Hip Study

 AP Projection

1. Patient in supine position;
2. Medially rotation of the lower limb 15º.

Central ray perpendicular to the femoral neck.

Respiration: Suspended.

Evaluation Criteria:

• Visualization of the hip joint;
• Greater trochanter in profile;
• Visualization of one third of the proximal femur;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Lateral Projection

1.  Patient start in supine position;
2. Rotate slightly the patient from the affected side (30-45º);
3. Flex the affected knee 90º and the other lower limb it is in extension.

Central ray perpendicular to hip joint.

Respiration: Suspended.

 Evaluation Criteria:

• Visualization of one third of the proximal femur;
• Hip joint in the center of the image;
• Femoral neck is overlapped by the greater trochanter;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Femur Study

AP Projection

1. Patient in supine position;
2. Medial rotation of 15º.

Central ray perpendicular to the middle of the femur.

Note: To study the distal femur it is necessary to include the knee joint and in study of proximal femur it is necessary to include the hip joint.

Evaluation Criteria:

• In study of distal femur it is necessary to see no rotation in the knee joint;
• In study of the proximal femur it is necessary to see the lesser trochanter in medial border and greater trochanter in profile;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

                Proximal Fémur

                Distal Fémur

Lateral Projection

1.  Patient turn to the affected side;
2. For the study of distal femur flex the knee 30º;
3. For the study of the proximal femur it is necessary to flex the knee 45º and rotate 5º for the lateral position.

Central ray perpendicular to the middle of the femur.

Proximal Fémur

Distal Fémur

Evaluation Criteria:

• In study of distal femur:
• Patella in profile;
• Patellofemural joint open;
• In study of proximal femur:
• Greater and lesser trochanters not proeminent;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

                                                           Proximal Fémur

Distal Fémur

Patella Study

PA Projection

1. Patient in prone position;
2. Tip of the foot supported in the table (patella parallel with the plane of the IP).

Central ray perpendicular to the middle of the popliteal area.

Evaluation Criteria:

• Patella superimposed by the femur;
• No rotation;
• Visualization of the knee joint;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Lateral projection

1. Patient in the lateral recumbent position;
2. Flex the knee at 30º.

Central ray perpendicular to the middle of pattelofemoral joint.

Evaluation Criteria:

• Knee flexed 0º;
• Patellofemural joint open;
• Patella in profile;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Tangential Projection

1. Patient in supine position;
2. Flex the knee at 30º, 60º or 90º;
3. Ask to patient hold the IP.

Central ray angled 15º (knee flexed 30º), 20º (knee flexed 60º) or 25º (knee flexed 90º) cephalic and tangential to the patella.

Evaluation Criteria:

• Patella in profile;
• Patellofemural joint open;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Standing Knee Study

AP Projection

1. Patient in upright position;
2. Knees extended and the toes straight ahead.

Central ray horizontal and perpendicular to the center of IP, 2 cm below the apices of the patella.

Evaluation Criteria:

• Visualization of all the knees, from femoral distal to proximal tibia and fibula;
• No rotation of the knees: Femoral condyles equidistants;
• Fibular head and tibia slightly superimposed;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Lateral Projection

1. Patient in  upright position;
2. Turn to side of the study to the potter;
3. The other limb it is in forward, flexed and resting in a chair;
4. Rotation of the limb in study to the external, slightly, wich should be extended.

Central ray to the level of the apice of the patella, at the middle of the knee.

Knee Study

AP Projection

1. Patient in supine;
2. Leg in extension and in slightly medial rotation at 15º.

Central ray perpendicular to 2 cm below the apice of the patella.

Evaluation criteria:

• Visualization of the open femorotibial joints space;
• Tibia and fibula moderately overlapped in the proximal level;
• Patella completely superimposed on the femur;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Lateral Projection

1. Patient in supine;
2. turn toward the affected side until it is in lateral position;
3. flexion of the knee at 30º;

Central ray angle of  5-10º cephalic, to 2 cm posterior of the apice of the patella.

Evaluation Criteria:

• Femoral condyles superimposed;
• Open joint spaces between femoral condyles and tibia;
• Knee flexed;
• Patella in profile;
• Fibular head and tibia slightly superimposed;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Leg Study

AP Projection

1. Patient in supine;
2. Leg in extension ;
3. Dorsiflexion of the foot at 90º;
4. Medial rotation at 15º.

Central Ray perpendicular to the center of the leg.

Evaluation Criteria:

• Visualization of the ankle and the knee joints without rotation;
• Tibia and fibula moderately overlapped at the level of the proximal and the distal;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Lateral Projection

1. Patient in supine;
2. Turn toward the affected side with the leg until it is in lateral position;
3. Dorsiflexion of the foot at 90º;
4. Slight rotation such that the malleoli become superimposed.

Central ray perpendicular to the midpoint of the leg.

Evaluation Criteria:

• Visualization of the ankle and knee joints without rotation;
• Distal fibula lying over the posterior half of the tibia;
• Tibia and fibula moderately overlapped in the distal level;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Ankle Study

AP Projection

1. Patient in supine;
2. Lower limb extended;
3. Dorsiflexion of the foot at 90º;
4. Medial rotation at 15º.

Central ray perpendicular to the ankle joint at middle at the malleoli.

Evaluation Criteria:

• Visualization of the tibiotalar joint space;
• Talus slightly overlapped to the distal fibula;
• Visualization of the both malleolis;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Lateral Projection

1. Patient in supine and then turn toward to the affected side until it is in lateral position;
2. Dorsiflexion of the foot at 90º.

Central ray perpendicular to the medial malleolus.

Evaluation Criteria:

• Visualization of the both malleolus superimposed;
• Fibula overlapped to the posterior half of the tibia;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Subtalar Joint Study

AP Axial Oblique Projection

1. Patient in supine position;
2. Leg extended;
3. Dorsiflexion of the foot at 90º;
4. Ankle joint in flexion at 45º medially.

Central ray angled cephalic 10, 20, 30, 40º to the joint.

Evaluation Criteria:

• Visualization of the anterior and posterior portions of the posterior subtalar joint;
• Visualization of the distal ankle to calcaneus;
• Dorsiflexion of the foot at 90º;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

10º

20º

30º

40º

Calcaneus Study

Lateral Projection

1. Patient in supine;
2. Turn to the affected side until is in lateral side;
3. Foot in dorsiflexion at 90º.

Central ray perpendicular to the calcaneus.

Evaluation Criteria:

• No rotation of the calcaneus;
• Visualization of the sinus tarsi and sustentaculum tali;
• Dorsiflexion of the foot at 90º;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Axial Projection

1. Patient in supine and the leg extended;
2. Place a long gauze around the foot and make the patient hold it to make the right dorsiflexion.

Central ray angled 30-40º cephalic to the calcaneus.

Evaluation Criteria:

• Visualization of the calcaneus and subtalar joint;
• Sustentaculum tali in profile;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Standing foot study

AP Axial Projection

1. Patient in the standing-upright position over the IP with the feet centered on each side.

Central ray angled 10-15º cephalic at the level of the base of the first metatarsals.

 

Evaluation Criteria:

• Both feet centered on image;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Lateral Projection

1. Patient in the standing-upright position;
2. Place the IP between the foots;
3. Medial face of the foot against the sensitive part of the IP.

Central ray perpendicular and horizontal to the base of the fifth metatarsal.

Evaluation Criteria:

• Superimposed of the fibula and tibia;
• Overlapped of the metatarsal heads;
• Visualization of the entire foot and distal leg;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).