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Medrad 1 (RADI1221) > DR Topic 4: Foot & Ankle imaging > Flashcards

DR Topic 4: Foot & Ankle imaging Flashcards

(56 cards)

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1
Q

Exposures and rationale for feet/toes

A

50kVp

  • High contrast image (large attenuation diff between adjacent anatomical structures
  • Low beam penetration as small/thin anatomical area

100mA

  • Require fine focus for image detail
  • Doesn’t need exceptionally short exposure time as minimal movement risk

0.04/0.02s

  • 4/2 mAs provides appropriate image density

No grid

  • Small anatomical area = minimal scatter radiation
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2
Q

Exposure and rationale for ankle/lateral foot

A

55kVp

  • High contrast image (large attenuation diff between adjacent anatomical structures
  • Low beam penetration as small/thin anatomical area

100mA

  • Require fine focus for image detail
  • Doesn’t need exceptionally short exposure time as minimal movement risk

0.05s

  • 5 mAs provides appropriate image density

No grid

  • Small anatomical area = minimal scatter radiation
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3
Q

Foot & Ankle projections

A
  • Dorsi-plantar (DP) foot
  • DP oblique foot
  • Lateral foot
  • Weight-bearing lateral foot
  • Toes
  • AP (Mortise) ankle
  • Lateral ankle
  • Oblique ankle
  • Lateral calcaneum
  • Axial calcaneum
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4
Q

DP foot imaging technique

A
  • Patient seated on table, plantar aspect of foot in contact with IR
  • Centre over base of 2nd metatarsal
  • Collimate all phalanges, metatarsals, tarsals, soft tissue
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5
Q

DP oblique foot imaging technique

A
  • From DP, internally rotate foot 30 degrees, pad placed under lateral aspect of foot
  • Centre over base of 3rd metatarsal
  • Collimate all phalanges, metatarsals, tarsals, soft tissue
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6
Q

Lateral foot imaging technique

A
  • Leg extended, externally rotate foot until lateral aspect of foot in contact with IR
  • Centre over navicular cuneiform region
  • Collimate all phalanges, metatarsals, tarsals, soft tissues
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7
Q

Weight-bearing lateral foot imaging technique

A
  • Patient stands on platform, IR in erect, landscape position in grove of platform
  • Centre over tubercle (head) of 5th metatarsal
  • Collimate all phalanges, metatarsals, tarsals, soft tissues
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8
Q

Toes imaging technique

A
  • Exact same as feet
  • Centre at metatarsophalangeal joint of toe under examination
  • Collimate to include distal half of metatarsal, all phalanges of affected toe
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9
Q

AP (Mortise) ankle imaging technique

A
  • Seated on table, legs extended, posterior aspect of lower leg in contact with IR, ankle joint flexed as near to 90 degrees as possible, internally rotate ankle to line up base of 5th toe vertically with centre of heel
  • Centre midway between the malleoli
  • Collimate lower third of tibia and fibula, ankle joint, lateral and medial malleoli, talus, soft tissue
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10
Q

Lateral ankle imaging technique

A
  • Roll on affected side, knee locked straight, foot dorsiflexed as close to 90 degrees as possible, wedge placed under lateral border of foot
  • Centre over medial malleolus
  • Collimate lower third of tibia and fibula, talus, calcaneum, navicular, soft tissue
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11
Q

Oblique ankle imaging technique

A
  • From AP, ankle rotated 30 degrees internally, pad used to support ankle
  • Centre midway between malleoli
  • Collimate medial and lateral malleoli, distal tibia and fibula, talus, soft tissue
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12
Q

Lateral calcaneum imaging technique

A
  • Position same as lateral ankle
  • Centre middle of calcaneum, below medial malleolus
  • Collimate calcaneum, ankle joint, navicular, soft tissue
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13
Q

Axial calcaneum imaging technique

A
  • Seated on table, legs extended, posterior aspect of heel on IR, foot dorsiflexed
  • Cranial angle of 40 degrees
  • Centre at point midway on plantar aspect of heel
  • Collimate calcaneum, talocalcaneal and cubocalcaneal joints, soft tissue
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14
Q

Foot & Ankle pathologies

A
  • Fractured toes
  • Avulsion/corner fracture
  • Gout
  • Hallux Valgus/Bunions
  • Lisfranc injury
  • Fractured metatarsals
  • Jones’ fracture
  • Fractured talus
  • Fractured calcaneum
  • Avulsion fracture distal fibula
  • Trimalleolar fracture
  • Potts’ fracture
  • Maisonneuve fracture
  • Pilon fracture
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15
Q

Fractured toes

A

Fracture in toes

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16
Q

Projections and rationale for fractured toes

A

DP foot

  • Assess fracture line, identify exact phalange/metatarsal involved

Oblique foot

  • Assess other fractures not visible

Lateral foot

  • Assess anterior posterior displacement
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17
Q

Radiographic appearance of fractured toes

A

Fracture line in toes, potential fragmentation

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17
Q

Avulsion/corner fracture

A

Tendon attached to bone pulls fragment off bone

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18
Q

Projections and rationale for avulsion/corner fracture

A

DP foot

  • See overall foot anatomy, assess where fragment has detached

Oblique foot

  • Show fractures not visible in other views

Lateral foot

  • Assess posterior/anterior displacement of fragment
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19
Q

Radiographic appearance of avulsion/corner fracture

A

Fragment pulled off corner of bone

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20
Q

Gout

A

Inflammatory arthritis

  • Build-up of urate crystals
  • Cause swelling and pain in metatarsophalangeal joints
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21
Q

Projections and rationale for gout

A

DP foot

  • See bone erosion, overall foot anatomy, swelling

Oblique foot

  • Extra view

Lateral foot

  • Assess posterior/anterior displacement of foot

Beam filtration

  • Used to address attenuation difference between foot and toe due to swelling
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22
Q

Radiographic appearance of gout

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A

Erosion, swelling of metatarsophalangeal joints

23
Q

Hallux Valgus/Bunions

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A

Deformity of the first metatarsophalangeal joint

24
Projections and rationale for Hallux Valgus/Bunions
Weight-bearing DP foot - Assess alignment of 1st metatarsophalangeal joint - WB to visualise abnormality, assess lateral displacement of toe Weight-bearing lateral foot - Visualise joint spaces under pressure
25
Radiographic appearance of Hallux Valgus/Bunions
Lateral deviation of big toe
26
Lisfranc injury
Injury in Lisfranc joint complex (between metatarsals and tarsals) - Fracture, ligament tear, dislocation
27
Projections and rationale for Lisfranc injury
DP foot - Overall view of foot, assess malalignment of Lisfranc joint complex Oblique foot - Better visualisation of 4th metatarsal base with cuboid, and medial aspect of navicular and medial cuneiform Weight-bearing lateral foot - Visualise foot under pressure, posterior displacement of proximal base of 1st and 2nd metatarsals
28
Radiographic appearance of Lisfranc injury
Fracture, potential fragmentation, dislocation, soft tissue swelling in Lisfranc complex
29
Fractured metatarsals
Fracture in metatarsals - Usually caused by direct impact
30
Projections and rationale for fractured metatarsals
DP foot - Visualise alignment of foot, alignment of metatarsals, fractures Oblique foot - Extra perspective of foot, visualise fractures that may not be visible in other views Lateral foot - Assess posterior/anterior displacement of fragment
31
Radiographic appearance of fractured metatarsals
Fracture lines, displacement of metatarsals, potential fragmentation, swelling
32
Jones' fracture
Fracture through base/neck of 5th metatarsal
33
Projections and rationale for Jones' fracture
DP foot - Assess fracture line in base of 5th metatarsal + overall view of foot Oblique foot - Better visualisation of shaft and base of 5th metatarsal Lateral foot - Assess posterior/anterior displacement of fragment
34
Radiographic appearance of Jones' fracture
Fracture line in shaft/neck/base of 5th metatarsal
35
Fractured talus
Fracture in talus bone - Most commonly fractured tarsal bone
36
Projections and rationale for fractured talus
DP foot - Assess fracture line, overall foot view, alignment Oblique foot - Extra view Lateral foot - Better visualisation of talus, view fracture, posterior/anterior displacement
37
Radiographic appearance of talus fracture
Fracture line through talus, potential fragmentation, malalignment
38
Fractured calcaneum
Fracture in calcaneum (heel)
39
Projections and rationale for fractured calcaneum
Lateral calcaneum - Assess fractures in heel, posterior/anterior displacement Axial calcaneum - Assess calcaneum from bottom, better visualise alignment of heel bone
40
Radiographic appearance of fractured calcaneum
Fracture through calcaneum, potential fragmentation
41
Avulsion fracture distal fibula
Stretch of tendon causing force down, pulling a fragment of bone off the distal fibula
42
Projections and rationale for avulsion fracture distal fibula
AP (Mortise) ankle - Assess distal fibula, inferior displacement of bone fragment, alignment of joint Lateral ankle - Assess posterior/anterior displacement of fragment, alignment of joint
43
Radiographic appearance of avulsion fracture distal fibula
Fragment of distal fibula pulled off corner
44
Trimalleolar fracture
Fracture through all malleoli - Lateral malleolus (fibula) - Medial malleolus (tibia) - Posterior malleolus (tibia)
45
Projections and rationale for trimalleolar fracture
AP (Mortise) ankle - Assess malalignment of joint, fracture lines, fragmentation of malleoli HB lateral ankle - Serious fracture, unlikely to move - Assess posterior/anterior displacement of fragments - Clear visualisation of posterior malleolus
46
Radiographic appearance of trimalleolar fracture
Fracture and potential fragmentation in all malleoli
47
Potts' fracture
Fracture of lateral and medial malleolus (no posterior malleolus)
48
Projections and rationale for Potts' fracture
AP (Mortise) ankle - Assess malalignment of joint, fracture lines, fragmentation of malleoli HB lateral ankle - Serious fracture, unlikely to move - Assess posterior/anterior displacement of fragments - Clear visualisation of posterior malleolus
49
Radiographic appearance of Potts' fracture
Fracture through lateral and medial malleolus, potential fragmentation
50
Maisonneuve fracture
Fracture of proximal fibula together with unstable ankle injury
51
Projections and rationale for Maisonneuve fracture
AP (Mortise) ankle - Assess fracture line in fibula - Visualise gap between medial malleolus and talus (widening of ankle joint space) HB lateral ankle - Serious fracture, unlikely to move - Assess posterior/anterior displacement of fragments
52
Radiographic appearance of Maisonneuve fracture
- Widening of ankle joint space - Fracture through proximal fibula
53
Pilon fracture
Fracture at distal tibia and potentially fibula - Usually occurs due to high impact force
54
Projections and rationale for pilon fracture
AP (Mortise) ankle - Assess fracture through tibia, malalignment, joint space HB lateral ankle - Serious fracture, unlikely to move - Assess posterior/anterior displacement of fragments
55
Radiographic appearance of pilon fracture
Fracture through tibia, potential fragmentation, reduced joint space

Medrad 1 (RADI1221) (16 decks)

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