Evaluation Criteria For Projections In Positioning Ii

Front 1

PA (Lungs and Heart)

Back 1

1. Entire lung fields from the apices to the costophrenic angles
2. No rotation: sternal ends of clavicles equidistant from vertebral column
3. Scapulae projected outside lung fields
4. 10 Posterior ribs visible above diaphragm
5. Trachea visible in the midline
6. Sharp outlines of the heart and diaphragm
7. Faint shadow of the ribs and superior thoracic vertebrae visible through heart shadow
8. Lung markings visible from the hilum to the periphery of the lung
9. W/ inspiration and expiration images, diaphragm demonstrated on expiration at a higher level so that at least one less rib is seen w/n the lung field

Front 2

Lateral (R or L; Heart and Lungs)

Back 2

1. Superimposition of the ribs posterior to the vertebral column
2. Arm or its soft tissues not overlapping the superior lung field
3. Long axis of the lung fields demonstrated in vertical position, w/o forward or backward leaning
4. Lateral sternum w/ no rotation
5. Costophrenic angles and lower apices of lungs
6. Penetration of the lung fields and heart
7. Open thoracic intervertebral spaces and intervertebral foramina, except in pts w/ scoliosis
8. Sharp outlines of heart and diaphragm
9. Hilum in the approximate center of the radiograph

Front 3

PA Oblique (RAO and LAO; Heart and Lungs)

Back 3

1. Both lungs in their entirety
2. Trachea filled w/ air
3. Visible ID markers
4. Heart and mediastinal structures w/n the lung field of the elevated side in oblique images of 45 degrees
5. Maximum area of the right lung on the LAO
6. Maximum area of the left lung on the RAO

Front 4

AP Oblique (RPO and LPO; Lungs and Heart)

Back 4

1. Both lungs in their entirety
2. Trachea filled w/ air
3. Visible ID markers
4. Lung fields and mediastinal structures
5. Maximum area of the left lung on the LPO
6. Maximum area of the right lung on the RPO

Front 5

AP (Chest)

Back 5

1. Medial portion of the clavicles equidistant from the vertebral column
2. Trachea visible in the midline
3. Clavicles lying more horizontal and obscuring more of the apices than in the PA projection
4. Equal distance from the vertebral column to the lateral border of the ribs on each side
5. Faint image of the ribs and thoracic vertebrae visible through the heart shadow
6. Entire lung fields, from the apices to the costophrenic angles
7. Pleual vascular markings visible from the hilar regions to the periphery of the lungs

Front 6

AP Axial (Lindblom Method; Pulmonary Apices)

Back 6

1. Clavicles lying superior to the apices
2. Sternal ends of the clavicles equidistant from the vertebral column
3. Apices and lungs in their entirety
4. Clavicles lying horizontally w/ their medial ends overlapping only the 1st or 2nd ribs
5. Ribs distorted w/ their anterior and posterior portions somewhat superimposed

Front 7

AP or PA (R or L Lateral Decubitus; Lungs and Pleurae)

Back 7

1. No rotation, as evidenced by the clavicles being equidistant from the spine
2. Affected side in its entirety
3. Apices
4. Proper ID visible to indicate that decubitus was performed
5. Pt's arms not visible in the field of interest

Front 8

Lateral (R or L; Ventral or Dorsal Decubitus; Lungs and Pleurae)

Back 8

1. Entire lung fields, including the anterior and posterior surfaces
2. No rotation
3. Upper lung field not obscured by the arms
4. Proper ID marker visible to indicate the decubitus was performed
5. T7 in center of IR`

Front 9

AP (Supine and Upright; Abdomen)

Back 9

1. Size and shape of liver, spleen, and kidneys
2. Intraabdominal calcifications
3. Evidence of tumor masses
4. Proper pt alignment, which is ensured by:
a. Centered vertebral column
b. Ribs, pelvis, and hips equidistant to the edge of the radiograph on both sides
5. No rotation of pt, indicated by:
a. Spinous processes in center of lumbar vertebrae
b. Ischial spines of pelvis symmetric, if visible
c. Alae or wings of ilia symmetric

Front 10

AP (L Lateral Decubitus; Abdomen)

Back 10

1. Both sides of abdomen. If not possible:
a. Elevate and demonstrate the side down when fluid is suspected
b. Demonstrate the side up when free air is suspected
2. Abdominal wall, flank structures, and diaphragm
3. No rotation of pt
4. Shows size and shape of liver, spleen, and kidneys
5. Most valuable position for demonstrating free air and air-fluid
levels when an upright abdomen projection can’t be obtained

Front 11

Lateral (R or L; Abdomen)

Back 11

1. No rotation of pt, indicated by
a. Superimposed ilia
b. Superimposed lumbar vertebrae pedicles and open intervertebral foramina
2. Demonstrates prevertebral space occupied by abdominal aorta
3. Shows any Intraabdominal calcifications or tumor masses

Front 12

Lateral (R or L Dorsal Decubitus; Abdomen)

Back 12

1. Valuable in demonstrating prevertebral space
2. Useful in determining air-fluid levels in abdomen

Front 13

PA (2nd-5th Digits hand)

Back 13

1. No rotation of the digit:
2. Concavity of the phalangeal shafts and an equal amount of soft tissue on both sides of the phalanges
3. Fingernail, if visualized and normal, centered over the distal phalanx
4. Entire digit from fingertip to distal portion of adjoining metacarpal
5. No soft tissue overlap from adjacent digits
6. Open IP and MCP joint spaces w/o overlap of bones
7. Soft tissue and bony trabeculation
*Note: Digits that can’t be extended can be examined in small sections. When joint injury is suspected, an AP projection is recommended instead of a PA*

Front 14

Lateral (Lateromedial or Mediolateral; 2nd-5th Digits hand)

Back 14

1. Entire digit in a true lateral position
a. Fingernail in profile, if visualized and normal
b. Concave, anterior surfaces of the phalanges
c. No rotation of the phalanges
2. No obstruction of the proximal phalanx or MCP joint by adjacent digits
3. Open IP joint spaces
4. Soft tissue and bony trabeculation

Front 15

PA Oblique (Lateral Rotation; 2nd-5th Digits hand)

Back 15

1. Entire digit rotated at a 45˚ angle, including distal portion of the
adjoining metacarpal
2. No superimposition of the adjacent digits over the proximal phalanx or MCP joint
3. Open IP and MCP joint spaces
4. Soft tissue and bony trabeculation

Front 16

AP and PA (1st Digit hand)

Back 16

1. No rotation
a. Concavity of the phalangeal and metacarpal shafts
b. Equal amount of soft tissue on both sides of the
phalanges
c. Thumbnail, if visualized, in the center of the distal thumb
2. Area from distal tip of thumb to trapezium
3. Open IP and MCP joint spaces w/o overlap of bones
4. Overlap of soft tissue profile of the palm over the midshaft of the 1st metacarpal
5. Soft tissue and bony trabeculation
6. PA thumb projection magnified compared w/ AP projection

Front 17

Lateral (1st Digit hand)

Back 17

1. First digit in a true lateral position
a. Thumbnail, if visualized and normal, in profile
b. Concave, anterior surface of the proximal phalanx
c. No rotation of the phalanges
2. Area from the distal tip of thumb to the trapezium
3. Open IP and MCP joint spaces
4. Soft tissue and bony trabeculation

Front 18

PA Oblique (1st Digit hand)

Back 18

1. Proper rotation of phalanges, soft tissue, and 1st metacarpal
2. Area from distal tip of thumb to trapezium
3. Open IP and MCP joint spaces
4. Soft tissue and bony trabeculation

Front 19

PA (Hand)

Back 19

1. No rotation of the hand
a. Equal concavity of the metacarpal and phalangeal shafts on both sides
b. Equal amount of soft tissue on both sides of phalanges
c. Fingernails, if visualized, in center of each distal phalanx
d. Equal distance between metacarpal heads
2. Open MCP and IP joints, indicating that the hand is placed flat on IR
3. Slightly separate digits w/ no soft tissue overlap
4. All anatomy distal to the radius and ulna
5. Soft tissue and bony trabeculation
*Note: When MCP joints are under examination and pt can’t extend the hand enough to place its palmar surface in contact w/ IR, the position of the hand can be reversed for an AP projection. This position is also used for the metacarpals when the hand can’t be extended b/c of an injury, a pathologic condition, or the use of dressings*

Front 20

PA Oblique (Lateral Rotation; Hand)

Back 20

1. Minimal overlap of the 3rd-4th and 4th-5th metacarpal shafts
2. Slight overlap of the metacarpal bases and heads
3. Separation of the 2nd and 3rd metacarpals
4. Open IP and MCP joints
5. Digits separated slightly w/ no overlap of their soft tissues
6. All anatomy distal to the distal radius and ulna
7. Soft tissue and bony trabeculation

Front 21

Lateral Projection (Mediolateral or Lateromedial; Extension and Fan Lateral; Hand)

Back 21

1. Hand is in a true lateral position
a. Superimposed phalanges (individually demonstrated on fan lateral)
b. Superimposed metacarpals
c. Superimposed distal radius and ulna
2. Extended digits
3. Thumb free of motion and superimposition
4. Each bone outlined through the superimposed shadows of the other metacarpals
*Note: To better demonstrate fractures of the 5th metacarpal, Lewis recommended rotating the hand 5˚ posteriorly from the true lateral position. This positioning removes the superimposition of the 2nd-4th metacarpals*

Front 22

PA Wrist

Back 22

1. Distal radius and ulna, carpals, and proximal half of metacarpals
2. No rotation in carpals, metacarpals, or radius
3. Open radioulnar joint space
4. Soft tissue and bony trabeculation
5. No excessive flexion to overlap and obscure metacarpals w/ digits

Front 23

Lateral (Lateromedial; Wrist)

Back 23

1. Distal radius and ulna, carpals, and proximal half of metacarpals
2. Superimposed distal radius and ulna
3. Superimposed metacarpals

Front 24

PA Oblique (Lateral Rotation; Wrist)

Back 24

1. A well-demonstrated trapezium and distal half of scaphoid
2. Distal radius and ulna, carpals and proximal half of metacarpals
3. Open trapeziotrapezoid and scaphotrapezial joint space
4. Usually, adequate amount of obliquity in the following circumstances
a. Slight interosseus space between the 3rd-4th and 4th-5th metacarpal shafts
b. Slight overlap of distal radius and ulna
5. Soft tissue and bony trabeculation

Front 25

PA; Ulnar Deviation (Wrist)

Back 25

1. Scaphoid w/ adjacent articulations open
2. No rotation of wrist
3. Extreme ulnar deviation, as revealed by the angle formed between longitudinal axes of the forearm compared w/ the longitudinal axes of the metacarpals
4. Soft tissue and bony trabeculation

Front 26

PA Axial; Stecher Method (Scaphoid; Wrist)

Back 26

1. Scaphoid
2. No rotation of carpals, metacarpals, radius, or ulna
3. Distal radius and ulna, carpals, and proximal half of metacarpals
4. Soft tissue and bony trabeculation

Front 27

Tangential Projections; Gaynor-Hart Method (Carpal Canal)

Back 27

1. Carpals in an arch arrangement
2. Pisiform in profile and free of superimposition
3. Hamulus of hamate
4. All carpals

Front 28

AP (Forearm)

Back 28

1. Wrist and distal humerus
2. Slight superimposition of the radial head, neck, tuberosity over the proximal ulna
3. No elongation or foreshortening of the humeral epicondyles
4. Partially open elbow joint if the shoulder was placed in the same plane as the forearm
5. Open radioulnar space
6. Similar radiographic densities of the proximal and distal forearm

Front 29

Lateral (Lateromedial; Forearm)

Back 29

1. Wrist and distal humerus
2. Superimposition of the radius and ulna at their distal end
3. Superimposition by the radial head over the coronoid process
4. Radial tuberosity facing anteriorly
5. Superimposed humeral epicondyles
6. Elbow flexed 90˚
7. Soft tissue and bony trabeculation along the entire length of the radial and ulnar shafts

Front 30

AP (Elbow)

Back 30

1. Radial head, neck, and tuberosity slightly superimposed over the proximal ulna
2. Elbow joint open and centered to the central ray
3. No rotation of humeral epicondyles
4. Soft tissue and bony trabeculation

Front 31

Lateral (Lateromedial; Elbow)

Back 31

1. Open elbow joint centered to the central ray
2. Elbow flexed 90˚
3. Superimposed humeral epicondyles
4. Radial tuberosity facing anteriorly
5. Radial head partially superimposing the coronoid process
6. Olecranon process seen in profile
7. Bony trabeculation and any elevated fat pads in the soft tissue at the anterior and posterior distal humerus and the anterior proximal forearm
***When injury to the soft tissue around the elbow is suspected, the joint should be flexed only 30 or 35˚
a. This partial flexion doesn’t compress or stretch the soft structures as does the full 90˚ lateral flexion
b. The posterior fat pad may become visible in this position

Front 32

AP Oblique (Medial Rotation; Elbow)

Back 32

1. Coronoid process in profile
2. Trochlea
3. Elongated medial humeral epicondyles
4. Ulna superimposed by the radial head and neck
5. Olecranon process w/n the olecranon fossa
6. Soft tissue and bony trabeculation

Front 33

AP Oblique (Lateral Rotation; Elbow)

Back 33

1. Radial head, neck, and tuberosity projected free of the ulna
2. Capitulum
3. Open elbow joint
4. Soft tissue and bony trabeculation

Front 34

AP; Partial Flexion (Distal Humerus)

Back 34

1. Distal humerus w/o rotation or distortion
2. Proximal radius superimposed over ulna
3. Closed elbow joint
4. Greatly foreshortened proximal forearm
5. Trabecular detail on the distal humerus

Front 35

AP; Partial Flexion (Proximal Forearm)

Back 35

1. Proximal radius and ulna w/o rotation or distortion
2. Radial head, neck, and tuberosity slightly superimposed over the proximal ulna
3. Partially open elbow joint
4. Foreshortened distal humerus
5. Trabecular detail on the proximal forearm

Front 36

Axiolateral; Coyle Method (Radial Head and Coronoid Process)

Back 36

RH1. Open joint space between radial head and capitulum
RH2. Radial head, neck, and tuberosity in profile and free from superimposition w/ the exception of a small portion of the coronoid process
RH3. Humeral epicondyles distorted due to CR angulation
RH4. Radial tuberosity facing posteriorly
RH5. Elbow flexed 90 degrees
RH6. Soft tissue and bony trabeculation
CP1. Open joint space between coronoid process and trochlea
CP2. Coronoid process in profile and elongated
CP3. Radial head and neck superimposed by ulna
CP4. Elbow flexed 80 degrees
CP5. Soft tissue and bony trabeculation

Front 37

AP (Upright; Humerus)

Back 37

1. Elbow and shoulder joints
2. Maximal visibility of epicondyles w/o rotation
3. Humeral head and greater tubercle in profile
4. Outline of lesser tubercle, located between the humeral head and the greater tubercle
5. Beam divergence possibly partially closing the elbow joint
6. No great variation in radiographic densities of the proximal and distal
humerus

Front 38

Lateral Projection (Lateromedial, Mediolateral Upright; Humerus)

Back 38

1. Elbow and shoulder joints
2. Superimposed epicondyles
3. Lesser tubercle in profile
4. Greater tubercle superimposed over the humeral head
5. Beam divergence possibly partially closing the elbow joint
6. No great variation in radiographic densities of the proximal and distal
humerus

Front 39

AP (Recumbent; Humerus)

Back 39

1. Elbow and shoulder joints
2. Maximal visibility of epicondyles w/o rotation
3. Humeral head and greater tubercle in profile
4. Outline of the lesser tubercle, located between the humeral head and the greater tubercle
5. Beam divergence possibly partially closing the elbow joint
6. No great variation in radiographic densities of the proximal and distal
humerus

Front 40

Lateral (Lateromedial Recumbent; Humerus)

Back 40

1. Elbow and shoulder joints
2. Superimposed epicondyles
3. Lesser tubercle in profile
4. Greater tubercle superimposed over the humeral head
5. Beam divergence possibly partially closing the elbow joint
6. No great variation in radiographic densities of the proximal and distal humerus

Front 41

Lateral (Lateromedial Recumbent or Lateral Recumbent; Humerus)

Back 41

1. Distal humerus
2. Superimposed epicondyles

Front 42

AP (External Rotation Humerus; Shoulder)

Back 42

1. Superior scapula, lateral half of clavicle, and proximal humerus
2. Soft tissue around shoulder, along w/ bony trabecular detail
3. Humeral head in profile
4. Greater tubercle in profile on lateral aspect of humerus
5. Scapulohumeral joint visualized w/ slight overlap of humeral head on glenoid cavity
6. Outline of lesser tubercle between humeral head and greater
tubercle

Front 43

AP (Neutral Rotation Humerus; Shoulder)

Back 43

1. Superior scapula, lateral half of clavicle, and proximal humerus
2. Soft tissue around shoulder, along w/ bony trabecular detail
3. Greater tubercle partially superimposing humeral head
4. Humeral head in partial profile
5. Slight overlap of humeral head on glenoid cavity

Front 44

AP (Internal Rotation Humerus; Shoulder)

Back 44

1. Superior scapula, lateral half of clavicle, and proximal humerus
2. Soft tissue around shoulder, along w/ bony trabecular detail
3. Lesser tubercle in profile and pointing medially
4. Outline of greater tubercle superimposing humeral head
5. Greater amount of humeral overlap of glenoid cavity than in external and neutral positions

Front 45

Transthoracic Lateral Projection; Lawrence Method; R or L Position (Shoulder)

Back 45

1. Proximal humerus
2. Scapula, clavicle, and humerus seen through lung field
3. Scapula superimposed over the thoracic spine
4. Unaffected clavicle and humerus projected above the shoulder closest to the IR

Front 46

Inferosuperior Axial Projection; Lawrence Method & Rafert Et Al Modification (Shoulder Joint)

Back 46

1. Scapulohumeral joint w/ slight overlap
2. Coracoid process, pointing anteriorly
3. Lesser tubercle in profile and directed anteriorly
4. AC joint, acromion, and acromial end of clavicle projected through the humeral head
5. Soft tissue in axilla w/ bony trabecular detail

Front 47

Scapular Y; PA Oblique; RAO or LAO Position (Shoulder Joint)

Back 47

1. Humeral head and glenoid cavity superimposed
2. Humeral shaft and scapular body superimposed
3. No superimposition of the scapular body over the bony thorax
4. Acromion projected laterally and free of superimposition
5. Coracoid possibly superimposed or projected below the clavicle
6. Scapula in lateral profile w/ lateral and vertebral borders superimposed

Front 48

Glenoid Cavity; AP Oblique: Grashey Method; RPO or LPO Position (Shoulder Joint)

Back 48

1. Open joint space between the humeral head and glenoid cavity
2. Glenoid cavity in profile
3. Soft tissue at the scapulohumeral joint along w/ trabecular detail on the glenoid and humeral head

Front 49

Intertubercular Groove; Tangential Projection; Fisk Modification (Proximal Humerus)

Back 49

1. Intertubercular groove in profile
2. Soft tissue along w/ enhanced visibility of the intertubercular groove

Front 50

Acromioclavicular Articulations; AP Projection; Bilateral; Pearson Method

Back 50

1. AC joints visualized w/ some soft tissue and w/o excessive density
2. Both AC joints, w/ and w/o weights, entirely included on one or two single radiographs
3. No rotation or leaning by the pt
4. Right or left and weight or nonweight markers
5. Separation, if done, clearly seen on the images w/ weights

Front 51

AP (Clavicle)

Back 51

1. Entire clavicle centered on the image
2. Uniform density
3. Lateral half of the clavicle above the scapula, w/ the medial half
superimposing the thorax

Front 52

AP Axial; Lordotic Position (Clavicle)

Back 52

1. Most of the clavicle projected above the ribs and scapula w/ the medial end overlapping the first or second rib
2. Clavicle in a horizontal placement
3. Entire clavicle along w/ the AC and SC joints

Front 53

Tangential (Clavicle)

Back 53

1. Midclavicle w/o superimposition
2. Acromial and sternal ends superimposed
3. Entire clavicle along w/ AC and SC joints

Front 54

AP (Scapula)

Back 54

1. Lateral portion of scapula free of superimposition from ribs
2. Scapula horizontal and not obliqued
3. Scapular detail through the superimposed lung and ribs (shallow breathing should help obliterate lung detail)
4. Acromion process and inferior angle

Front 55

Lateral; RAO or LAO Position (Scapula)

Back 55

1. Lateral and medial borders superimposed
2. No superimposition of the scapular body on the ribs
3. No superimposition of the humerus on the area of interest
4. Inclusion of the acromion process and inferior angle
5. Lateral thickness of scapula w/ proper density
***For trauma pts this projection can be performed using the LPO or RPO
positions***

Front 56

AP or AP Axial (Toes)

Back 56

1. No rotation of phalanges; soft tissue width and midshaft concavity equal on both sides
2. Open IP and MTP joint spaces on the axial projections
3. Toes separated from each other
4. Distal ends of the metatarsals
5. Soft tissues and bony trabecular detail

Front 57

AP Oblique; Medial Rotation (Toes)

Back 57

1. All phalanges
2. Oblique toes; more soft tissue width and more midshaft concavity on side away from IR
3. Open IP and 2nd-5th MTP joint spaces
4. 1st MTP joint (not always opened)
5. Toes separated from each other
6. Distal ends of the metatarsals
7. Soft tissue and bony trabecular detail

Front 58

Lateral; Mediolateral or Lateromedial (Toes)

Back 58

1. Phalanges in profile (toenail should appear lateral)
2. Phalanx, w/o superimposition of adjacent toes. When superimposition cannot be avoided, the proximal phalanx must be demonstrated
3. Open IP joint spaces. The MTP joints will be overlapped but may be
seen in some pts
4. Soft tissue and bony trabecular detail

Front 59

AP or AP Axial (Foot)

Back 59

1. No rotation of the foot
2. Equal amount of space between the adjacent midshafts of the 2nd-4th metatarsals
3. Overlap of the 2nd-5th metatarsal bases
4. Visualization of the phalanges and tarsals distal to the talus, as well as the metatarsals
5. Open joint space between medial and intermediate cuneiforms

Front 60

AP Oblique; Medial Rotation (Foot)

Back 60

1. 3rd-5th metatarsal bases free of superimposition
2. Lateral tarsals w/ less superimposition than in the AP projection
3. Lateral TMT and intertarsal joints
4. Sinus tarsi
5. Tuberosity of the 5th metatarsal
6. Bases of the 1st and 2nd metatarsals
7. Equal amount of space between the shafts of the 2nd-5th metatarsals
8. Sufficient density to demonstrate the phalanges, metatarsals, and tarsals

Front 61

Lateral; Mediolateral (Foot)

Back 61

1. Metatarsals nearly superimposed
2. Distal leg
3. Fibula overlapping the posterior portion of tibia
4. Tibiotalar joint
5. Sufficient density to demonstrate the superimposed tarsals and
metatarsals

Front 62

Axial; Plantodorsal (Calcaneus)

Back 62

1. Calcaneus and subtalar joint
2. No rotation of the calcaneus —the 1st or 5th metatarsals not projected to the sides of the foot
3. Anterior portion of the calcaneus w/o excessive density over the posterior portion
a. Otherwise, 2 images may be needed for the 2 regions of thickness

Front 63

Lateral; Mediolateral (Calcaneus)

Back 63

1. No rotation of the calcaneus
2. Density of the sustentaculum tali, lateral tuberosity, and soft tissue
3. Sinus tarsi
4. Ankle joint and adjacent tarsals

Front 64

AP (Ankle)

Back 64

1. Tibiotalar joint space
2. Ankle joint centered to exposure area
3. Normal overlapping of the tibiofibular articulation w/ the anterior tubercle slightly superimposed over the fibula
4. Talus slightly overlapping the distal fibula
5. No overlapping of the medial talomalleolar articulation
6. Medial and lateral malleoli
7. Talus w/ proper density
8. Soft tissue

Front 65

Lateral; Mediolateral (Ankle)

Back 65

1. Ankle joint centered to exposure area
2. Tibiotalar joint well visualized, w/ medial and lateral talar domes
superimposed
3. Fibula over posterior half of the tibia
4. Distal tibia and fibula, talus, and adjacent tarsals
5. 5th metatarsal should be seen to check for Jones fracture
6. Density of ankle sufficient to see the outline of distal portion of fibula

Front 66

AP Oblique; Medial Rotation (Ankle)

Back 66

1. Distal tibia, fibula, and talus
2. Distal tibia and fibula overlap some of the talus
3. Talus and distal tibia and fibula adequately penetrated
4. Tibiofibular articulation

Front 67

Mortise Joint; AP Oblique; Medial Rotation (Ankle)

Back 67

1. Entire ankle mortise joint
2. No overlap of the anterior tubercle of the tibia and the superolateral portion of the talus w/ the fibula
3. Talofibular joint space in profile
4. Talus demonstrated w/ proper density

Front 68

AP (Leg)

Back 68

1. Ankle and knee joints on one or more AP projections
2. Ankle and knee joints w/o rotation
3. Proximal and distal articulations of tibia and fibula moderately
overlapped
4. Fibular midshaft free of tibial superimposition
5. Trabecular detail and soft tissue for the entire leg

Front 69

Lateral; Mediolateral (Leg)

Back 69

1. Ankle and knee joints on 1+ images
2. Distal fibula lying over the posterior half of the tibia
3. Slight overlap of the tibia on the proximal fibular head
4. Ankle and knee joints not rotated
5. Possibly no superimposition of femoral condyles b/c of divergence of the beam
6. Moderate separation of the tibial and fibular bodies or shafts (except at their articular ends)
7. Trabecular detail and soft tissue

Front 70

AP (Knee)

Back 70

1. Open femorotibial joint space, w/ interspaces of equal width on both
sides if knee is normal
2. Knee fully extended if pt’s condition permits
3. Patella completely superimposed on femur
4. No rotation of femur (femoral condyles symmetrical) and tibia
(intercondylar eminence centered)
5. Slight superimposition of fibular head if tibia is normal
6. Soft tissue around knee joint
7. Bony detail surrounding patella on distal femur

Front 71

Lateral; Mediolateral (Knee)

Back 71

1. Femoral condyles superimposed (locate adductor tubercle on posterior surface of medial condyle to identify the medial condyle and to determine whether the knee is over-rotated or under-rotated)
2. Open joint space between femoral condyles and tibia
3. Patella in a lateral profile
4. Open patellofemoral joint spaces
5. Fibular head and tibia slightly superimposed (over-rotation causes less superimposition, and under-rotation causes more superimposition)
6. Knee flexed 20-30˚
7. All soft tissue around knee
8. Femoral condyles w/ proper density

Front 72

AP; Weight-Bearing Method; Standing (Knee)

Back 72

1. No rotation of knees
2. Both knees
3. Knee joint space centered to exposure area
4. Adequate IR size to demonstrate the longitudinal axis of femoral and
tibial bodies or shafts

Front 73

AP Oblique; Lateral Rotation (Knee)

Back 73

1. Medial femoral and tibial condyles
2. Tibial plateaus
3. Open knee joint
4. Fibula superimposed over the lateral half of the tibia
5. Margin of the patella projected slightly beyond the edge of the lateral femoral condyle
6. Soft tissue around the knee joint
7. Bony detail on the distal femur and proximal tibia

Front 74

AP Oblique; Medial Rotation (Knee)

Back 74

1. Tibia and fibula separated at their proximal articulation
2. Posterior tibia
3. Lateral condyles of the femur and tibia
4. Both tibial plateaus
5. Open knee joint
6. Margin of the patella projecting slightly beyond the medial side of the femoral condyle
7. Soft tissue around the knee joint
8. Bony detail on the distal femur and proximal tibia

Front 75

PA Axial; Holmblad Method (Intercondylar Fossa)

Back 75

1. Open fossa
2. Posteroinferior surface of the femoral condyles
3. Intercondylar eminence and knee joint space
4. Apex of patella not superimposing the fossa
5. No rotation, evident by slight tibiofibular overlap
6. Soft tissue in fossa and interspaces
7. Bony detail on intercondylar eminence, distal femur, and proximal tibia

Front 76

PA Axial; Camp-Coventry Method

Back 76

1. Open fossa
2. Posteroinferior surface of femoral condyles
3. Intercondylar eminence centered in open femorotibial joint space
4. Apex of patella not superimposing the fossa
5. No rotation, evident by slight tibiofibular overlap
6. Soft tissue in fossa and interspaces
7. Bony detail on the intercondylar eminence, distal femur, and proximal tibia

Front 77

PA (Patella)

Back 77

1. Patella completely superimposed by femur
2. Adequate penetration for visualization of patella clearly through the superimposing femur
3. No rotation

Front 78

Lateral; Mediolateral (Patella)

Back 78

1. Knee flexed 5-10˚
2. Open patellofemoral joint space
3. Patella in lateral profile
4. Close collimation

Front 79

Tangential; Settegast Method (Patella and Patellofemoral Joint)

Back 79

1. Patella in profile
2. Open patellofemoral articulation
3. Surfaces of femoral condyles
4. Soft tissue of patellofemoral articulation
5. Bony detail on patella and femoral condyles

Front 80

AP (Femur)

Back 80

1. Majority of femur and joint nearest to the pathologic condition or site of injury (A second projection of the other joint is recommended)
2. Femoral neck not foreshortened on the proximal femur
3. Lesser trochanter not seen beyond the medial border of the femur or only a very small portion seen on the proximal femur
4. No knee rotation on the distal femur
5. Gonad shielding when indicated, but the shield not covering proximal femur
6. Any orthopedic appliance in its entirety
7. Trabecular recorded detail on the femoral shaft

Front 81

Lateral; Mediolateral (Femur)

Back 81

1. Majority of femur and joint nearest to pathologic condition or site of injury (A second radiograph of the other end of the femur is
recommended)
2. Any orthopedic appliance in its entirety
3. Trabecular detail on the femoral body
4. W/ Knee Included
a. Superimposed anterior surface of femoral condyles
b. Patella in profile
c. Open patellofemoral space
d. Inferior surface of femoral condyles not superimposed b/c of divergent rays
5. W/ Hip Included
a. Opposite thigh not over area of interest
b. Greater and lesser trochanters not prominent