Sesamoids Study

Tangential Projection

1. Patient in prone position;
2. Rest the first toe in the IP of dorsiflexion.

Central ray perpendicular and tangential to the first metatarsophalangeal joint.

Evaluation Criteria:

• Sesamoids free of any portion of the first metatarsal;
• Good visualization of the metatarsal heads;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Foot Study

AP Projection

1. Patient in supine position;
2. Flex the knee with the sole of the foot firmly on the IP;
3. Toes on extension.

Central ray angled 10º toward to the base of the third metatarsal.

Evaluation Criteria:

• No rotation of the foot;
• Equal amount of space between the second and fourth metatarsals;
• Overlap of the second through fifth metatarsal bases;
• Base of the first and second metatarsal, medial and intermediate cuneiform free of superimposing;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

AP Oblique Projection

1. Patient in supine position;
2. Medial aspect of the foot on the IP at an angle of 30-45º with the same.

Central Ray perpendicular to the base of the third metatarsal.

Evaluation Criteria:

• Visualization of the sinus tarsi and tuberosity of the fifth metatarsals;
• Base of the first and second metatarsal, medial and intermediate cuneiform superimposed;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Study of the first toe

AP projection

1. The patient is seated or placed supine on the table;
2. Flex the knee;
3. sole of the foot in IP;
4. The contralateral limb in extension.

Central ray perpendicular through the first interphalangeal or metatarsophalangeal joint.

 

Evaluation Criteria:

• No rotation of the toe;
• Visualization of metatarsophalangeal joint;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

  

Lateral Projection

1.  The patient is seated or placed supine on the table;
2. Flex of the knee;
3. Support of the internal face of the first toe;

Central ray perpendicular through the first interphalangeal or metatarsophalangeal joint.

Evaluation Criteria:

• Phalange in profile;
• Without superimposition of adjacent toes;
• Open interphalangeal and metatarsophalangeal joints;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Toes (second to fifth) Study

AP Projection

1. The patient is seated or placed supine on the table;
2. Flex the knee;
3. sole of the foot in IP;
4. The contralateral limb in extension.

Central ray perpendicular through the third metatarsophalangeal joint.

Evaluation criteria:

• No rotation of phalanges;
• Toes separated from each other;
• Distal ends of the metatarsals;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

 

AP Oblique Projection

1. The patient is seated or placed supine on the table;
2. Flex the knee and rest the sole of the foot on the IP;
3. Medial rotation of the leg and the foot 45º.

Central ray perpendicular through the third metatarsophalangeal joint.

Evaluation Criteria:

• Visualization of all phalanges;
• Oblique toes and separate from each other;
• Open interphalangeal and second through fifth metatarsophalangeal joint  space;
• The first metatarsophalangeal joint isn’t always open;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

 

Chest

PA Projection

1. Patient in upright position;
2. Flexed of the arms with the back of the hands resting on the hips;
3. Extended the chin upward;
4. Adjust the shoulders in the same plane.

Central ray perpendicular at the lever T7.

Respiration: Full inspiration.

Evaluation Criteria:

• Visualization of the entire lungs, from the apices to the costophrenic angles;
• No rotation;
• Scapula projected outside the lung fields;
• Spine in the center of the image;
• Visualization of the first three dorsal vertebrae, and the others will be erasing progressively.

Lateral Projection

1. Patient in upright position;
2. Turn the patient to the lateral position;
3. Extended the upper limbs with the forearms above the head.

Central ray perpendicular on the midcoronal plane ate the level of T7.

Respiration: Full inspiration.

Evaluation Criteria:

• Superimposed of the ribs posterior in the spine;
• Sternum in profile without rotation;
• Visualization of the all lungs, from apices to costophrenic angles.