Lower Limb Radiography

Foot (Radiographic Anatomy)

Foot
  Film size: 24 cm × 30 cm.
 Patient position: The patient is seated on the X-ray table, with
the hip and knee flexed. The plantar aspect of the foot is placed
on the IR.
 Direction and location of x-ray beam: The collimated beam is

Dorsi-plantar angled 15o cranially (posteriorly) and centred over the base of the
3rd metatarsal.
(AP)
projection
  Film size: 24 cm × 30 cm.
 Patient position: From the basic DP position, the affected limb is
leaned medially, bringing the plantar surface of the foot to
approximately 30–45° to the IR.
 Direction and location of the x-ray beam: The collimated
Dorsi-plantar vertical beam is centred over the base of the 3rd metatarsal.
oblique
(medial oblique)
projection
  Film size: 24 cm × 30 cm.
 Patient position: From the DP position, the leg is rotated
outwards to bring the lateral aspect of the foot in contact with the
IR. the plantar aspect should be perpendicular to the IR.
 Direction and location of the x-ray beam: The collimated
vertical beam is centred midfoot over the base of the 1 st metatarsal.
Lateral
projection
Ankle (Radiographic Anatomy)
  Film size: 18 cm × 24 cm.
 Patient position: The patient is either supine or seated on the
X-ray table with both legs extended. The affected ankle is
supported in dorsiflexion by a firm 90° pad placed against the
plantar aspect of the foot. The limb is rotated medially
(approximately 20°) until the medial and lateral malleoli are
equidistant from the receptor.
 Direction and location of the x-ray beam: The collimated
AP projection vertical beam is centred midway between the malleoli.
  Film size: 18 cm × 24 cm.
 Patient position: From the supine position, the patient rotates on to
the affected side. The leg is rotated until the medial and lateral
malleoli are superimposed vertically.

Lateral  Direction and location of the x-ray beam: The collimated vertical
beam is centred over the medial malleolus.
(medio-lateral)
projection
Calcaneum
  Film size: 18 cm × 24 cm.
 Patient position: From the supine position, the patient rotates
on to the affected side. The leg is rotated until the medial and
lateral malleoli are superimposed vertically.
 Direction and location of the x-ray beam: The vertical

Lateral collimated beam is centred 2.5 cm distal to the medial

malleolus.
projection
  Film size: 18 cm × 24 cm.
 Patient position: The patient sits or lies supine on the X-ray
table with both limbs extended. The affected leg is rotated
medially until both malleoli are equidistant from the receptor.
The ankle is dorsiflexed. The position is maintained by using a
bandage strapped around the forefoot and held in position by
the patient.
 Direction and location of the x-ray beam: The X-ray tube is
directed cranially at an angle of 40° to the plantar aspect of the
Axial projection heel. The collimated beam is centred to the plantar aspect of the
heel at the level of the base of the 3rd metatarsal.
 Leg
(Tibia & Fibula)
  Film size: 35 cm × 43 cm.
 Patient position: The patient is either supine or seated on the
X-ray table, with both legs extended. The ankle is supported in
dorsiflexion by a firm 90°pad placed against the plantar aspect
of the foot. The limb is rotated medially until the medial and
lateral malleoli are equidistant from the receptor. The leg might
be positioned diagonally across the receptor to ensure inclusion
of the knee and ankle joints in the image.
Antero-posterior  Direction and location of the x-ray beam: The collimated
(AP) vertical beam is centred to the mid-shaft of the tibia
  Film size: 35 cm × 43 cm.
 Patient position: From the supine/seated position, the patient
rotates onto the affected side. The leg is rotated further until the
malleoli are superimposed.
 Direction and location of the x-ray beam: The collimated
vertical beam is centred to the mid-shaft of the tibia.
Lateral projection
Knee joint
  Film size: 24 cm × 30 cm.
 Patient position: The patient stands with their back against the
vertical bucky. The knee is rotated so that the patella lies equally
between the femoral condyles. If the patient is unable to stand,
supine position is applied.
 Direction and location of the x-ray beam: The collimated
horizontal beam is centred 1 cm below the apex of the patella
through the joint space. Frequently, both knees are requested for
comparison, in which case, the beam should be centred at a point
AP – weight-bearing midway between both knees at a level 1 cm below both patellae.
  Film size: 24 cm × 30 cm.
 Patient position: The patient lies on the side to be examined,
with the knee flexed at 45° or 90°. The other limb is brought
forward in front of the one being examined
 Direction and location of the x-ray beam: The collimated
Lateral vertical beam is centred to the middle of the tibial condyle.
(medio-lateral)
projection
  Film size: 18 cm × 24 cm.
 Patient position: The patient lies prone on the X-ray table,
with the IR placed under the knee joint and the knee flexed
through 90°. A bandage placed around the ankle and held by
the patient may prevent unnecessary movement. The patient
flexes the knee a further 5°, to remove any chance of
superimposition of the tibia or foot on the patellofemoral joint
space.
 Direction and location of the x-ray beam: The collimated
Skyline vertical beam is centred behind the patella, with the vertical
projections central ray angled approximately 15° towards the knee,
avoiding the toes.
Femur
(Thigh)
  Film size: 35 cm × 43 cm.
 Patient position: The patient lies supine on the X-ray table,
with both legs extended. The IR/Bucky mechanism is located
directly under the posterior aspect of the thigh to include both
the hip and the knee joints. If this is impossible to achieve, then
the joint nearest the site of injury should be included.
 Direction and location of the x-ray beam: The collimated
AP projection vertical beam is centred to the mid-shaft of the femur.
  Film size: 35 cm × 43 cm.
 Patient position: From the AP position, the patient rotates on to
the affected side with the knee slightly flexed. The pelvis is rotated
backwards to separate the thighs. The position of the limb is then
adjusted to superimpose the femoral condyles vertically. Both the
hip and knee joints should be included, but if not possible, then the
joint nearest the site of injury should be included.

Lateral  Direction and location of the x-ray beam: The collimated

projection vertical beam is centred to the middle of the femoral shaft.

 Pelvis
Hips & Sacroiliac joints
  Film size: 35 cm × 43 cm.
 Patient position: The patient lies supine and symmetrical on the X-
ray table with the median sagittal plane perpendicular to the tabletop.
To avoid pelvic rotation the anterior superior iliac spines must be
equidistant from the tabletop. The limbs are slightly abducted and
internally rotated to bring the femoral necks parallel to the IR. The
whole pelvis and proximal femora should be included.

AP projection  Direction and location of the x-ray beam: The collimated vertical

(pelvis) beam is centred over the midline midway between the upper border
of the symphysis pubis and anterior superior iliac spines (ASIS).
  Film size: 24 cm × 30 cm.
 Patient position: The patient is positioned as described for the AP
position of pelvis. The affected limb is internally rotated to bring the
neck of femur parallel to the tabletop.
 Direction and location of the x-ray beam: The collimated vertical
beam is centred 2.5 cm distal to the middle of a line joining the ASIS
AP projection and the symphysis pubis.

(one hip)