposed. What type of positioning error led to this radiographic outcome?
Overrotation of foot (toward medial direction)
A radiograph of a plantodorsal axial projection of the calcaneus reveals considerable foreshortening of the calcaneus. What type of positioning modification is needed on the repeat exposure?
Increase cephalad angle of the CR to correctly elongate the calcaneus
A radiograph of an AP projection of the ankle reveals that the lateral surface of the ankle joint is totally open. (It should not be open on a true AP projection.) The RT is positive that the ankle was in the correct, true AP position with the long axis of the foot perpendicular to the IR. What else could have led to this joint space being open?
Possibly a spread of the ankle mortise caused by ruptured ligaments.
A radiograph of an intended AP mortise projection reveals that the lateral malleolus is superimposed over the talus, and the distal tibiofibular joint is not well demonstrated. What is the most likely reason for this radiographic outcome?
Underroration of the ankle (toward the medial direction). The described appearance is that of a true AP ankle with little or not obliquity.
A radiograph of an AP knee projection demonstrates that the femorotibial joint space is not open at all. The patient is young and has no history of degenerative disease. What type of positioning modification may improve the outcome of this projection?
Angling the CR correctly to keep it parallel to the articular facets (tibial plateau)
A radiograph of an AP oblique with medial rotation of the knee to demonstrate the proximal fibula reveals that there is total superimposition of the proximal tibia and the fibula. What must be modified to correct this projection?
The wrong oblique position of the knee was obtained. This description is that of a laterally or externally oblique position of the knee.
A radiograph of a lateral recumbent knee reveals that the posterior border of the medial femoral condyle (identified by the adductor tubercle) is not superimposed but is slightly posterior to the lateral condyle. The fibular head is also completely superimposed by the tibia. What type of positioning error led to this radiographic outcome?
Underrotation of the knee (excessive rotation of patella away from IR)
A patient with trauma to the medial aspect of the foot comes to the ER. A heavy object was dropped on the foot near the base of the 1st metatarsal. Basic foot projections do not clearly demonstrate this region. What other projection of the foot could be used to better delineate this area?
An AP lateral oblique projection with 30* of external rotation will separate the bases of the 1st and 2nd metatarsals.
A radiograph of an AP and lateral tibia and fibula reveals that the ankle joint is not included on the AP projection, but both the knee and the ankle are included on the lateral projection. What should the technologist
Repeat the AP projection to ensure the ankle joint is demonstrated.
A radiograph obtained by using the PA axial (Camp Coventry method) reveals that the distal femoral condyles, articular facets, and intercondylar fossa are asymmetric. What possible positioning errors may have produced this distortion of the anatomy?
Rotation of the affected limb or incorrect CR angle to match the degree of flexion of the lower limb.
A radiograph of a lateral patella reveals that the patella is drawn tightly against the intercondylar sulcus. Which positioning modification should be performed to improve the quality of the image during the repeat exposure?
Decrease the amount of flexion of the knee to 5* to 10*
A patient with a history of degenerative disease of the left knee joint comes to the radiology department. The orthopedic surgeon orders a radiographic study to determine the extent of damage to the joint space. Which projection(s) should be performed?
An AP or PA weight-bearing bilateral knee projection will best evaluate the joint space.
A patient with a possible Lisfranc jouint injury. Which radiographic position(s) would best demonstrate this type of injury?
AP and lateral weight-bearing foot projections
A patient with a history of pain in the feet comes to the radiology department. The referring physician orders a study to evaluate the longitudinal arches of the feet. Which positioning routine should be used?
AP and lateral weight-bearing projections
A young male patient comes to the radiology department with a clinical history of Osgood-Schlatter disease. Which single projection of the basic knee series will best demonstrate this condition?
The lateral knee projection will best demonstrate any separatation of the tibial tuberosity from the shaft of the tibia.
A radiograph of a mediolateral knee projection demonstrates that the medial femoral condyle is projected inferior to the lateral condyle. What can the RT do to correct this problem during the repeat exposure?
By angling the CR 5* to 7* cephalad, the medial femoral condyle will be superimposed with the lateral condyle. If CR angulation was used on the initial projection, increase the amount of angle with the repeat exposure.
A physician orders a bilateral, tangential projection of the patella and patellofemoral joint space. But the patient is restricted to a wheelchair and can't lie on the radiographic table due to chronic pain. Which projection could be performed with the patient remaining in the wheelchair?
The superoinferior sitting tangential method is best suited for this patient. While remaining in the wheelchair, the patient's knees can be flexed, the IR can be positioned on a foot stool, and the CR is placed vertically above the knees.
A tangential (inferosuperior) projection of the patellofemoral joint space reveals that the patella is seated into the intercondylar sulcus and the joint space is not demonstrated. What possible positioning errors may have produced this radiographic outcome?
The most common error with the tangential (inferosuperior) projection is overflexion of the knee which will draw the patella into the intercondylar sulcus. Flexion of the lower limb should not exceed 45*. Another possible error is that the CR is not parallel to the joint space.
The largest and strongest bone of the body is the ___.
A small depression located in the center of the femoral head is the ___.
The less trochanter is located on the ___ aspect of the proximal femur.
The lesser trochanter projects ___ from the junction between the neck and shaft.
Because of the alignment between the femoral head and pelvis, the lower limb must be rotated ___ degrees internally to place the femoral neck parallel to the plane of the IR to achieve a true AP projection.
The upper margin of the greater trochanter is approximately ___ above the level of the superior border of the symphysis pubis, and the ischial tuberosity is about ___ below.