Radiographic Positioning of the Femur

Radiographic Positioning of the Femur

Section objectives: Femur Series

At the conclusion of this course the student doctor should;

1. Be able to efficiently conduct all parts of a 2 view femur series including determining the cassette size and orientation, setting of technical factors, patient positioning, placement of filters/shields, and giving patient instructions.

2. Be able to identify the significant anatomy demonstrated on each view of the series.

Standard Femur Series -2 view series

AP Femur
Lateral Femur (requires 2 separate images)

A-P Femur

PREPARE THE ROOM

Cassette: black; 14" x 17", LW (flash up, use bucky)

Tube: 40" FFD, no tube tilt

Technique: 70 kVp, small focal spot

Measure: through central ray

Filter/shield: gonad ( ½ apron)

PREPARE THE PATIENT

Position: R or L, patient is fully gowned and supine on the table preferred), or
standing. The affected femur is centered to the midline of the table.
Leg is rotated 150 medially to provide true AP of femur.
The anode of the x-ray tube should be toward the patient's feet.

Central ray: If the entire femur will fit in one shot, center the femur to the cassette.
If not, include as much of the femur as possible and the joint closest to the
site of injury. You will then need an AP knee or AP hip to complete the
AP femur.

Collimation: Open to full cassette vertically, side-to-side soft tissue.

Marker: R or L.

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA: A-P Femur

The femur should be centered to the area of collimation with the entire knee and/or hip joint visible.
Optimum exposure should demonstrate both bone and soft tissue density and make good use of the anode heel effect.
Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning #5822 26 last updated: May, 99

Radiographic Positioning of the Femur

Lateral Femur

In most instances, this requires 2 views; a frogleg lateral hip and a lateral femur shot as indicated below. If the patient is very short, a frogleg lateral can be obtained by placing the central ray in the middle of the femur shaft.

PREPARE THE ROOM

Cassette: black; 14" x 17", LW (flash up, use bucky)

Tube: 40" FFD, no tube tilt

Technique: 70 kVp, small focal spot

Measure: through central ray

Filter/shield: gonad (½ apron)

PREPARE THE PATIENT

Position: R or L, patient is fully gowned and in a decubitus position with the affected femur closest to the table.
The affected femur is centered to the midline of the table and the anode of the x-ray tube should be toward the patient's feet.
The patient lies with the affected leg's knee slightly flexed and the opposite hip flexed to 90º.
Support the opposite knee to limit rotation of the femur.

Central ray: If the entire femur will fit in one shot, center the femur to the cassette. If not, include as much of the femur as possible and the joint closest to the site of injury. You will then need an lateral knee or frogleg hip to complete the femur.

Collimation: Open to full cassette vertically, side-to-side soft tissue.

Marker: R or L.

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA: Lateral Femur

The femur should be centered to the area of collimation with the entire knee and/or hip joint visible.
Optimum exposure should demonstrate both bone and soft tissue density and make good use of the anode heel effect.
Anterior and posterior margins of the femoral condyles should be superimposed and aligned.
Patellofemoral joint space should be open, it is distorted because it is not at the central ray.
Patient identification should be clear and legible; R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning 45822 27 last updated: May, 99

Radiographic Positioning of the Knee

Section objectives: Knee Series

At the conclusion of this course the student doctor should;

1. Be able to efficiently conduct all parts of a 4 view knee series including determining the cassette size and orientation, setting of technical factors, patient positioning, placement of filters/shields, arid giving patient instructions.

2. Be able to identify series.

the significant anatomy demonstrated on each view of the

Standard Knee Series -4 view series

· AP Knee

· Lateral Knee

· intercondylar (Tunnel) Knee

· Tangential Patella (Sunrise)

A-P Knee

PREPARE THE ROOM

Cassette: black/gray; 8" x 10", LW (flash up)

Tube: 40" FFD, 5º cephalad tube tilt

Technique: 70 kVp, small focal spot

Measure: through central ray at appropriate angle

Filter/shield: gonad ( ½ apron)

PREPARE THE PATIENT

Position: R or L, patient is fully gowned and supine on the table with the affected
knee centered to the table in lull extension.
The lower leg is rotated 15º medially.

Central ray: 1 cm distal to the apex of the patella.

Collimation: Open to lull cassette vertically, side-to-side soft tissue.

Marker: R or L.

EXPOSURE

Patient directions; "Hold still, don't move" - expose.

EVALUATION CRITERIA: A-P Knee

· The center of the collimation field should be the mid-knee joint space.

· The femorotibial joint space should be open with the articular facets of the tibia seen tangentially with only minimal surface area visualized.

· Optimum exposure will outline the patella through the distal femur and the fibular neck will not be overexposed.

· Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning #5822 28 last updated: May, 99

Radiographic Positioning of the Knee

Lateral Knee

PREPARE THE ROOM

Cassette: black/gray; 8" x 1 ~ LW (flash up)

Tube: 40" FFD, 5º cephalad tube tilt

Technique: 70 kVp, small focal spot

Measure: through central ray at appropriate angle

Filter/shield: gonad (½ apron), stop primary beam leak anterior to thigh and lower leg using lead vinyl.

PREPARE THE PATIENT

Position: R or L, patient is fully gowned and in a lateral decubitus position on the table with the affected knee centered to the table.
The knee should be flexed 30º and the knee in a true lateral position with the femoral epicondyles directly superimposed, and the plane of the patella perpendicular to the film.

Central ray: 1 cm distal to the medial epicondyle of the femur.

Collimation: Open to full cassette vertically, side-to-side soft tissue.

Marker: R or L.

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA: Lateral Knee

The center of the collimation field should be the mid-knee joint space.
The tibiofemoral joint space should be open with only the pointed intercondyloid eminence (tibial spines) superimposed by the femoral condyles.
The patella should be seen in profile with the patellofemoral joint space open.
Optimum exposure will outline the patella through the distal femur and the fibular neck will not be overexposed.
Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning #5822 29 last updated: May, 99

Radiographic Positioning of the Knee

Intercondylar (Tunnel) Knee

PREPARE THE ROOM

Cassette: black/gray; 8" x 10", LW (flash up)

Tube: 40" FED, 45º caudad tube tilt (remember: decrease tube height 1" for
every 5º of tilt, 31")

Technique: 70 kVp, small focal spot

Measure: through central ray at appropriate angle

Filter/shield: gonad (72 apron)

PREPARE THE PATIENT

Position: R or L, patient is fully gowned arid prone on the table with the affected
knee centered to the table.
The affected knee should be flexed 45º, support the foot.

Central ray: To mid-popliteal crease and center the film to this. Be certain to allow for
the tube tilt!

Collimation: Open to fall cassette vertically, side-to-side soft tissue.

Marker: R or L.

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA; Intercondylar (Tunnel) Knee

The center of the collimation field should be the mid-knee joint space.
The intercondyloid fossa should be open without superimposition of the patella.
No rotation will be evidenced by the symmetrical appearance of the femoral and tibial condyles and the joint space.
Optimum exposure will visualize soft tissue in the knee joint space and an outline of the patella through the femur.
Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning #5822 30 last updated: May, 99

Radiographic Positioning of the Knee

Tangential Patella (Sunrise)

PREPARE THE ROOM

Cassette: black/gray; 8" x 10", LW (flash up)

Tube: 40" FYD, 5º cephalad tube tilt

Technique: 70 kVp, small focal spot

Measure: through central ray at appropriate angle

Filter/shield: gonad (½ apron)

PREPARE THE PATIENT

Position: R or L, patient is fully gowned and prone on the table with the affected
knee centered to the table and in full flexion.
It will help to loop a strap around the foot. Allow the patient to hold the
strap keeping the knee in full flexion.

Central ray: Directly through the patellofemoral joint space.

Collimation: Open to include area of interest.

Marker: R or L.

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA: Tangential Patella (Sunrise)

· Four sided collimation should be limited to the patella and anterior femoral condyles.

· The intercondyloid sulcus (trochlear groove) and patella of each femur should be visualized in profile.

· The patellofemoral joint space should be open with the bony margins of condyles and patella clearly defined.

· Optimum exposure will clearly visualize soft tissue, joint space margins and trabecular markings of the patella.

· Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning #5822 31 last updated: May, 99

Radiographic Positioning of the Leg

Section objectives: Leg Series

At the conclusion of this course the student doctor should;

1. Be able to efficiently conduct all parts of a 2 view leg series including determining the cassette size and orientation, setting of technical factors, patient positioning, placement of filters/shields, and giving patient instructions.

2. Be able to identify the significant anatomy demonstrated on each view of the series.

Standard Leg Series -2 view series

· AP Leg

· Lateral Leg

A-P Leg

PREPARE THE ROOM

Cassette: gray; ½ of 14" x 17", lengthwise or entire 14" x 17" diagonally if patient has a long leg.

Tube: 40" FFD, no tube tilt

Technique: 60 kVp, small focal spot

Measure: through central ray

Filter/shield: gonad (½ apron)

PREPARE THE PATIENT

Position: R or L, ½ of cassette is masked to be used for lateral leg or opposite leg.
Patient is supine with affected extremity toward the anode end of the table. The leg is rotated 15º medially (so the femoral condyles are parallel to the film) and foot flexed to 90º. No rotation of the pelvis.
Center the affected leg to the unmasked portion of the cassette.

Central ray: Perpendicular to the film to a point mid-shaft on the leg.

Collimation: Vertically include knee joint and distally the ankle joint, side-to-side soft tissue.

Marker: R or L..

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA: A-P Leg

· Visualization of the tibia, fibula, and adjacent joints on one or more A-P views.

· Ankle and knee joints without rotation.

· Proximal and distal articulations of tibia end fibula moderately overlapping.

· Trabecular detail and soft tissue for the entire leg.

· Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning #5322 32 last updated: May, 99

Radiographic Positioning of the Leg

Lateral Leg

PREPARE THE ROOM

Cassette: gray; ½ of 14" x 17", lengthwise or entire 14" x 17t1 diagonally if patient

has a long leg.

Tube: 40" FFD, no tube tilt

Technique: 60 kVp, small focal spot

Measure: through central ray

Filter/shield: gonad (½ apron)

PREPARE THE PATIENT

Position: R or L, ½ of cassette is masked to be used for A-P leg or opposite leg. Patient on side with affected extremity toward the anode end of the table. Adjust the rotation of the patient to place the patella perpendicular to the cassette, ensuring a line drawn through the femoral condyles is perpendicular to the film.
Center the affected leg to the unmasked portion of the cassette.

Central ray: Perpendicular to the film to a point mid-shaft on the leg.

Collimation: Vertically include knee joint and distally the ankle joint, side-to-side soft tissue.

Marker: R or L.

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA: Lateral Leg

Visualization of the tibia, fibula, and adjacent joints on one or more lateral views.
Distal fibula lying over the posterior half of the tibia.
Slight overlap of the tibia on the proximal fibular head.
Ankle and knee joints are not rotated.
Possibly no superimposition of femoral condyles due to beam divergence.
Moderate separation of the tibial and fibular shafts seen, except at their articular ends.
Trabecular detail and soft tissue for the entire leg.
Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning #5822 33 last updated: May, 99

Radiographic Positioning of the Ankle

Section objectives: Ankle Series

At the conclusion of this course the student doctor should;

3. Be able to efficiently conduct all parts of a 3 view ankle series including determining the cassette size and orientation, setting of technical factors, patient positioning, placement of filters/shields, and giving patient instructions.

4. Be able to identify the significant anatomy demonstrated on each view of the series.

Standard Ankle Series -3 view series

· A-P Mortise Ankle

· Medial Oblique Ankle

· Lateral Ankle

A-P Mortise Ankle

PREPARE THE ROOM

Cassette: gray; ½ of 10" x 12", crosswise

Tube: 40" FFD, no tube tilt

Technique: 60 kVp, small focal spot

Measure: through central ray at appropriate angle

Filter/shield: gonad (½ apron)

PREPARE THE PATIENT

Position: R or L, ½ of the cassette is masked to be used for the medial oblique.
Patient is supine with affected extremity toward the anode end of the table.
The foot is rotated 15º medially (so the intermalleolar plane is parallel to
the film) and slightly dorsiflexed.
Center the affected ankle to the unmasked portion of the cassette.

Central ray: Perpendicular to the film to a point midway between the malleoli.

Collimation: Open to full, unmasked cassette vertically, side-to-side soft tissue.

Marker: R or L.

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA: A-P Mortise Ankle

· The center of the four-sided collimation field should be the mid-ankle joint.

· The entire ankle mortise should appear open with no overlap between distal fibula and talus, or between tibia and talus.

· There should be minimal overlap at the distal tibiofibular joint space.

· Optimum exposure should demonstrate both bone and soft tissue density.

Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Note: Mortise refers to a type of carpenter's joint.

Radiographic Positioning #5822 34 last updated: May, 99

Radiographic Positioning of the Ankle

Medial Oblique Ankle

PREPARE THE ROOM

Cassette: gray; ½ of 10" x 12", crosswise

Tube: 40" FFD, no tube tilt

Technique: 60 kVp, small focal spot

Measure: through central ray at appropriate angle

Filter/shield: gonad (½ apron)

PREPARE THE PATIENT

Position: R or L, ½ of the cassette is masked, it was used with the A-P mortise view.
Patient is supine with affected extremity toward the anode end of the table.
The foot is rotated 30~ medially and slightly dorsiflexed.
Center the affected ankle to the unmasked portion of the cassette.

Central ray: Perpendicular to the film to a point midway between the malleoli.

Collimation: Open to lull, unmasked cassette vertically, side-to-side soft tissue.

Marker: R or L.

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA; Medial Oblique Ankle

The center of the four-sided collimation field should be the mid-ankle joint.

· The distal tibiofibular joint space should be primarily open with only minimal "touching" on an average ankle.

· Both the distal fibula and tibia may have some overlap with the talus.

· No rotation.

· Optimum exposure should demonstrate both bone and soft tissue density.

· Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning #5822 35 last updated; May, 99

Radiographic Positioning of the Ankle

Lateral Ankle

PREPARE THE ROOM

Cassette: gray; 8" x 10", lengthwise

Tube: 40" FFD, no tube tilt

Technique: 60 kVp, small focal spot

Measure: through central ray at appropriate angle

Filter/shield: gonad (½ apron)

PREPARE THE PATIENT

Position: R or L, patient is lying on the affected side with the extremity toward the anode end of the table.
Place support under the knee if ankle is not in contact with the film, so as to place the ankle in a true lateral position.
The leg and foot should be perpendicular to each other.

Central ray: Perpendicular to the film to medial malleolus.

Collimation: Open to lull cassette vertically, side-to-side soft tissue.

Marker: R or L.

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA: Lateral Ankle

· The center of the four-sided collimation field should be the mid-ankle joint.

· The upper arch of the tibiotalar joint should appear open with a uniform joint space.

· The talus and calcaneus should be seen in their entirety, as well as portions of the adjoining tarsal bones.

· Optimum exposure should demonstrate distal fibula as well as soft tissue detail.

· Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning #5822 36 last updated: May, 99

Radiographic Positioning of the Calcaneus

Section objectives: Calcaneus Series

At the conclusion of this course the student doctor should;

1. Be able to efficiently conduct all parts of a 2 view calcaneus series including determining the cassette size and orientation, setting of technical factors, patient positioning, placement of filters/shields, and giving patient instructions.

2. Be able to identify the significant anatomy demonstrated on each view of the series.

Standard Calcaneus Series -2 view series

· plantodorsal (Axial) Calcaneus

· Lateral Calcaneus

Plantodorsal (Axial) Calcaneus

PREPARE THE ROOM

Cassette: gray; ½ of 10" x 12", or one S" x 10", lengthwise

Tube: 40" FFD, 400 cephalad tube tilt

Technique: 60 kVp, small focal spot

Measure: through central ray at appropriate angle

Filter/shield: gonad (½ apron)

PREPARE THE PATIENT

Position: R or L, ½ of the cassette is masked to be used with the lateral calcaneus.
Patient is supine with affected extremity toward the anode end of the table. Dorsiflex the foot so the plantar surface is near perpendicular to the film.
Loop a strap around the foot and ask the patient to pull gently but firmly and hold the plantar surface as near perpendicular as possible (be fast as this may be very uncomfortable for the injured patient).

Central ray: To the joint space between the calcaneus and cuboid/navicular.

Collimation: Closely to area of the calcaneus.

Marker: R or L..

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA: Plantodorsal (Axial) Calcaneus

The entire calcaneus should be visualized from the tuberosity posteriorly, to the talocalcaneal joint anteriorly.
No rotation; the bases of the 1^st and 5^th metatarsals should NOT be visible on either side. A portion of the sustentaculum tali should appear in profile laterally.
Optimum exposure should faintly visualize the talocalcaneal joint without overexposing the distal tuberosity.
Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning #5822 37 last updated: May, 99

Radiographic Positioning of the Calcaneus

Lateral Calcaneus

PREPARE THE ROOM

Cassette: gray; ½ of 10" x 12", or one 8" x 10", lengthwise

Tube: 40" FFD, no tube tilt

Technique: 60 kVp, small focal spot

Measure: through central ray

Filter/shield: gonad (½ apron)

PREPARE THE PATIENT

Position: R or L, ½ of the cassette is masked as it was used with the plantodorsal (axial) calcaneus.
Patient is on their side with affected extremity toward the anode end of the table. Place support under the knee so that the calcaneus is in a true lateral position,lateral portion of the foot is in contact with the cassette. Dorsiflex the foot so the plantar surface is near perpendicular to the leg (use a sandbag or some support to hold the foot in this position).

Central ray: 2cm distal to the medial malleolus.

Collimation: To outer skin margins to include about 2cm proximal to ankle joint.

Marker: R or L.

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA: Lateral Calcaneus

Four-sided collimation should include the ankle joint proximally and talonavicular joint anteriorly.
The calcaneus arid talus should be visualized without rotation as evidenced by lateral malleolus superimposed over the posterior half of the tibia and talus.
The tarsal sinus and calcaneocuboid joint space should appear open.
Optimum exposure should visualize soft tissue as well as the more dense portions of the calcaneus and talus.
Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning #5822 38 last updated: May, 99

Radiographic Positioning of the Foot

Section objectives: Foot Series

At the conclusion of this course the student doctor should;

1. Be able to efficiently conduct all parts of a 3 view foot series including determining the cassette size and orientation, setting of technical factors, patient positioning, placement of filters/shields, and giving patient instructions.

Be able to identify the significant anatomy demonstrated on each view of the series.

Standard Foot Series - 3 view series

A-P (dorsiplantar) Foot

· Medial Oblique

· Lateral Foot

A-P (Dorsiplantar) Foot

PREPARE THE ROOM

Cassette: gray; ½ of 10" x 12", lengthwise

Tube: 40" FFD, 10º cephalad tube tilt

Technique: 60 kVp, small focal spot

Measure: through central ray at appropriate angle

Filter/shield: foot filter to cover distal metatarsals and toes (thick portion over toes)
For clear lead, #1 or #2 for Nolan filters
gonad (½ apron)

PREPARE THE PATIENT

Position: R or L, ½ of the cassette is masked to be used with the medial oblique foot.
Patient is supine, flex the knee and place the planter surface of affected foot flat on cassette.
Align the center long axis of the foot to long axis of unmasked portion of film.

Central ray: To the base of the third metatarsal.

Collimation: Include outer margins of skin on four sides (include toes).

Marker: R or L.

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA: A-P (Dorsiplantar) Foot

The center of the four-sided collimation should be the base of the third metatarsal.
The entire foot, including the phalanges, should be well visualized.
Optimum exposure should demonstrate the sesamoid bones (if present) through the head of the first metatarsal.
Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning #5822 39 last updated: May, 9¼

Radiographic Positioning of the Foot

Medial Oblique Foot

PREPARE THE ROOM

Cassette: gray; ½ of l0" x 12", lengthwise

Tube: 40" FFD, no tube tilt

Technique: 60 kVp, small focal spot

Measure: through central ray at appropriate angle

Filter/shield: foot filter to cover distal metatarsals and toes (thick portion over toes) for clear lead, #1 or #2 for Nolan filters.
gonad (½ apron)

PREPARE THE PATIENT

Position: R or L, ½ of the cassette is masked to be used with the A-P (dorsiplantar) foot.
Patient is supine, flex the knee and place the plantar surface of foot on cassette.
Align and center long axis of foot to long axis of unmasked portion of film.
Rotate the foot medially to place the plantar surface 45º to plane of film (use a 45º radiolucent block if available).

Central ray: To the base of the third metatarsal.

Collimation: Include outer margins of skin on four sides (include toes).

Marker: R or L.

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA: Medial Oblique Foot

The center of the four-sided collimation should be the base of the third metatarsal.
The third through the fifth metatarsals should be completely free of superimposition.
The tuberosity at the base of the fifth metatarsal should be well visualized.
Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning #5822 40 last updated: May, 99

Radiographic Positioning of the Foot

Lateral Foot

PREPARE THE ROOM

Cassette: gray; 10" x 12", lengthwise

Tube: 40" FFD, no tube tilt

Technique: 60 kVp, small focal spot

Measure: through central ray

Filter/shield: gonad (½ apron)

PREPARE THE PATIENT

Position: R or L, patient in lateral recumbent position with the affected side down.
Flex the knee of the affected side, position opposite leg out of the way so
it does not interfere with the image.
Center long axis of foot to long axis of film.

Central ray: To the first (medial) cuneiform.

Collimation: Include outer margins of skin on four sides (include toes).

Marker: R or L.

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA: Lateral Foot

The center of the four-sided collimation should be the first (medial) cuneiform.
The entire foot, including the phalanges, should be well visualized.
The distal fibula should be superimposed over a posterior portion of the tibia.
The tibiotalar joint space should be clearly visualized.
Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning #5822 41 last updated: May, 99

Radiographic Positioning of the Toe

Section objectives: Toe Series

At the conclusion of this course the student doctor should;

1. Be able to efficiently conduct all parts of a 3 view toe series including determining the cassette size and orientation, setting of technical factors, patient positioning, placement of filters/shields, and giving patient instructions.

2. Be able to identify the significant anatomy demonstrated on each view of the series.

Standard Toe Series -3 view series

A-P (Dorsiplantar) Toe

Oblique Toe

Lateral Toe

A-P (Dorsiplantar) Toe

PREPARE THE ROOM

Cassette: gray; ¼ of 10" x 12", crosswise

Tube: 40" FFD, 15º cephalad

Technique: 60 kVp, small focal spot

Measure: through central ray

Filter/shield: gonad (½ apron)

PREPARE THE PATIENT

Position: R or L, ¾ of the cassette is masked to be used with the oblique toe and lateral toe.
Patient is supine, flex the knee and place the planter surface of affected
toe(s) flat on cassette.
Align center long axis of toe(s) to long axis of unmasked portion of film.

Central ray: To the proximal interphalangeal joint of the affected digit(s). For the great toe the interphalangeal joint.

Collimation: If a general evaluation is required all of the toes should be exposed. If a specific toe is being evaluated appropriate collimation demonstrated

Marker: R or L.

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA: A-P (Dorsiplantar) Toe

Center of the four-sided collimation field should be the PIP of the digit being examined.
Distal metatarsal heads should be demonstrated.
Each phalanx is examined noting their diaphyseal constriction, expanded articular ends, ungual tufts, and open interphalangeal and metatarsophalangeal joint spaces.
Optimum exposure should demonstrate soft tissue outlines of each digit, and bony trabecular detail.
Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning #5822 42 last updated: May, 99

Radiographic Positioning of the Toe

Oblique Toe

PREPARE THE ROOM

Cassette: gray; 74 of l0" x 12", crosswise

Tube: 40" FFD, no tube tilt

Technique: 60 kVp, small focal spot

Measure: through central ray

Filter/shield: gonad (½ apron)

PREPARE THE PATIENT

Position: R or L, ¾ of the cassette is masked (¼ used with A-P toe and ¼ to be used with lateral toe).
Patient is supine, flex the knee and place the planter surface of affected foot on cassette.
Center and align the long axis of digit(s) in question to long axis of unmasked film.
Rotate the foot 30° medially if 1^st through 3^rd toe, or laterally if 4^th of 5^th toe, using a radiolucent block if available.

Central ray: Perpendicular to the third metatarsophalangeal (MPT) joint.

Collimation: Include phalanges and MINIMUM of 2/3 of metatarsals. Include at least one digit on each side of the digit in question.

Marker: R or L.

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA: Oblique Toe

Four-sided collimation should include the digit in question and at least 2/3 of metatarsals without overlap.
Correct obliquity should be evident by increased concavity on one side of shafts and by overlapping of soft tissues and digits.
Heads of metatarsals should appear directly side by side with no overlapping.
Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning #5822 43 last updated: May, 99

Radiographic Positioning of the Toe

Lateral Toe

PREPARE THE ROOM

Cassette: gray; ¼ of 10" x 12", crosswise

Tube: 40" FFD, no tube tilt

Technique: 60 kVp, small focal spot

Measure: through central ray

Filter/shield: gonad (½ apron)

PREPARE THE PATIENT

Position: R or L, ¾ of the cassette is masked (¼ used with A-P toe and ¼ to be used with oblique toe).
Rotate the foot medially if 1^st through 2^nd toe, or laterally if 3^rd through 5^th toe.
Center and align the long axis of digit(s) in question to long axis of unmasked film.
Use tape, gauze or tongue blade to flex arid separate unaffected toes to prevent superimposition.

Central ray: Perpendicular to interphalangeal joint if first toe, or proximal interphalangeal (PIP) joint if second through fifth toe.

Collimation: Closely on four sides to affected digit.

Marker: R or L.

EXPOSURE

Patient directions: "Hold still, don't move" - expose.

EVALUATION CRITERIA: Oblique Toe

Four-sided collimation should include the digit in question in lateral position free of superimposition by other digits.
The interphalangeal joints should all appear open and unobstructed.
The metatarsophalangeal joint should be visualized even if superimposed.
Patient identification should be clear and legible, R/L marker should be clearly visible on lateral border without superimposing anatomy.

Radiographic Positioning 45822 44

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