Bontrager Chapter 6

Front 1

Toes Special - sesamoids

Back 1

Foot dorsiflexed
15 - 20 degree angle

Shows sesamoids free of superimposition

Front 2

Foot Special - AP & lateral weight bearing

Back 2

Plantar surface perpendicular to IR
Entire foot should be shown

Front 3

Ankle Special - AP oblique medial rotation

Back 3

Leg extended and medially rotated 15 - 20 degrees
Foot rotated medially to 45 degrees

Front 4

Ankle Special - AP stress

Back 4

Patient supine with leg extended
Foot rotated both medially and laterally by second provider - protective gloves required
Utmost care with injured patient

Front 5

Knee Special - AP or PA weight bearing

Rosenberg method

For distal femur, proximal tibia, fibula, knee joint space

Back 5

Patient standing, knee partially flexed to 45 degrees
Use Bucky device for support
Knees touching Bucky device
CR angled 10 degrees caudad
CR centered mid-point between knee joints

Front 6

Knee Special - Intercondyloid fossa

Camp-Coventry method

Back 6

Patient PA recumbent (prone)
Knee flexed so that tibia is 40 degrees to tabletop
Foot rested on support
CR 40 degree caudad (perpendicular to tibial long axis)

Front 7

Knee Special - Intercondylar fossa, articular facets, knee joint space

Holmblad method

Back 7

Kneeling position, with 60 - 70 flexion
CR perpendicular to IR & lower leg at mid-popliteal crease

Front 8

Knee Special -Intercondylar fossa, tibial plateau

Beclere method

Back 8

Knee flexed 40 - 45 degrees
Rest knee on supported IR
CR 45 degrees cephalic, aimed at patella

Front 9

How many Phalanges are there in the foot?

Back 9

14

Front 10

How many Metatarsals are there in the foot?

Back 10

5

Front 11

How many Tarsals are there in the foot?

Back 11

7
3 cuneiforms, cuboid, navicular, talus, calcaneus

Front 12

Which tuberosity of the foot is palable and a common site of foot trauma?

Back 12

Tuberosity of base of fifth metatarsal

Front 13

Where are the sesamoid bones of the foot most commonly located?

Back 13

The plantar surface of the foot

Front 14

What is the largest and strongest tarsal bone?

Back 14

Calcaneus

Front 15

What is the smallest cuneiform?

Back 15

Intermediate

Front 16

For a oblique foot radiograph what is the degree of the angle of the foot?

Back 16

45 degrees

Front 17

For a AP mortise foot radiograph what is the degree of the angle of the foot?

Back 17

15 - 20 degree medial rotation

Front 18

The extreme distal end of the fibula forms which malleolus?

Back 18

Lateral malleolus

Front 19

Why must the CR be angled 5 to 7 degrees cephalad for a lateral knee position?

Back 19

because the medial condyle extends lower than the lateral condyle.

Front 20

What are the two palpable bony landmarks found on the distal femur?

Back 20

Medial and lateral epicondyle

Front 21

When you extend the ankle or point the foot and toes downwards is called what?

Back 21

Plantar flexion

Front 22

Decreasing the angle between the dorsum pedis and anterior lower leg is called?

Back 22

Dorisflexion

Front 23

Why is the central ray angled 10 to 15 degrees toward the calcaneus for an AP projection of the toes?

Back 23

It opens up the interphalangeal and metarsophalangeal joints

Front 24

Where is the CR centered for an AP oblique projection of the foot?

Back 24

At the base of the third metatarsal

Front 25

Why should the CR ray be perpendicular to the metatarsals for an AP projection of the foot?

Back 25

Opens up metarsophalangeal and certain intertarsal joints

Front 26

Which oblique projection of the foot best demonstrates the majority of the tarsal bones?

Back 26

AP oblique with medial rotation

Front 27

Which oblique projection of the foot demonstrates the navicular and the first and second cuneiforms with minimal superimposition?

Back 27

AP Oblique with lateral rotation

Front 28

How should the CR be angled from the long axis of the foot for the plantodorsal axial projection of the calcaneus?

Back 28

40 degree cephalad

Front 29

Where is the CR placed for a lateral projection fo the calcaneus?

Back 29

1 1/2 inch inferior to the medial malleolus

Front 30

Why should AP, 45 degree, oblique, and lateral ankle radiographs include the proximal metatarsals?

Back 30

To demonstrate a possible fracture of the 5th metarsar tuberosity (common fracture site)

Front 31

Which projection of the ankle best demonstrates a possible fracture of the lateral malleolus?

Back 31

45 degree AP oblique with medial rotation

Front 32

How many views are used for a Tibia and Fibula and what are they?

Back 32

2 views, AP and Lateral projection

Front 33

What is the recommended CR angulation for an AP projection of the knee for a patient with thick thighs and buttocks measuring greater than 24 cm?

Back 33

3 to 5 degree cephalad

Front 34

Where is the CR centered for an AP projection of the knee?

Back 34

1/2 inch (1.25cm) distal to apex of patella

Front 35

Which basic projection of a knee best demonstrates the proximal fibula free of superimposition?

Back 35

AP oblique, 45 degree

Front 36

The AP oblique medial rotation projection of the knee best vizualizes?

Back 36

The lateral condyle of the tibia and the head and neck of the fibula.

Front 37

How much flexion is reccommended for a lateral projection of the knee?

Back 37

20 to 30 degree

Front 38

Which special projections of the knee best demonstrates the intercondylar fossa?

Back 38

Camp-Coventry Method, Holmblad Method, and Beclere Method

Front 39

How much flexion of the lower leg is required for the Camp-Conventry projection.

Back 39

40 degree flexion
Centeral ray is angled 40 degrees caudad

Front 40

How much knee flexion is required for a Holmblad method?

Back 40

60 -70 degrees

Front 41

How much part flexion is recommended for a lateral projection of the patella?

Back 41

5 to 10 degrees

Front 42

Situation: A geriatric patient comes to the radiology department for a study of the knee. The patient is unsteady and unsure of himself. Which intercondylar fossa projection would provide the best results without risk of injury to the patient?

Back 42

Camp-Coventry method / trash can view

Front 43

A patient enters the ER with a possible transverse fracture of the patella. Which of the following routines would safely provide the best images of the patella?

Back 43

AP and horizontal beam lateral, no flexion

Front 44

How much part flexion is required for the Hughston method?

Back 44

45 - 55 degrees

Front 45

How much part flexion is required for the Setegast method?

Back 45

90 degrees

Front 46

How much foot rotation is required for the AP oblique, medial rotation projection of the foot?

Back 46

30 - 40 degrees

Front 47

What CR angle is generally required for the AP projection of the foot?

Back 47

10 degrees posterior

Front 48

Which projection of the foot best demonstrates the cubiod?

Back 48

AP oblique medial rotation

Front 49

The upper or superior portion of the patella is called the what?

Back 49

Base of the batells

Front 50

What are 2 differences in the phalanges of the foot as compared with the phalanges of the hand?

Back 50

They are smaller and the joint movements are more limited (in the phalanges of the foot)

Front 51

What is the name of the joint found between the talus and calcaneus?

Back 51

Subtalar or talocalcaneal

Front 52

T/F: the cuboid articulates with the four bones of the foot

Back 52

True

Front 53

The calcaneus articulates with the talus and the ____

Back 53

Cuboid

Front 54

What are the two arches of the foot?

Back 54

Longitudinal and transverse arches

Front 55

What 3 bones make up the ankle joint?

Back 55

Talus, tibia, fibula

Front 56

The _____ is the weight bearing bone of the lower leg

Back 56

Tibia

Front 57

The ankle joint is classified as a synovial joint with ______ type of movement

Back 57

Sellar

Front 58

The metatarsophalangeal joints are of what type?

Back 58

Modified ellipsoidal or condyloid

Front 59

The interphalangeal joints are of what type?

Back 59

Ginglymus or hinge

Front 60

The tarsometatarsall joints are of what type?

Back 60

Plane or gliding

Front 61

The intertarsal joints are of what type?

Back 61

Plane or gliding

Front 62

The femorotibial joints are of what type?

Back 62

Bicondylar

Front 63

Patellofemoral joint is of what type

Back 63

Sellar or sadle

Front 64

Proximal tibiofibular joint is or what type

Back 64

Plane or gliding

Front 65

What is the largest sesamoid bone in the body/

Back 65

Patella

Front 66

The most posterior-inferior part of the calcaneus is a process called the _____

Back 66

Tuberosity

Front 67

The talus articulates with_____(4 bones)

Back 67

Tibia, fibula, calcaneus, navicular

Front 68

The inferior portions of the tibia and the fibula form a deep socket or 3-sided opening called a _________.

Back 68

Mortise

Front 69

What are the 4 views for the ankle?

Back 69

AP, AP mortise, 45 degree oblique, lateral

Front 70

Should the patient dorsiflex for an AP ankle projection?

Back 70

Yes

Front 71

In a true AP projection of the ankle are the malleoli on the same plane?

Back 71

No

Front 72

In an AP ankle projection which malleoli is more anterior?

Back 72

Medial

Front 73

A fracture at the base of the 5th metatarsal is called ______

Back 73

Jones fracture

Front 74

If the patient does not dorsiflex the foot in an ankle mortise projection what happens to the lateral mortise?

Back 74

the calcaneus superimposes the lateral mortise

Front 75

If you are doing an ankle mortise projection and can visualize the sinus tarsi then what is the positioning error?

Back 75

too much oblique

Front 76

Where do you center for a lateral ankle?

Back 76

Medial malleolus

Front 77

T/F: stress views are done by the lead technologist

Back 77

False (physician or resident)

Front 78

What is the rule about imaging long bones?

Back 78

Include both joints

Front 79

What size cassette is used for tib/fib projections?

Back 79

14x17
diagonal

Front 80

What SID is used for tib/fib projections?

Back 80

44 - 48 inches

Front 81

Would you use grid on knee projections

Back 81

yes

Front 82

Where do you center for a calcaneus projection?

Back 82

1 inch below medial maleolus

Front 83

T/F: the distal end of the 5th metatarsal is a common injury site.

Back 83

False, proximal end

Front 84

Where is a common site for bone spurs in the foot?

Back 84

Calcaneal tuberosity

Front 85

T/F: the navicular articulates with all 3 cuneiforms.

Back 85

True

Front 86

T/F: the lateral malleolus is the distal end of the tibia

Back 86

False

Front 87

What is the injury to the ligament that spans across the articulation of the medial cuneiform and the 1st and 2nd metatarsal base called? What kind of study would be done to confirm this injury?

Back 87

Lisfranc injury, weight-bearing study

Front 88

What is the major disadvantage of the settegast method?

Back 88

Requires overflexion of the knee

Front 89

When performing an AP oblique projection of the toes how much do you angle the tube, if any?

Back 89

None

Front 90

What are the 3 divisions of the hip bone?

Back 90

Ilium, ischium, pubis

Front 91

The ASIS, PSIS, iliac crest, and anterior inferior iliac spine are all part of what hip division? (ilium, ischium, or pubis?)

Back 91

Ileum

Front 92

Where is the fovea capitis located?

Back 92

Center of the femoral head

Front 93

The greater pelvis is also called the _____ pelvis

Back 93

false

Front 94

The ______ pelvis forms the actual birth canal.

Back 94

True

Front 95

Is the male or female pelvis more wider with the ilia more flared and more shallow from front to back?

Back 95

Female

Front 96

The sacroiliac and hip joints are what classification of joints?

Back 96

Synovial

Front 97

The symphysis pubis and the union of acetabulum are what classification of joints?

Back 97

Cartilagenous

Front 98

By ______ rotating the entire lower limb, the proximal femur and the hip are positioned in a true AP projection

Back 98

Internally

Front 99

When the femur and hip are in a true AP projection, what structure should not be seen, or is seen minimally?

Back 99

Lesser trochanter

Front 100

T/F: when performing an AP pelvis projection (bilateral hips) the CR is perpendicular to IR, directed midway between the level of ASISs and symphysis pubis

Back 100

True

Front 101

When the lower leg is not internally rotated it causes _____ of the femoral neck. (elongation, foreshortening)

Back 101

Foreshotrtening

Front 102

The greater and lesser trochanter are connected by the _____

Back 102

Intertrochanteric ridge

Front 103

Name the facets of the sub talor joint.

Back 103

Anterior, middle anterior

Front 104

Where are the interphalangeal joints located?

Back 104

Between phalanges

Front 105

Where is the intercondylar sulcus AKS trochlear groove l

Back 105

Patellar surface of the femur

Front 106

What attaches to the tibial tuberosity, which can be seen on the AP and l

Back 106

Patellar tendon

Front 107

Describe osteogenic sarcome

Back 107

Highly malignant primary bone tumor seen in late childhood and young adults. Tib

Front 108

Describe bone cysts

Back 108

Benign, neoplastic lesions, filled with fluid that often occur near the knee joint in children and adolescents. These are not usually detected on X-rays until a pathologic fracture occurs.
If detected, they appear as lucent areas with thin cortex.

Front 109

Describe osteochonromas

Back 109

Most frequently encountered neoplasm of the skeleton. Made of both cartilage and bone commonly co

Front 110

Can torn ligaments be seen on X-ray

Back 110

No, MRI required for visualiz

Front 111

Do you angle for AP of toes?

Back 111

Yes, 10 degrees.
Opens up joint spaces.
CR to metatarsal of 2nd toe
AP medial oblique

Front 112

Which projection would best demonstrate the medial and intermediate cunierform bones?

Back 112

??

Front 113

Describe projections needed for imaging

Back 113

2 projections needed:
AP axial (40 degrees angjulation)
Lateral (centered at maleolus

Front 114

In an AP ankle, which joints are open?

Back 114

Medial and

Front 115

Ankle mortise opens

Back 115

Opens up lateral joints.
Medial rotation of 15 - 20 degrees may help.

Front 116

Why are ankle stress images done?

Back 116

For joint and ligament tears

Front 117

What does the AP of the knee demonstrate?

Back 117

Distal femur, proximal tibia and fibula.
Femoral-tibial joint space should be open.

Front 118

Do you angle the CR on a lateral knee?

Back 118

Yes.
Short/wide person - 7 - 10 degrees
Narrow/tall person - 5 degrees

Front 119

How is the leg flexed for a lateral knee projection?

Back 119

20 degrees

Front 120

Describe Rosenberg method

Back 120

Skier's position, 45 degree knee flexion
Weight bearing
Views interdondylar fossa and joint degenera

Front 121

Why is the bilateral Merchant method used?

Back 121

To detect abnormalities of the patella and femeropatellar joint
Merchant method - patient at edge of table knees flexed to 40 degrees, CR 30 degrees

Front 122

What technique is used to image the patella

Back 122

Hobbs method

Front 123

??

Back 123

Superoinferior sitting tangential method
SID 48 inches
90 degree flexion

Front 124

Which joints are open in AP ankle?

Back 124

??

Front 125

How do you modify technique when patient

Back 125

Use AP, not PA and cros

Front 126

Describe Osgood -Schlatter disease

Back 126

Inflammation of the anterior proximal tibia, usually seen in adolescent boys.
Patella tendon detaches part of the tibial tuberosity
Visualize with AP and Lateral knee.

Front 127

What is the angle for weight bearing

Back 127

Patient standing, no angle

Front 128

Describe differences between Houston and Settagast.

Back 128

Hughston - 55 degree flexion
Settagast - 90 degree flexion

Front 129

Differences between male and female pelvis

Back 129

1) Males - narrower, deeper and less flared
2) Males - acute pubic angle less than 90 degrees
3) Males - oval shaped (females-round)

Front 130

What do you do if you are unable to adequately shield the gonads?

Back 130

Increase KV, lower

Front 131

Describe frogleg

Back 131

Legs abducted 45 - 50 degrees

Front 132

??

Back 132

Views bilateral pubis for pelvic trauma
Patient supine with support under knees
CR angled 20 - 35 for males
CR angled 30 - 45 for females

Front 133

What is the Teufel method?

Back 133

Views acetabulum
Patient semiprone (35 - 40 degree anterior oblique), affected side down
CR - 12 degrees cephalad

Front 134

What is the Judet method?

Back 134

Views acetabulum
Semi supine, patient 45 degree oblique
Anatomy of interest is the downside

Front 135

Describe the Clements-Nakayama method

Back 135

Views hip fracture
Patient supine

Front 136

Modified Cleaves

Back 136

Views hip joint and proximal femur
Used in nontrauma situations
Unilateral frogleg position

Front 137

How can your

Back 137

Look for equal ala and foramen

Front 138

What image should be first taken in pa

Back 138

AP pelvis