Chapter 6 Radiographic Positioning
1. The three bones of the ankle form a deep socket into which the talus fits. The socket is called the?
2. The distal tibial joint surface forming the roof of the distal ankle joint is called the?
3. The medial malleolus is approximately 1/2 inch posterior to the lateral malleolus.
4. The ankle joint is classifies as a synovial joint with _________ type of movement.
5. The ___ is the weight-bearing bone of the lower leg.
6. What is the name of the small prominence located on the posterolateral aspect of the medial condyle of the femur that is an identifying landmark of to determine possible rotation of a lateral knee?
7. What is the name of the large prominence located on the midanterior surface of the proximal tibia that serves as an attachment for the patellar tendon?
8. A small, triangular depression located on the tibia that helps form the distal tibiofibular joint is called the?
9. The articular facets of the proximal tibia are also referred to as the?
10. The articular facets slope is ____ posteriorly
10 to 15
11. The most proximal aspect of the fibula is the
Apex of styloid process
12. The extreme distal end of the fibula forms the
13. Largest sesamoid bone in the body?
14. What are two other names for the patellar surface of the femur?
Intercondylar sulcus and trochlear groove.
15. What is the name of the depression located on the posterior aspect of the distal femur?
16. Why must the central ray be angled 5 degrees to 7 degrees cephalad for a lateral knee projection.
Because the medial condyle extends lower than the lateral condyle of the femur.
17. The slightly raised area located on the posterolateral aspect of the medial femoral condyle is called
18. What are the palpable bony landmarks found on the distal femur?
Medial epicondyle and lateral epicondyle
19. The general region of the posterior knee is called?
20.True or false. Flexion of 20 degrees of the knee forces the patella firmly against the patellar surface of the femur
21. True or False: The patella acts like a pivot to increase the leverage of a large muscle found in the anterior thigh.
22. True or False: The posterior surface of the patella is normally rough
23. For which large muscle does the patella serve as a pivot to increase the leverage
Quadriceps femoris muscle
24. Between the patella and distal femur is what joint
25. Between the two condyles of the femur and tibia is what joint
26. Four major ligaments of the knee
Fibular collateral, Tibial collateral, Anterior cruciate, posterior cruciate.
27. The crescent-shaped fibrocartilage disks that act as shock absorbers in the knee joint are called
medial and lateral menisci
28. Two bursa that are found in the knee joint
Suprapatellar and infrapatellar bursa
29. Match the following to the correct bone: tibial plafond
30. Match the following to the correct bone: medial malleolus
31. Match the following to the correct bone: lateral epicondyle
32. Match the following to the correct bone: Patellar surface
33. Match the following to the correct bone: articular facets
34. Match the following to the correct bone: fibular notch
35. Match the following to the correct bone: styloid process
36. Match the following to the correct bone: base
37. Match the following to the correct bone: Intercondyloid eminence
38. Match the following to the correct bone: Neck
39. Match the following articulations to the correct joint classification or movement type: Ankle Joint
40. Match the following articulations to the correct joint classification or movement type: Patellofemoral
41. Match the following articulations to the correct joint classification or movement type: Proximal tibiofibular
42. Match the following articulations to the correct joint classification or movement type: Knee joint
43. Match the following articulations to the correct joint classification or movement type: Distal tibiofibular
Amphiarthrodial (syndesmosis type)
44. True or false: The recommendation SID for lower limb radiography is 40 ich
45. True or false: Multiple images can be placed on the same IR when using analog imaging systems.
46. T or F: with careful and close collimation, gonadal shielding does not have to be used during lower limb radiography.
47. T or F: A kV range between 50 and 70 should be used for analog lower limb radiography.
48. T or F: A kV range for digital imaging is typically lower as compared with film-screen ranges.
49. Osgood-schlatter disease
An inflammatory condition involving the anterior, proximal tibia
50. Also known as osteitis deformans
51. Malignant tumor of the cartilage
52. Inherited type of arthritis that commonly affects males
53. Benign, neoplastic bone lesion caused by overproduction of bone at a joint
54. Benign bone lesion usually developing in teens or young adults
55. Most prevalent primary bone malignancy in pediatric patients
56. Benign, neoplastic bone lesion located between the base of the first and second metatarsal
Lisfranc joint injury
57. condition affecting the sacroiliac joints and lower limbs of young men, especially the posterosuperior margin of the calcaneus
58. Former name for runners knee
59. Another term for osteomalacia
60. Asymmetric erosion of joint spaces with a calcaneal erosion
61. Uric acid deposits in joint spaces
62. Well-circumscribed lucency
63. Small, round/oval density with lucent center
64. Narrowed, irregular joint surfaces with sclerotic articular surfaces
65. Fragmentation or detachment of the tibial tuberosity
66. Ill-defined area of bone destruction with surronding "onion peel"
67. Decreased bone density and bowing deformities of weight-bearing limbs
68. Which calcaneal structure should appear medially on a well-positioned plantodorsal axial projection?
69. Where is the central ray placed for a mediolateral projection of the calcaneus?
1 inch inferior to medial malleolus
70. Which joint surface of the ankle is not typically visualized with a correctly positioned AP projection of the ankle
lateral surface of the joint
71. Why should AP, 45 oblique, and lateral ankle radiographs include the proximal metatarsals
To demonstrate a possible fracture of the fifth metatarsal tuberosity (a common fracture site)
72. How much if any should the foot and ankle be rotated for an AP mortise projection of the ankle?
15 - 20 medially
73. Which projection of the ankle best demonstrates a possible fracture of the lateral malleolus
AP oblique with 45 medial rotation
74. With a true lateral projection of the ankle, the lateral malleolus is
projected over the posterior aspect of the distal tibia
75. Which projections of the ankle require forced inversion and eversion movements
AP stress projections
76. What is the basic positioning routine for a study of the tibia and fibula
AP and lateral
77. Why is it important to include the knee joint for an initial study of tibia trauma, even if the patient's symptoms involve the middle and distal aspect
A fracture may also be present at the proximal fibula in addition to distal
78. To include both joints for a lateral projection of the tibia and fibula for an adult, the technologist may place the cassette _____ in relation to the part.
79. What is the recommended central ray angulation for an AP projection of the knee for a patient with thick thighs and buttocks ( greater than 24 cm)
3 to 5 degrees caudad
80. Where is the central ray centered for an AP projection of the knee?
1/2 inch distal to apex of patella
81. Which basic projection of a knee best demonstrates the proximal fibula free of superimposition
AP oblique, 45 degrees medial rotation
82. For the AP oblique projection of the knee, the ____ rotation best visualizes the lateral condyle of the tibia and the head and neck of the fibula
83. What is the recommended central ray placement for a lateral knee position on a tall, slender male patient with a narrow pelvis (without support of the lower leg)
5 degree cephalad
84. How much flexion is recommended for a lateral projection of the knee
20 - 30 degrees
85. Which positioning error is present if the posterior portions of the femoral condyles are not superimposed on a radiograph of a lateral knee on a average patient
Improper angle of CR
86. Which positioning error is present if the posterior portion of the femoral condyles are not superimposed on a lateral knee radiograph
Over rotation (towards IR) or under rotation of knee (away from IR)
87. Which anatomic structures of the femur can be used to determine which rotation error (over rotated or under rotated) is present on a slightly rotated lateral knee radiograph?
Adductor tubercle on posterior lateral aspect of medial femoral condyle
88. Which special projection of the knee best evaluates the knee joint for cartilage degeneration or deformities?
AP or PA weight bearing knee
89. What is the best modality to examine ligament injuries to the knee
90. Which special projections of the knee best demonstrates the intercondylar fossa?
91. How much flexion of the lower leg is required for the PA axial projection (camp-Coventry method) when the central ray is angled 40 degrees caudad
40 degree flexion
92. Why is the PA axial projection for the intercondylar fossa recommended instead of an AP axial projection?
Distortion caused by central ray angle and increased OID for AP axial projection.
93. What type of CR angulation is required for the PA axial weight-bearing projection (Rosenberg method)
10 degrees caudad
94. How much flexion of the knees is required for the PA axial weight-bearing projection (Rosenberg method)
95. How much knee flexion is required for the PA axial projection (Holmblad method)
96. What type of CR angle is required for the PA axial (Holmblad method)
None. CR is perpendicular to IR
97. T or F: To place the interepicondylar line parallel to the IR for a PA projection of the patella, the lower limb must be rotated approximately 5 degrees internally.
98. How much part flexion is recommended for a lateral projection of the patella
99. How much central ray angle from the long axis of the femora is required for a tangential (merchant method) bilateral projection
30 degrees from horizontal
100. How much part flexion is required for the (Hughston method)
101. How much part flexion is required for the (Settegast method)
102. What type of CR angle is required for the superoinferior sitting tangential method for the patella?
None. CR is perpendicular to IR
103. Knee projection that can be performed using a wheelchair or lowered radiographic table
104. Knee projection with the patient prone; requires 90 knee flexion
105. Knee projection with patient prone with 40 to 50 degree knee flexion and with equal 40 to 50 degree caudad CR angle
Camp Coventry method
106. Knee projection when the IR is placed on a footstool to minimize OID
107. Knee projection with the patient prone with 55 degree knee flexion and 15 degree to 20 degree CR angle from long axis of lower leg.
108. Knee projection with patient supine with cassette resting on midthighs
Inferosuperior for patellofemoral joint
109. Knee projection with patient supine with 40 degree knee flexion and with 30 degree caudad CR angle from horizontal
110. Which of the following special projections of the knee must be performed erect.
111. How much knee flexion is required for the horizontal beam lateral patella projection
112. A lateral knee radiograph that is overrotated toward the image receptor can be recognized by what?
The fibular head will appear less superimposed by the tibia than a true lateral.
113.What CR angle should be used for a lateral projection of the knee on a short, wide-pelvis patient
7-10 degrees cephalad
114. Which special position of the knee requires that the patient be placed supine with 40° flexion of knee with CR angled 30 degrees from long axis of femur?
bilateral merchant method
115. The posterior visibility of the adductor tubercle on a lateral knee projection indicates:
underrotation of knee toward the IR.
116. Situation: A radiograph of a lateral projection of the patella reveals that the femoropatellar joint space is not open. The patella is within the intercondylar sulcus. The most likely cause of this is:
excessive flexion of knee
117. Situation: A radiograph of an AP knee reveals rotation with almost total superimposition of the fibular head and the proximal tibia. What must the technologist do to correct this positioning error on the repeat exposure?
rotate knee slightly medial
118. Situation: A radiograph of a PA axial projection for the intercondylar fossa does not demonstrate the fossa well. It is foreshortened. The following positioning factors were used: patient prone, knee flexed 40 to 45, CR angled to be perpendicular to the femur, 40-inch SID, and no rotation of the lower limb. Based on the factors used, what changes need to be made to produce a more diagnostic image?
CR must be perpendicular to lower leg
119. Situation: A radiograph of a AP mortise projection of the ankle reveals that the lateral malleolus is slightly superimposed over the talus and the lateral joint space is not open. What is most likely the cause for this radiographic outcome?
insufficient medial rotation of foot and ankle
120. Situation: A patient comes to radiology with a clinical history of osteoarthritis of both knees. The referring physician wants a projection to evaluate the damage to the articular facets. Which of the following projections will provide the best image of this region of the knee?
PA axial weight-bearing bilateral knee projection (Rosenberg method)
121. 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?
122. Situation: A patient comes to radiology with a history of chondromalacia of the patella. Her physician orders a projection of the patellofemoral joint space. Due to advanced emphysema, the patient cannot lie recumbent for this projection. Which of the following projections would be best for this patient?
Superoinferior sitting tangential method
123. For the AP weight-bearing knee projection on an average patient, the CR should be:
perpendicular to image receptor
124. Which of the following projections of the patella requires the patient to be placed in a prone position, a 45° flexion of the knee, and a 15° to 20° angle of the CR?
125. Which of the following knee projection requires the use of a special IR holding device?
bilateral merchant method