RAD141 - Lower Extremities
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| Where should the flasher be positioned on all lower extremities? | heel should be placed towards flasher
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| What should be done if only a portion of a film will be used for an exposure? | the other part of the film should be blocked off with lead
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| What is proper collimation for foot projections? | include ankle
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| What film sizes s/b used for foot projections? | 1/2 of 10 x 12 for all, except use 8 x 10 for lateral
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| Where should the CR be positioned for foot projections? | base of 3rd metatarsal for AP and medial oblique; medial cuneiform (at level of base of 3rd metatarsal) for lateral; PIP or IP for lateral toe
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| Should a CR tube angle be used for foot projections? | the AP foot s/b 10 deg cephalic; the AP weight-bearing s/b 15 deg cephalic; for all other foot projections, the CR s/b perpendicular
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| How should the foot be rotated for a medial oblique foot? | normally, a mortise projection is required -> 15 deg medial rotation; a 45 deg medial rotation may sometimes be requested
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| How can you tell if the foot is rotated 15 deg medially? | if you can place one finger under the foot
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| Fot a lateral toe, when should medial rotation be used? Lateral rotation? | medial rotation for 1st-3rd digits; lateral rotation for 4th & 5th digits
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| For a lateral foot, what s/b done to ensure a true lateral position? | the knee s/b flexed 45 deg and slightly elevated, using sponge if necessary; plantar surface of foot s/b perpendicular to IR
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| In general, how should the foot be positioned for all foot/ankle projections? | if the ankle is included, foot s/b dorsiflexed (not for AP or oblique foot)
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| What foot projections are used to demonstrate the arches of the foot? | AP weight-bearing for horizontal; lateral weight-bearing for longitudinal arch
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| How should ankle projections be collimated? | should include base of 5th metatarsal
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| Where should the CR be directed for ankle projections? | for all but lateral, midway between the malleoli; for lateral, thru ankle joint, directed to medial malleolus
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| What should be done to confirm that a mortise ankle is properly aligned? | put fingers (or thumbs) on malleoli and check if parallel; s/b medially rotated 15 - 20 deg
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| When critiquing a lateral ankle image, what demonstrates proper positioning? | the malleoli s/b superimposed
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| When should a 45 deg medial oblique ankle be performed? | routinely for trauma; demonstrates distal fibula & tibia free of superimposition of talus
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| Which projections are routine for the foot? Supplementary? | routine foot -> AP, lateral, medial oblique (15 deg); supplementary -> lateral toe, 45 deg medial oblique, weight-bearing feet (lateral & AP)
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| Which projections are routine for the ankle? Supplementary? | routine ankle -> AP, lateral, mortise (15 deg medial oblique); supplementary --> 45 deg medial oblique (routine for trauma)
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| What are the 3 calcaneus projections? | lateral, axial tangential (plantodorsal), and posterior tangential (aka Harris Method)
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| Which fillm sizes are used for ankle projections? | 8 x 10 for single exposures; 1/2 of 10 x 12 for AP, mortise, or 45 deg oblique; 1/3 11 x 14 for AP
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| How is a lateral calcaneous performed? | foot and ankle in lateral position, centered to film; CR centered at the posterior 1/3 of foot; collimate to include junctions w/tarsal bones
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| How is the axial tangential (plantodorsal) calcaneus performed? | leg extended, ankle centered to film lengthwise; hyperflex ankle, using linen to ensure plantar surface is perpendicular to IR; angle tube 40 deg cephalic (to plane of foot) at posterior 1/3 of foot, level w/base of 5th metatarsal; inc technique
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| How is the posterior tangential calcaneus performed? | aka Harris method; patient erect, foot flat, calcaneus centered to cassette; patient takes small step w/unaffected foot; CR angled 45 deg anterior and enters at posterior aspect of flexed ankle and exits at base of 5th metatarsal
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| How should tib-fibs be collimated? | both the ankle and knee joints s/b included; if they don't both fit, make a clean break of one joint and get the other joint on a separate film
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| What film size s/b used for tib-fibs? | 7 x 17 or 1/2 14 x 17
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| What are the routine tib-fib projections? supplementary? | routine tib-fib -> AP and lateral; supplementary -> medial & lateral obliques (45 deg)
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| Where should the CR be positioned for a tib-fib? Any angulation? SID? | CR is positioned perpendicular to the mid-point of the tib-fib; minimum SID is 40 inches
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| What is correct patient position for a tib-fib? | patient s/b supine w/leg extended for AP and obliques; on affected side w/knee flexed and patella perpendicular to film for a lateral; foot s/b dorsi-flexed for all tib-fibs
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| What do the medial and lateral tib-fib obliques demonstrate? | medial oblique demonstrates the proximal & distal tibiofibular articulations (max space seen between tib-fib); lateral demonstrates the tibial plateau
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| How should a lateral tib-fib be modified for trauma? | have 2 people raise the leg, building it up w/sheets; take cross-fire lateral using a horizontal CR
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| What are the routine projections for the knee? supplementary? | routine knee -> AP, lateral; supplementary -> medial & lateral oblique
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| How should knee projections be collimated? Should a tube angle be used? Film size? | collimation should include the distal femur and proximal tib-fib; tube s/b angles 5-7 deg cephalad; film size -> 10 x 12
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| Where should the CR be positioned for knee projections? | 1/2 inch inferior to the apex of the patella for all but lateral; for lateral, 1 inch distal to medial epicondyle
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| How should the patient be positioned for AP & oblique knee projections? | supine w/leg extended & foot dorsiflexed; AP -> femoral condyles s/b parallel to IR & 15 deg medial rotation of foot; obliques -> leg s/b rotated 45 deg in requested direction
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| How should the patient be positioned for a lateral knee projection? | lateral recumbent on affected side; knee flexed 30 deg; patella perpendicular to film
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| What do the different knee projections demonstrate? | AP -> open tibiofemoral join space; lateral -> superimposed condyles, open joint space between patella & femur; medial oblique -> proximal tib-fib articulation (rotates fib away from tib); lateral oblique -> tibial plateau
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| What is another name for interchondyloid fossa projections? | tunnel-views
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| How should interchondyloid fossa projections be collimated? Where should the CR be pointed? | to include the distal femur and proximal tib-fib; CR s/b positioned at the joint space
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| What are the interchondyloid fossa methods and brief description for each? | Camp-Coventry -> prone, knees flexed to form 40 deg angle w/table; Holmblad -> hands & knees; Beclere -> AP projection onto curved cassette
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| Describe the Camp-Coventry Method: | a tunnel view of the knee with PA projection; patient prone, knee flexed to form 40 deg angle w/table (can be supported w/pillows or blankets); CR perpendicular to tib-fib -> 40 deg caudad
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| Describe the Holmblad Method: | patient on hands & knees w/film under affected knee; patient leans forward so femur forms a 70 deg angle from the table
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| Describe the Beclere Method: | patient supine, knee slightly bent; curved cassette placed under affected knee; CR perpendicular to long axis of tibia
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| What are the various patella projections? | PA, lateral, obliques, and Tangential (Settegast Method, Merchant Method, Hughston Method)
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| What film size s/b used for PA, lateral and oblique patella projections? for tangential? | PA, lateral, oblique -> 8 x 10, lengthwise; tangential -> either 8 x 10 crosswise, or 10 x 12 crosswise
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| How should patella projections be collimated? | to include the patella and knee joint
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| What is the SID for patella projections? | for all projections except Merchant, SID = 40 inches; Merchant Method is 48 - 72 inches
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| How should a patella projection be handled for a patient who cannot lie prone? | seat patient at table end w/knee flexed as much as possible; patient holds cassette firmly on femur , extending beyond the femur distally; CR perpendicular to joint space btw patella & femoral condyles, deg of angulation dependent on knee flexion
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| What is patient and CR position for a PA patella? | patient prone, legs extended, foot & knee medially rotated 5-10 deg; CR perpendicular to mid-popliteal area
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| What are patient and CR position for lateral patella? | patient in lateral recumbent position, affected side down; true lateral position (patella perpendicular to plane of IR); flex knee very slightly (5-10 deg); CR perpendicular, directed at mid-femoropatellar joint
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| What are patient and CR position for the Settegast method? What is the Settegast method used for? | Settegast -> tangential patella projection (sunrise/skyline); patient prone, knee flexed until patella is perpendicular to table; patient holds onto gauze/tape to maintain position; CR perpendicular, directed btw patella & femoral condyles
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| What is the patient position for Merchant Method? | patient supine, leg flexed 40 deg over the end of the table, feet resting on leg support; quadriceps muscle must be relaxed
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| What is the CR position and SID for the merchant method? | CR 30 deg caudad, positioned midway between patella (bilateral study); SID -> 48-72 inches
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| What are the patient and CR position for the Hughston method? | patient prone; knee flexed 50-60 deg (book has 45 deg); CR perpendicular, directed to midfemoropatellar joint
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| What are the femur projections? | AP and lateral
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| How should femur projections be collimated? | include knee joint; for AP projection, also include hip if possible; if not, include AP hip on a 10 x 12; if fracture is obvious, the joint closest to the fracture s/b on the 14 x 17 and the opposite joint on 10 x 12
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| What are patient and CR position for an AP femur? | patient supine, legs extended; medially rotate foot 15 deg (for true AP projection of femoral neck); CR perpendicular thru mid-shaft
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| What are patient and CR position for a lateral femur? | lateral recumbent on affected side; patella perpendicular to IR; flex knee slightly; CR perpendicular thru mid-shaft
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| What must always be done with a lateral femur? | an axiolateral hip (on a 10 x 12 film)
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| What are the joints in the foot and what type are they? | all are synovial, diarthrodial; interphalangeal -> ginglymus (hinge); metatarsophalangeal -> modified ellipsoidal (condyloid); tarsometatarsal -> plane (glliding); intertarsal -> plane (gliding); ankle -> ginglymus (hinge)
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| What are the joints in the lower leg and knee and what types are they? | knee: femorotibial -> ginglymus (hinge) and patellofemoral -> sellar (saddle); proximal tibiofibular joint -> plane (gliding); distal tibiofibular -> fibrous, amphiarthrodial -> syndesmosis
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| What are the hip projections (non-trauma)? | AP and frogleg lateral (aka modified Cleaves Method - i.e. unilateral)
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| What size film is used for non-trauma hip projections? SID? Grid? | 10 x 12" film, with a grid; SID = 40 inches
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| What is patient and CR position for an AP hip? Are there any special instructions? | patient supine w/affected hip centered to the midpoint of the table; feet inverted 15 degrees; CR perpendicular; special instructions -> expiration
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| What anatomy must be present on an AP hip? | femoral head, neck, trochanters, and proximal third of the femoral shaft
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| What is the difference between a "true" Cleaves Method and the modified version we use in class? | a "true" Cleaves Method is a bilateral hip study; the modified Cleaves Method used in class is unilateral
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| What is the Lauenstein method? | the modified Cleaves Method (i.e. unilateral) with the femur parallel to the table
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| When are the Cleaves or Lauenstein methods used? | for non-trauma patients; mainly for arthritis
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| What is patient and CR position for a unilateral Frogleg Lateral hip? | patient supine, leg bent approx 90 deg, rotated out onto table; top of film between ASIS and iliac crest; CR perpendicular
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| What anatomy s/b present on a Frogleg lateral hip? | axial projection of the femoral head, neck, and trochanters
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| Where should the CR be directed for an AP hip? for a frogleg lateral hip (unilateral)? | AP hip -> 1-2 inches medial and 3-4 inches distal to the ASIS; frogleg -> in the crease of the leg, midway between the ASIS and pubic symphysis
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| What is patient position for a Bilateral frog-leg hip projection? | patient supine, arms crossed on chest; no pelvis rotation; center IR to CR at level of femoral heads, top of IR approx at level of iliac crest; flex both knees 90 deg; place plantar surfaces of feet together; abduct femurs 40-45 deg from vertical
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| In a bilateral frog-leg hip projection, how do you ensure that the pelvis is not rotated? | there should be equal distance of ASISs to tabletop
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| Where is CR directed for a frog-leg bilateral hip? Any angulation? | CR is perpendicular to IR, to a point 3 inches below level of ASIS (i.e. 1 inch above symphysis pubis
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| What film size s/b used for Cleaves Method hip? SID? grid? | 10 x 12" w/grid; 40" SID
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| When is the axiolateral hip - crossfire projection done? | for hip trauma
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| What is patient position for an axiolateral hip - cross-fire; | patient supine, hands resting on upper chest; elevate entire pelvis; flex the unaffected leg up & out of the way
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| Where should the CR be directed for an axiolateral hip - cross-fire? | draw imaginary line from ASIS to symphysis pubis and draw a point at the center of that line; mark one inch distal to the most prominent portion of the greater trochanter; draw a line connecting these 2 points & mark its center -> aim CR here
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| For an axiolateral hip, crossfire, how should the CR be angled? Where should the film be? | the CR s/b perpendicular (horizontal) to the hip join with the grid and cassette perpendicular to the table centered to the centering mark
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| What anatomy s/b demonstrated on an axiolateral hip - crossfire? | the femoral head, neck, and trochanters; as much of the femoral neck s/b seen as possible; the acetabulum s/b seen; any orthopedicu device s/b included in its entirety (may need to use a 14 x 17)
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