Radiographic technique of Femur, knee joint, patella and leg 6th presentation Radiographic technique of Femur, knee joint, patella and leg

Femur, knee joint, patella and leg BASIC SPECIAL AP distal and Mid femur Lateral Femur(Mid and proximal femur) (Mid and distal femur) AP Knee Joint APO Knee Joint Lateral Knee Joint PA Axial Tunnel View Knee Bilateral Knee (weight-bearing) PA Patella Lateral Patella Tangential (Axial) Patella AP leg Lat leg

AP distal and Mid femur Basic Film Size : HD 35x43 cm14x17in (lengthwise). SHIELDING: Place lead shield over patient’s lap. Patient Position : patient supine ,give pillow for head. Part Position: leg rotated internally 5 for a true AP of the distal femur. For proximal femur ,leg rotated internally(10 to 15), knee joint must be included. Distance: 100 cm or 40 in) . (Grid used, hip under cathode end) p.44 bontrager C P : Mid shaft of femur. CR : perpendicular to the film. Collimation: collimate on four sides to area of interest.

Structure shown: distal two thirds of distal femur including knee joint is shown .knee joint space will not appear fully open because of divergent x-ray beam.

Lateral Femur (Mediolateral/Lateromedial) (Mid and distal femur) Basic Film Size: HD 35x43 cm14x17in (lengthwise). SHIELDING: Place lead shield over patient’s lap. Patient Position: Patient in a lateral recumbent (supine in case of a trauma patient). Part Position Lateral recumbent: Patient on affected side, flexed affected knee about 45, sound leg behind affected leg, and supported under knee and leg, lower end of film 2 inches below knee joint. Trauma Lateromedial: Support under affected leg and knee, support foot and ankle in true AP position. Film against the medial aspect of thigh (beam horizontally) Distance : ( 100 cm or 40 in) . **** (Grid used, hip under cathode end). C P : Mid shaft of femur. CR : perpendicular to the film. Collimation: collimate on four sides to area of interest.

Structure shown: distal two thirds of distal femur including knee joint is shown. knee joint space will not appear fully open because of divergent x-ray beam.

Lateral Femur (Mediolateral/Lateromedial) (Mid and proximal femur) Basic Film Size : HD 35x43 cm14x17in (lengthwise). SHIELDING: Place lead shield over patient’s lap. Patient Position: Patient in a lateral recumbent(supine in case of a trauma Pt). Part Position: Lateral recumbent: patient on affected side, flexed affected knee about 45, rolled back 15 posteriorly, sound leg behind affected leg, lower end of film 2 inches below knee joint. Trauma Lateromedial: Support under affected leg and knee, foot/ ankle in true AP, film against the medial aspect of thigh (beam horizontally). Distance: 100 cm or 40 in CP : Mid shaft of femur. CR : perpendicular to the film. Collimation: collimate on four sides to area of interest. (Grid used, hip under cathode end).

Structure shown: proximal one half to two thirds of proximal femur, including hip joint is shown. Proximal femur and hip joint should not be superimposed by opposite limb.

AP Knee Joint Basic Film Size : HD 18x24 cm (8x10in) lengthwise. * SHIELDING: Place lead shield over patient’s lap. Patient Position : Patient supine, give pillow for head. *Part Position : leg fully extended, leg is rotated internally 3 - 5 for a true AP knee( or until interepicondylar line is parallel to film),place sandbags by foot and ankle to stabilize if needed. Distance: 100 cm or 40 in) . C P: 0.5 inch (1.25cm) distal to apex of patella.*** CR :90 to film (for average thigh), 3-5caudal(for thin thigh), 3 - 5 cephalic (for thick thigh). Collimation: collimate on four sides to area of interest. (Grid or Bucky for > 10 cm )

Structure shown: the distal femur and proximal tibia and fibula is shown. the femurotibia joint space should be open . 1. Femur 2. Patella 3. Medial epicondyle of femur 4. Lateral epicondyle of femur 5. Medial Condyle of femur 6. Lateral Condyle of femur 7. Intercondylar eminence 8. Intercondylar notch 9. Knee joint 10. Lateral condyle of tibia 11. Medial condyle of tibia 12. Tibia 13. Fibula

APO Knee Joint (medial ‘internal’ rotation) Basic Film Size : 18x24 cm (8x10in) lengthwise. SHIELDING: Place lead shield over patient’s lap. Patient Position : Patient semi- supine. Part Position: Entire body and leg rotated partially away from side of interest. Rotate entire leg internally 45 (interepicondylar line 45 to the film), place support under elevated hip, give pillow for head. Distance: 100 cm or 40 in). Grid or Bucky for > 10 cm ) . C P: 0.5 inch (1.25cm) distal to apex of patella. CR:perpendicular to the film. Collimation: collimate on four sides to area of interest.

Structure shown: distal femur and proximal tibia and fibula with the patella superimposing the medial femur Condyle are shown. the Lateral Condyle of femur and tibia are well demonstrated, And the Medial and lateral knee joint spaces well appear unequal.

(medial ‘internal’ rotation) Rotate entire leg externally 45

Lateral Knee Joint( Mediolateral): Basic Film Size:18x24 cm (8x10in) lengthwise. SHIELDING: Place lead shield over patient’s lap. Patient Position: Patient in lateral recumbent position , give pillow for head. Part Position: affected side down, provide support for knee of opposite limb place behind knee being examined to prevent over rotation. Body and leg rotated until knee is in true lateral position, knee flexed 20 to 30.(femoral epicondyles) directly superimposed and plane of patella Perpendicular to film). Distance: 100 cm or 40 in) ****** (Grid or Bucky for > 10 cm ) . CP:1in (2.5cm) distal to medial epicondyle. CR : 5 to 7 cephalic . Collimation: collimate on four sides to area of interest.

Structure shown: the distal femur and proximal tibia and fibula and patella are shown in lateral profile . Femurotibia and joints should be open. 1. Femur 2. Lateral condyle of femur 3. Medial condyle of femur 4. Fabella 5. Patella 6. Base of patella 7. Apex of patella 8. Intercondylar eminence 9. Apex of fibula 10. Fibula 11. Tibia 12. Tibial tuberosity

Bilateral Knee (weight-bearing) S Film Size: HD 35x43 cm (14x17 in) (crosswise). SHIELDING: Place lead shield over patient’s lap. Patient Position: Patient erect standing on step stool. Part Position: Position feet straight ahead with weight evenly distributed on both feet, provide support handles for patient stability. Distance: 100 cm or 40 in) . ***** Grid or Bucky for > 10 cm ) . C P : Midpoint between the knees (0.5 in (1.25cm) below the apex of the patella). CR : perpendicular to the film or 5 - 10 caudal for thin patient. Collimation: Collimate on four sides to area of interest

Structure shown: the distal femur and proximal tibia and fibula and tibiofemur joint spaces are demonstrated bilaterally .

PA Axial Tunnel View Knee (Intercondylar fossa) Basic Film Size : 18x24 cm (8x10in) lengthwise. * SHIELDING: Place lead shield over patient’s lap. *Patient Position.1- Patient prone, give pillow for head, knee flexed 40- 50 place support under ankle. Patient Position. 2- kneeling with patient kneeling on all "fours", place cassette under affected knee. Place support under ankle and leg of affected limb. Ask patient to support body weight on opposite knee. Ask patient to slowly lean forward 2o to 30 and hold that position (result in 60 to70knee flex) flexed 40- 50 Camp Coventry method Distance: 100 cm or 40 in) .****(Grid or Bucky for > 10 cm ) . CP: Mid patella area (midpopliteal crease). CR :( prone) 90 to lower leg (40 – 50 caudal). Kneeling: Collimation: collimate on four sides to area of interest. flexed 60- 70 Holmblad method

PA Patella Basic Film Size : HD 18x24 cm (8x10in) lengthwise. SHIELDING: Place lead shield over patient’s lap. Patient Position : Patient prone, give pillow for head. Part Position: legs extended place support under ankle and leg, small support under femur to prevent direct pressure on the patella, Intercondylar line parallel to film Distance: 100 cm or 40 in) .*****(Grid or Bucky for > 10 cm ) . C P :Mid patella area( midpopliteal crease). CR : perpendicular to the film or 5 - 10 caudal for thin patient. Collimation: collimate on four sides to area of interest.

Structure shown: knee joint and patella with optimal recorded detail of patella because of decreased OID if taken as a PA projection are shown.

Lateral Patella( Mediolateral Patella ) Basic Film Size: HD 18x24 cm (8x10in) lengthwise. SHIELDING: Place lead shield over patient’s lap. Patient Position: Patient in lateral recumbent. Part Position: affected side down, unaffected limb behind the affected limb, provide support for knee of opposite limb placed behind affected knee, body and leg rotated for a true lateral knee, knee flexed 5 to 10. Distance: 100 cm or 40 in. ***(Grid or Bucky for > 10 cm ). CP :Mid patella area(midpopliteal crease). CR : 90 to film center. Collimation: collimate on four sides to area of interest.

Structure shown: a profile image of patella, the patellofemural tibiofemral joint are demonstrated.

Film Size : HD 24x30 cm (10x12in) or18x24cm (8x10in) crosswise. Tangential (Axial) Patella (Sun-rise/ skyline View) (Settegast method) S Film Size : HD 24x30 cm (10x12in) or18x24cm (8x10in) crosswise. SHIELDING: Place lead shield over patient’s lap. Patient Position : Patient prone. *Part Position : film under the knee, knees flexed 45,patient holds a cotton tape for support*Another method can be done as alternative with the knee flexed 90 with same CP and CR direction. This view should not be done in case of a suspected patellar fracture! Distance: 100 cm or 40 in) .***(Grid or Bucky for > 10 cm ). C P : Mid patellofemoral joint. CR : 15 to 20 tangential to the joint. Collimation: collimate on four sides to area of interest. (Hughston) method knee flex 45 (Settegast method) knee flexed 90

Axial Patella RADIOGRAPHIC ANATOMY 1. Patella 2. Medial part of patella 3. Lateral part of patella 4-5. Patellofemoral joint 6. Lateral femoral condyle 7. Medial femoral condyle Axial Patella

AP leg ( Tibia and Fibula ) Basic Film Size: HD 35x43 cm, (14x17in )lengthwise. SHIELDING: Place lead shield over patient’s lap. Patient Position: Patient supine give pillow for head. Part Position : leg fully extended, leg and knee in true AP, sandbag against the foot, foot dorsiflexed 90 to the leg, both the knee and ankle joint must be included (film can be placed in a diagonal orientation (corner to corner). Distance: 100 cm or 40 in. ) C P : Mid shaft of leg. CR : perpendicular to the film. Collimation: collimate on four sides to area of interest.

Structure shown: The entire tibia and fibula should be included with both the ankle and knee joints demonstrated on one(or two if needed) IR.

tibia. (A)Medial Condyle of RADIOGRAPHIC ANATOMY tibia. (A)Medial Condyle of (B)Body of shaft of tibia (C)Medial malleolus. (D)Lateral malleolus. (E)Body of shaft of tibia. (F) Neck of fibula. (G)Head of fibula. (H)Styloid process of fibula. (I)Lateral Condyle of tibia. (J)Intercondylar eminence (spine). AP Leg

Lat Tibia/ Fibula (leg) Basic Film Size: HD 35x43 cm, (14x17in )lengthwise. * SHIELDING: Place lead shield over patient’s lap. * Patient Position : Patient in the lateral recumbent. *Part Position : injured limb down, the opposite leg behind affected leg, sand bags for support or pillow, knee flexed 45, leg in true lateral (plane of patella 90 to the film), both joints must be included.(film can be placed in a diagonal orientation (corner to corner). CR : perpendicular to the film C P : Mid shaft of leg Distance: 100 cm or 40 in) . Collimation: collimate on four sides to area of interest.

Lateral Leg RADIOGRAPHIC ANATOMY 1. Femur 2. Knee joint 3. Intercondylar eminence 4. Tibial tuberosity 5. Fibula 6. Tibia 7. Ankle joint 8. Talus 9. Calcaneus Structure Shown: The entire tibia and fibula should be included with both the ankle and knee joints included on one(or two if needed) IR.s