Hand Series

Projection Clinical Indications Position

Hand (PA view) The PA hand view is requested for diagnosing a

variety of clinical indications such as rheumatoid
arthritis, osteoarthritis, suspected fracture or
dislocation and localising foreign bodies.
Technical Factors
mAs - 3-5
kVp - 50-60 Technical evaluation
SID - 100cm • 5th nger is positioned PA, with no
rotation as evidenced by the
symmetric appearance of the
Central Ray
concavities of the phalanges.
• third metacarpal head Interphalangeal and
metacarpophalangeal joint spaces
Collimation of digits 2 to 5 appear open.
• The concavity of the metacarpal
• laterally to the skin margins
• proximal to include distal radioulnar joint
shafts is equal.
• distal to the tips of the distal phalanges
• patient is seated alongside the table
• the a ected arm if possible is exed
at 90° so the arm and hand can rest
on the table
• the a ected hand is placed, palm
down on the image receptor
• shoulder, elbow, and wrist should all
be in the transverse plane,
perpendicular to the central beam
• the hand and elbow should be at
shoulder height which makes radius
and ulna parallel (lowering the arm
makes radius cross the ulna and
thus relative shortening of radius)

Projection Clinical Indications Position

Hand (oblique view) The oblique hand view is requested for
diagnosing a variety of clinical indications such as
rheumatoid arthritis, osteoarthritis, suspected
Technical Factors fracture or dislocation and localising foreign
mAs - 3-5
kVp - 50-60 Technical evaluation
SID - 100cm • Fingers are positioned parallel to
image receptor, indicated by open
interphalangeal and
Central Ray
metacarpophalangeal joint spaces.
• third metacarpal head Correct obliquity is evidenced by
the following:
Collimation • midshafts of 3rd to 5th
metacarpals do not overlap
• laterally to the skin margins
• proximal to include distal radioulnar joint
• some overlap of the distal heads of
• distal to the tips of the distal phalanges
• patient is seated alongside the table
• the a ected arm if possible is exed
at 90° so the arm and hand can rest
on the table
• the hand is rotated externally by 45
degrees from the basic PA
position with ngers kept in
extension and parallel to image
receptor
• shoulder, elbow, and wrist should all
be in the transverse plane,
perpendicular to the central beam
• the hand and elbow should be at
shoulder height which makes radius
and ulna parallel (lowering the arm
makes radius cross the ulna and
thus relative shortening of radius)

Projection Clinical Indications Position

“. Useful for visualising the degree of fracture
Hand (lateral view) displacement and the location of a foreign body.
A fan lateral view is also essential for visualising • patient is seated alongside the table
each phalange separately, allowing for diagnosis • hand is externally rotated by 90
Technical Factors of rheumatoid and osteoarthritis. degrees from the PA position so that
mAs - 3-5 the palm is perpendicular to the
kVp - 50-60
Technical evaluation image receptor
• ngers are kept extended with
SID - 100cm • interphalangeal joint spaces are thumb abducted
open • ngers should ideally be separated
Central Ray • metacarpals are mostly to minimise superimposition and
superimposed, with slight over- increase diagnostic information
• over the head of the second metacarpal rotation externally allowing the contained in the image
fracture at the base of the 5th
Collimation metacarpal to be visualised
• anteroposterior to the skin margins • posterior aspect of the distal radius
• distal to the tips of the ngers and ulna are superimposed
• proximal to include one-third of the distal

lateral fan view: o ers a view of the individual middle and distal phalanges, avoiding overlap
lateral exion view
ball-catcher view (also known as Nørgaard projection): specialised view used to demonstrate the
metacarpophalangeal (MCP) joints, often requested in the context of rheumatoid arthritis
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 Scaphoid Series
Projection Clinical Indications Position

Scaphoid (PA ulnar

This view aims to show the scaphoid in its • patient is seated alongside the table
deviation view) anatomical position, hence allowing the • the a ected arm if possible is exed
visualisation of any subtle distal, middle or at 90° so the arm and wrist can rest
Technical Factors proximal fractures 1 of the scaphoid.
on the table
• the a ected hand is placed, palm
mAs - 3-5
Technical evaluation down on the image receptor with
kVp - 50-60 hand in ulnar deviation (see practical
SID - 100cm • hand is in ulnar deviation with little points)
superimposition over the scaphoid • shoulder, elbow, and wrist should all
bone be in the transverse plane,
Central Ray
• minor superimposition of the perpendicular to the central beam
• anatomical snu box metacarpal bases • the wrist and elbow should be at
• articulation between the distal shoulder height which makes radius
Collimation
` radius and the ulna is open or has and ulna parallel (lowering the arm
• laterally to the skin margins little superimposition makes radius cross the ulna and
• distal to the midway up the metacarpals • concavity of the metacarpal shafts thus relative shortening of radius)
• proximal to the include one-quarter of the
distal radius and ulna

Projection Clinical Indications Position

Shows the scaphoid in true anatomical

Scaphoid (PA axial view) appearance without superimposition or
foreshortening. scaphoid sits in a slight volar tilt,
the angle of the axial view ensures there is no
Technical Factors
superimposition; allowing the visualisation of
mAs - 3-5 any subtle distal, middle or proximal fractures
kVp - 55-65
Technical evaluation
SID - 100cm check with ruler
• the scaphoid should appear
Central Ray
slightly elongated and almost free
from all superimposition
• angled 15-30° proximally- long axis of the
arm towards the elbow
• minor superimposition of the
metacarpal bases
Collimation • articulation between the distal
• laterally to the skin margins radius and the ulna is open or has
• distal to the base of the rst metacarpal little superimposition.
• proximal to the radiocarpal joint
• patient is seated alongside the table
• the a ected arm if possible is exed
at 90° so the arm and wrist can rest
on the table
• the a ected hand is placed, palm
down on the image receptor with
hand in ulnar deviation (see practical
points)
• shoulder, elbow, and wrist should all
be in the transverse plane,
perpendicular to the central beam
• the wrist and elbow should be at
shoulder height which makes radius
and ulna parallel (lowering the arm
makes radius cross the ulna and

Projection Clinical Indications Position

• patient is seated alongside the table

Scaphoid (oblique view) Although you would not request this view in
isolation, this is a great projection to assess the • the a ected arm if possible is exed
tubercle of the scaphoid and most of the distal at 90° so the arm and wrist can rest
Technical Factors aspect of the scaphoid for that matter. on the table
• the a ected hand is placed, palm
mAs - 3-5
down on the image receptor
Technical evaluation
kVp - 50-60 • shoulder, elbow, and wrist should all
SID - 100cm be in the transverse plane,
• The ulna head and distal radius are
perpendicular to the central beam
slight superimposed. The proximal
• wrist and elbow should be at
metacarpals 3 to 5 also being
Central Ray shoulder height which makes radius
partly superimposed.
• mid carpal region
and ulna parallel (lowering the arm
makes radius cross the ulna and
Collimation thus relative shortening of radius)
• laterally to the skin margins • from the positioning of the PA
• distal to the midway up the metacarpals projection, the wrist is externally
• proximal to the include one-quarter of the rotated 40°; a sponge can be placed
distal radius and ulna under the wrist to aid stability
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 Projection Clinical Indications Position

Scaphoid (lateral view) T

• patient is seated alongside the table
• the a ected arm if possible is exed
Technical Factors
at 90°, so the arm and wrist can rest
mAs - 3-5 on the table
Technical evaluation • abduct the humerus until it is parallel
kVp - 50-60
to the image receptor
SID - 100cm • shoulder, elbow, and wrist should all
• There is a superimposition of the be in the transverse plane,
carpal bones, including the distal perpendicular to the central beam
Central Ray
portion of the scaphoid and the • wrist and elbow should be at
• mid carpal region pisiform. The radius and ulna are shoulder height which makes radius
also superimposed. The ulna and ulna parallel (lowering the arm
Collimation styloid can be seen posterior. makes radius cross the ulna and
• anteroposterior to the skin margins thus relative shortening of radius)
• distal to the midway up the metacarpals
• proximal to include one-quarter of the

horizontal beam lateral view: modi ed lateral projection that requires little to no patient movement
produces a diagnostic lateral projection without risking patient pain
clenched st view: used for suspected scapholunate dissociation
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 Wrist Series
Projection Clinical Indications Position

The PA wrist radiograph is requested for trauma,

Wrist (PA view) suspected infective processes, injuries the distal
radius and ulna, suspected arthropathy or even • patient is seated alongside the table
suspected foreign bodies • the a ected arm if possible is exed
Technical Factors
at 90° so the arm and wrist can rest
mAs - 3-5 on the table
kVp - 50-60
Technical evaluation • the a ected hand is placed, palm
down on the image receptor
SID - 100cm • there is only minor superimposition • shoulder, elbow, and wrist should all
of the metacarpal bases be in the transverse plane,
• the articulation between the distal perpendicular to the central beam
Central Ray
radius and the ulna is open or has • the wrist and elbow should be at
• mid carpal region little superimposition. shoulder height which makes radius
• the concavity of the metacarpal and ulna parallel (lowering the arm
Collimation shafts is equal makes radius cross the ulna and
• laterally to the skin margins thus relative shortening of radius)
• distal to the midway up the metacarpals
• proximal to 1/4 of the distal R and U

Projection Clinical Indications Position

• patient is seated alongside the table

Wrist (oblique view) The PA wrist radiograph is requested for trauma,
suspected infective processes, injuries the distal • the a ected arm if possible is exed at
radius and ulna, suspected arthropathy or even 90° so the arm and wrist can rest on
Technical Factors suspected foreign bodies the table
• the a ected hand is placed, palm
mAs - 3-5 down on the image receptor
Technical evaluation
kVp - 50-60 • shoulder, elbow, and wrist should all
be in the transverse plane,
SID - 100cm • The ulna head and distal radius are
perpendicular to the central beam
slight superimposed. The proximal
• wrist and elbow should be at shoulder
metacarpals 3 to 5 also being
Central Ray height which makes radius and ulna
partly superimposed.
parallel (lowering the arm makes radius
• mid carpal region cross the ulna and thus relative
shortening of radius)
Collimation
• from the positioning of the PA
• laterally to the skin margins projection, the wrist is externally
• distal to the midway up the metacarpals rotated 40° - 45°; a sponge can be
• proximal to 1/4 of the distal R and U placed under the wrist to aid stability.

Projection Clinical Indications Position

requested for trauma, suspected infective

Wrist (lateral view) processes, injuries the distal radius and ulna,
suspected arthropathy or even suspected foreign • patient is seated alongside the table
bodies • the a ected arm if possible is exed
Technical Factors
at 90° so the arm and wrist can rest
mAs - 3-5 on the table
Technical evaluation • abduct the humerus so that it is
kVp - 50-70
parallel to the image receptor
SID - 100cm • There is a superimposition of the • shoulder, elbow, and wrist should all
carpal bones, including the distal be in transverse plane,
portion of the scaphoid and the perpendicular to the central beam
Central Ray
pisiform. The radius and ulna are • wrist and elbow should be at
• mid carpal region also superimposed. The ulnar shoulder height which makes radius
styloid can be seen posterior. and ulna parallel (lowering the arm
Collimation makes radius cross the ulna and
• collimation thus relative shortening of radius)
• anteroposterior to the skin margins
• distal to the midway up the metacarpals

horizontal beam lateral wrist: requires little to no patient movement

carpal tunnel view
carpal bridge view: used to assess the dorsal aspect of the scaphoid, lunate and the triquetrum
clenched st view: used for suspected scapholunate dissociation
radial deviation view: employed to examine the carpal bones at the ulnar aspect of the wrist
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 Forearm Series
Projection Clinical Indications Position

This view demonstrates the elbow joint in its

Forearm (AP view) natural anatomical position allowing for
assessment of suspected dislocations or • patient is seated alongside the table
fractures and localising foreign bodies within • forearm is supinated, and its dorsal
Technical Factors
the forearm. surface is kept in contact with the
mAs - 3-5 cassette with extension at the elbow
kVp - 50-70 Technical evaluation joint
• both elbow joint and wrist joints are
SID - 100cm • trochlea and capitulum being seen also kept in contact with the
in pro le cassette
• the wrist is in AP position, with
Central Ray
minimal superimposition of the
• mid-forearm region distal radius and ulna
• the arm should be extended
• Collimation appropriately, as evidenced by the
radial head being seen in pro le
• distal to the wrist joint
• proximal to elbow joint

Projection Clinical Indications Position

Forearm (lateral view) This view allows for the assessment of

suspected dislocations or fractures and
•
localising foreign bodies within the forearm.
patient is seated alongside the table
Technical Factors

mAs - 3-5 • elbow is exed to 90 degrees, and

Technical evaluation the medial aspect of the wrist,
kVp - 50-70
forearm and elbow joint are placed
SID - 100cm • elbow is in a lateral position, as in contact with the detector
con rmation by the trochlea and
capitulum being superimposed • shoulder, elbow and wrist should be
Central Ray
and the radial head being seen in in the same horizontal plane
• mid-forearm region pro le
• there should be superimposition of
• Collimation the distal radius and ulna
indicating a lateral position
• distal to the wrist joint
• proximal to elbow joint

posteroanterior view: demonstrates PA wrist distally and lateral elbow proximally

horizontal beam lateral view: demonstrates lateral wrist distally and AP elbow proximally

Projection Clinical Indications Position

ideal for patients who are unable to move their
Forearm (HBL) arm as per the standard forearm positioning
technique but require assessment of suspected • patient is seated alongside the table
radius and/or ulna dislocations or fractures.This • the medial border of the extended
Technical Factors shows a lateral view of R and AP view of U
elbow and palmar aspect of the
mAs - 3-5
forearm are kept in contact with the
Technical evaluation detector (see Figure 2)
kVp - 50-70 • detector is medial to the forearm
SID - 100cm

Central Ray • the elbow joint is in AP position

with little to no superimposition
• mid-forearm region
• the wrist joint is in lateral position
• Collimation
• distal to the wrist joint
• proximal to elbow joint
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 Elbow Series
Projection Clinical Indications Position
This view is clinically indicated for trauma,
Elbow (AP view) chronic discomfort or infection of the elbow
joint. It is the preferred projection to assess • patient is seated alongside the table
the medial and lateral epicondyles of the
• the fully extended arm and forearm,
Technical Factors humerus for avulsion-type fractures
in a supinated position, are kept in
mAs - 2-5 contact with the table by lowering
Technical evaluation the shoulder joint to the level of the
kVp - 50-60
table they all must be in the same
SID - cm • the elbow is in an AP position, with plane as the detector (see Figure 1)
slight internal rotation. • the detector is placed below the
• patient's arm should be rotated elbow joint
Central Ray
externally to ensure that the
• mid elbow which is approximately the trochlea and capitulum are seen in
midpoint between the epicondyles pro le.
Collimation

• superior to the distal third of the humerus

• inferior to include 1/3 of the proximal R&U
lateral and medial to the skin margin

Projection Clinical Indications Position

Elbow (lateral view) This view is clinically indicated for trauma

to, chronic discomfort or infection of the elbow
joint.
Technical Factors
mAs - 2-5
kVp - 50-60 Technical evaluation
• medial epicondyle is superimposed
SID - cm
over the anterior third of the distal
humerus, rather than dead centre
Central Ray • there is a superimposed, concentric
relationship of the trochlear groove
• lateral epicondyle of the humerus (smallest circle) and the medial lip of
the trochlea with the capitellum
Collimation
• olecranon process is visible in pro le
• superior to the distal third of the humerus • elbow joint is open
• inferior to include 1/3 of the proximal R&U • radial tuberosity is superimposed and
lateral and medial to the skin margin not in pro le (arm is not pronated)
• patient is sitting next to the table
• at 90 degrees elbow exion, the
medial border of the palm and
forearm are kept in contact with the
tabletop (see gures 1-3)
• the shoulder, elbow and wrist are
kept in the same horizontal plane
(see gure 1)
• rotate the hand so the thumb is
pointing towards the ceiling,
ensuring all aspects of the arm from
the wrist to the humerus are in the
same plane

horizontal beam lateral: modi ed lateral projection that requires little to no patient movement. produces a
diagnostic lateral/AP projection without risking patient pain
acute exion AP: modi ed AP projection when the patient cannot straighten the arm
inferosuperior view: modi ed elbow projection for patients in acute exion greater than 90 degrees
Coyle's view: an axial projection that focuses on the radial head, used when radial head fractures are
suspected
external oblique: an additional projection often performed to demonstrate the radial head free from
superimposition
internal oblique view: projection demonstrating the coronoid process in pro le
supracondylar AP
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 Humerus Series
Projection Clinical Indications Position
done to exclude large humeral shaft fractures or
Humerus (AP view) suspected symptomatic metastatic lesions. If an
occult fracture is suspected at either the
• the patient is preferably erect
proximal or distal end, it is best to do a separate
• the patient's back is against the
Technical Factors elbow or shoulder series.
image receptor
mAs - 60-70 • the a ected arm is abducted and
kVp - 7-15
Technical evaluation centred to the upright detector, if
possible, the arm is slightly
SID - 100cm • The humerus is positioned AP, externally rotated to mimic the true
evidenced by the medial and anatomical position
lateral epicondyles seen in pro le
Central Ray
and the greater tuberosity being
• mid humerus shaft
seen on the lateral aspect of the
Collimation humerus. The shaft is abducted
• superior to SM above the glenohumeral away from the patient's body,
joint minimising superimposition
• inferior to include the distal humerus
including the elbow joint
• lat. and med. to include the skin margin

Projection Clinical Indications Position

done to exclude large humeral shaft fractures or

Humerus (lateral view) suspected symptomatic metastatic lesions. If an
occult fracture is suspected at either the • patient is preferably erect
proximal or distal end, it is best to do a separate • patient stands facing the detector
Technical Factors
elbow or shoulder series. with the injured side closest to the
mAs - 60-70 detector
kVp - 7-15 Technical evaluation • patient is then rotated so that the
lateral aspect of the shoulder of the
SID - 100cm • medial and lateral epicondyles a ected side, the arm and the elbow
superimposed and scapula in are all in contact with the upright
lateral (Y-shaped) position bucky
Central Ray
• humerus is positioned away from • the elbow is exed 90° (as close to
• mid humerus shaft the patient's body, minimising 90° as possible)
Collimation superimposition • place the patient's hand on their
• superior to SM above the glenohumeral ASIS or stomach to maintain
joint position
• inferior to include the distal humerus
including the elbow joint
• lat. and med. to include the skin margin

supine AP view: a replacement examination to the AP view performed appropriate supine

examination for inspection of the entirety of the humerus
can be conducted regardless of body habitus or patient condition
supine lateral view: a replacement examination to the lateral view performed supine
appropriate examination for inspection of the entirety of the humerus
can be conducted regardless of body habitus or patient condition
normally done via tube angulation but can be done transthoracic
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 Calcaneus Series
Projection Clinical Indications Position

Calcaneus (lateral view)

This view is able to assess for bony lesions
and also helps in determining the extent and
alignment of fractures
Technical Factors
• the patient is in a lateral recumbent
mAs - 3-5 position on the table
Technical evaluation • the lateral aspect of the knee and
kVp - 50-60
ankle joint should be in contact with
SID - 100cm the table resulting in the tibia lying
• The calcaneus is seen; talonavicular
joint open; the distal bula is parallel to the table
Central Ray superimposed by the posterior • the leg can be bent or straight
portion of the distal tibia, the tarsal • foot in dorsi exion
• 2.5 cm inferior to the prominence of
sinus should appear open. • place the opposite leg behind the
the medial malleolus of the distal tibia
• The talar domes are superimposed injured limb to help avoid over-
Collimation rotation
(view of the superior articular surface
• anteriorly from the hindfoot to the extent of of the talus)
the skin margins of the most posterior • The joint space between the distal
portion of the calcaneus tibia and the talus is open and
• superior to examine talocrural joint uniform.
• inferior to the skin margins of the plantar
aspect of the foot

Projection Clinical Indications Position

Calcaneus (axial view) This projection is best used to visualise

pathologies or fractures resulting in medial • patient is supine or seated with the
or lateral displacement 2. Its diagnostic
a ected limb extended 2
Technical Factors
• the posterior aspect of the ankle is
mAs - 8-15 resting on the image receptor 2
kVp - 65-75
Technical evaluation • foot is dorsi exed until the plantar
surface is running perpendicular to
SID - 100cm the image receptor
• entire calcaneus is visible from the
• dorsi exion can be aided with tape
posterior tuberosity to the
Central Ray or fabric wrapped around the distal
talocalcaneal joint
• 40° cephalad from the long axis of the foot phalanges to be pulled backwards
centred at the base of the 3rd metatarsal by the patient, this should only be
• sustentaculum tali is evident on the
(midfoot) performed if the patient can tolerate
medial aspect of the image
Collimation
it
• lateral to the skin margins • subtalar joint should be visible on
• anterior to distal third of the foot the superior portion of the image
• posterior to the skin margins of the

https://www.youtube.com/watch?v=f2snumbdpMY

An ankle series and/or foot series may be required after the initial investigation to rule out further pathology.
Borden’s view: used to evaluate the posterior subtalar joint
Canale/Kelly view: used to evaluate the talar neck, anterior calcaneal process and calcaneocuboid joint well
visualised (also calcaneonavicular coalition)
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 Foot Series
Projection Clinical Indications Position
This view demonstrates the location and extent
Foot (DP view) of fractures in the foot, joint space
abnormalities, soft tissue e usions and is the
frontal view for the examination of foreign • the patient may be supine or upright
Technical Factors bodies. depending on comfort
mAs - 3-4
Technical evaluation • the a ected leg must be exed
kVp - 50-55
enough that the plantar aspect of
SID - 100cm • 1st metatarsal has even concavity the foot is resting on the image
receptor
Central Ray
• the spaces between the 2nd to
• x-ray beam centred to the base of the
5th metatarsal are equal, yet the
3rd metatarsal bases are overlapping
• Beam angled - 10°-15 up jp depending on arch
• intertarsal space between
Collimation
the medial and intermediate cuneif
• lateral to the skin margins
• anterior to distal third of the foot
orm should be open
• posterior to the skin margins of the

Projection Clinical Indications Position

Foot (medial oblique This view demonstrates the location and extent
view) of fractures in the foot and joint space
abnormalities. It is also used in the • the patient may be supine or upright
determination of osteomyelitis and examination depending on comfort
Technical Factors
of foreign bodies. • the a ected leg must be exed
mAs - 3-4 enough that the plantar aspect of
kVp - 55-60
Technical evaluation the foot is resting on the image
receptor
SID - 100cm • the foot is medially rotated until the
• entire calcaneus is visible from the
plantar surface sits at a 45° angle to
posterior tuberosity to the
Central Ray the image receptor
talocalcaneal joint
• 40° cephalad from the long axis of the foot
centred at the base of the 3rd metatarsal • sustentaculum tali is evident on the
(midfoot)
medial aspect of the image
Collimation
• lateral to the skin margins • subtalar joint should be visible on
• anterior to distal third of the foot the superior portion of the image
• posterior to the skin margins of the

Projection Clinical Indications Position

Calcaneus (axial This view is useful in the assessment for joint

view) abnormalities, determining the degree of dorsal
or plantar displacement in fractured bones, soft • the patient may be supine or upright
tissue e usions or gas (i.e. osteomyelitis) and in depending on comfort
Technical Factors locating opaque foreign bodies. • the a ected leg is externally rotated
mAs - 4-6 until the distal limb is parallel to the
kVp - 55-60
Technical evaluation table, in many cases, the patient will
have to half roll onto the a ected
SID - 100cm side
• the metatarsals are almost
• the lateral aspect of the foot will be
completely superimposed with
Central Ray in contact with the image receptor
only the tuberosity of the
• base of metatarsals or midfoot • the non-a ected side is kept
5th metatarsal seen in pro le
posterior to prevent over rotation
• the domes of the superior aspect
• the foot is in slight dorsi exion
Collimation of the talus are superimposed
• the planter surface should be
• anteriorly to skin margin of the distal • tibiotalar joint is open
perpendicular to the image receptor
phalanges
• posteriorly to skin margin of the calcaneus
• superior to the talocrural joint

weightbearing DP: the DP projection, however, weight-bearing. this projection is useful when observing how the
structures of the foot perform under weight
performed to assess for a dynamic widening of the Lisfranc joint, which would indicate a Lisfranc injury
weightbearing lateral: the lateral projection, however, weight-bearing. This projection is useful when observing
how the structures of the foot perform under weight
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 Ankle Series
Projection Clinical Indications Position
-performed in the setting of ankle trauma and
Ankle (AP view) suspected ankle fractures in addition to
the lateral and mortise views of the ankle.
- show bony diseases or lesions of the distal • the patient may be supine or sitting
Technical Factors lower leg, talus and proximal fth metatarsal. upright with their leg straighten on
mAs - 3-4 the table
Technical evaluation
kVp - 50-55
• the foot is in dorsi exion
SID - 100cm
• the distal bula should be slightly
• the toes will be pointing directly
superimposed the distal tibia
toward the ceiling
Central Ray • the lateral and medial malleoli of
• the midpoint of the lateral and medial malleoli the distal bula and tibia are in
pro le
• the tibiotalar joint space should be
Collimation open, yet the full mortise joint
• laterally to the skin margins should not be visualised on the AP
• superior to examine the distal 1/3 T F
• inferior to the proximal aspect of the

Projection Clinical Indications Position

Foot (medial oblique This view demonstrates the location and extent
view) of fractures in the foot and joint space
abnormalities. It is also used in the • the patient may be supine or upright
determination of osteomyelitis and examination depending on comfort
Technical Factors
of foreign bodies. • the a ected leg must be exed
mAs - 3-4 enough that the plantar aspect of
kVp - 55-60
Technical evaluation the foot is resting on the image
receptor
SID - 100cm • the foot is medially rotated until the
• entire calcaneus is visible from the
plantar surface sits at a 45° angle to
posterior tuberosity to the
Central Ray the image receptor
talocalcaneal joint
• 40° cephalad from the long axis of the foot
centred at the base of the 3rd metatarsal • sustentaculum tali is evident on the
(midfoot)
medial aspect of the image
Collimation
• lateral to the skin margins • subtalar joint should be visible on
• anterior to distal third of the foot the superior portion of the image
• posterior to the skin margins of the

Projection Clinical Indications Position

Calcaneus (axial This view is useful in the assessment for joint

view) abnormalities, determining the degree of dorsal
or plantar displacement in fractured bones, soft • the patient may be supine or upright
tissue e usions or gas (i.e. osteomyelitis) and in depending on comfort
Technical Factors locating opaque foreign bodies. • the a ected leg is externally rotated
mAs - 4-6 until the distal limb is parallel to the
kVp - 55-60
Technical evaluation table, in many cases, the patient will
have to half roll onto the a ected
SID - 100cm side
• the metatarsals are almost
• the lateral aspect of the foot will be
completely superimposed with
Central Ray in contact with the image receptor
only the tuberosity of the
• base of metatarsals or midfoot • the non-a ected side is kept
5th metatarsal seen in pro le
posterior to prevent over rotation
• the domes of the superior aspect
• the foot is in slight dorsi exion
Collimation of the talus are superimposed
• the planter surface should be
• anteriorly to skin margin of the distal • tibiotalar joint is open
perpendicular to the image receptor
phalanges
• posteriorly to skin margin of the calcaneus
• superior to the talocrural joint

weightbearing DP: the DP projection, however, weight-bearing. this projection is useful when observing how the
structures of the foot perform under weight
performed to assess for a dynamic widening of the Lisfranc joint, which would indicate a Lisfranc injury
weightbearing lateral: the lateral projection, however, weight-bearing. This projection is useful when observing
how the structures of the foot perform under weight
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 Projection Position
Clinical Indications
Calcaneus (axial view) This projection is best used to visualise
pathologies or fractures resulting in medial • patient is supine or seated with the
or lateral displacement 2. Its diagnostic
a ected limb extended 2
Technical Factors
• the posterior aspect of the ankle is
mAs - 8-15 resting on the image receptor 2
kVp - 65-75
Technical evaluation • foot is dorsi exed until the plantar
surface is running perpendicular to
SID - 100cm the image receptor
• entire calcaneus is visible from the
• dorsi exion can be aided with tape
posterior tuberosity to the
Central Ray or fabric wrapped around the distal
talocalcaneal joint
• 40° cephalad from the long axis of the foot phalanges to be pulled backwards
centred at the base of the 3rd metatarsal by the patient, this should only be
• sustentaculum tali is evident on the
(midfoot) performed if the patient can tolerate
medial aspect of the image
Collimation
it
• lateral to the skin margins • subtalar joint should be visible on
• anterior to distal third of the foot the superior portion of the image
• posterior to the skin margins of the

Projection Clinical Indications Position

Calcaneus (axial view) This projection is best used to visualise

pathologies or fractures resulting in medial • patient is supine or seated with the
or lateral displacement 2. Its diagnostic
a ected limb extended 2
Technical Factors
• the posterior aspect of the ankle is
mAs - 8-15 resting on the image receptor 2
kVp - 65-75
Technical evaluation • foot is dorsi exed until the plantar
surface is running perpendicular to
SID - 100cm the image receptor
• entire calcaneus is visible from the
• dorsi exion can be aided with tape
posterior tuberosity to the
Central Ray or fabric wrapped around the distal
talocalcaneal joint
• 40° cephalad from the long axis of the foot phalanges to be pulled backwards
centred at the base of the 3rd metatarsal by the patient, this should only be
• sustentaculum tali is evident on the
(midfoot) performed if the patient can tolerate
medial aspect of the image
Collimation
it
• lateral to the skin margins • subtalar joint should be visible on
• anterior to distal third of the foot the superior portion of the image
• posterior to the skin margins of the

Projection Position
Clinical Indications
Calcaneus (axial view) This projection is best used to visualise
pathologies or fractures resulting in medial • patient is supine or seated with the
or lateral displacement 2. Its diagnostic
a ected limb extended 2
Technical Factors
• the posterior aspect of the ankle is
mAs - 8-15 resting on the image receptor 2
kVp - 65-75
Technical evaluation • foot is dorsi exed until the plantar
surface is running perpendicular to
SID - 100cm the image receptor
• entire calcaneus is visible from the
• dorsi exion can be aided with tape
posterior tuberosity to the
Central Ray or fabric wrapped around the distal
talocalcaneal joint
• 40° cephalad from the long axis of the foot phalanges to be pulled backwards
centred at the base of the 3rd metatarsal by the patient, this should only be
• sustentaculum tali is evident on the
(midfoot) performed if the patient can tolerate
medial aspect of the image
Collimation
it
• lateral to the skin margins • subtalar joint should be visible on
• anterior to distal third of the foot the superior portion of the image
• posterior to the skin margins of the
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