All the following are posterior structures
the linea aspera
the popliteal surface
the intercondyloid fossa.
longest and strongest bone in body. femoral shaft is bowed slightly anteriorly. proximal end of femur consists of a head, which is received by the acetabulum of the pelvis. femoral head has a small notch, the fovea capitis femoris, for ligament attachment. femoral neck, joins the head and shaft, angles upward approx 120 degrees and forward (in anteversion) approx 15 degrees. The greater (lateral) and lesser (medial) trochanters are large processes on the posterior proximal femur. greater trochanter is a prominent positioning landmark that lies in the same transverse plane as public symphysis and coccyx. intertrochanteric crest runs obliquely between trochanters; intertrochanteric line runs anteriorly parallel to the crest. The femoral shaft presents a long, narrow ridge posteriorly called the linea aspera.
femur, distal portion
Its distal anterior portion presents the patellar surface—a triangular depression over which the patella glides during flexion. The distal posterior surface presents the popliteal surface—a depression that houses the popliteal artery. The medial and lateral femoral condyles are very prominent posterior structures, and between them is the deep intercondyloid fossa. Just above the condyles are the medial and lateral femoral epicondyles.
The ankle mortise, or ankle joint, is formed by
the articulation of the tibia, fibula, and talus. Two articulations form the ankle mortise, the talotibial and talofibular
AP projection of the knee with the knee extended.
The tibial intercondylar eminences are well demonstrated on the tibial plateau, and the femorotibial joint is well visualized. The intercondyloid fossa is not demonstrated here. A "tunnel" view of the knee is required to demonstrate the intercondyloid fossa.
Which of the following positions is used to demonstrate vertical patellar fractures and the patellofemoral articulation?
tangential ("sunrise") projection of the patella
the central ray is directed parallel to the longitudinal plane of the patella, thereby demonstrating a vertical fracture and providing the best view of the patellofemoral articulation
Which of the following can be used to demonstrate the intercondyloid fossa?
1. Patient PA, knee flexed 40°, central ray directed caudad 40° to the popliteal fossa
2. Patient AP, cassette under flexed knee, central ray directed cephalad to knee, perpendicular to tibia
PA axial (Camp-Coventry) projection
Patient PA, knee flexed 40°, central ray directed caudad 40° to the popliteal fossa
AP axial (Beclere) projection
Patient AP, cassette under flexed knee, central ray directed cephalad to knee, perpendicular to tibia
PA projection of the patella
Patient PA, patella parallel to IR, heel rotated 5° to 10° lateral, central ray perpendicular to knee joint
In the lateral projection of the foot, the
1. plantar surface should be perpendicular to the IR.
2. metatarsals are superimposed.
Which of the following projections of the calcaneus is obtained with the leg extended, the plantar surface of the foot vertical and perpendicular to the IR, and the central ray directed 40° caudad?
Axial dorsoplantar projection
done supine and requires cephalad angulation. The central ray enters the plantar surface and exits the dorsal surface.
Which of the following is (are) located on the posterior aspect of the femur?
1. Intercondyloid fossa
2. Intertrochanteric crest
In which of the following positions can the sesamoid bones of the foot be demonstrated free of superimposition with the metatarsals or phalanges?
The patient is best examined in the prone position, as this places the parts of interest closest to the IR. The affected foot is dorsiflexed so as to place its plantar surface 15° to 20° with the vertical. The CR is directed perpendicular to the posterior surface of the foot (near the metatarsophalangeal joints).
The dorsoplantar and oblique positions of the foot will demonstrate the sesamoid bones
superimposed on adjacent bony structures.
Which of the following bones participates in the formation of the knee joint?
(tibiofemoral joint) is the largest joint of the body, formed by the articulation of the femur, tibia, and patella.
the knee consists of three articulations:
the patellofemoral joint, the lateral tibiofemoral joint (lateral femoral condyle with tibial plateau), and the medial tibiofemoral joint (medial femoral condyle with tibial plateau)
Although the knee is classified as a
synovial (diarthrotic) hinge-type joint, the patellofemoral joint is actually a gliding joint, and the medial and lateral tibiofemoral joints are hinge-type.
Which of the following precaution(s) should be observed when radiographing a patient who has sustained a traumatic injury to the hip?
1. When a fracture is suspected, manipulation of the affected extremity should be performed by a physician.
2. To evaluate the entire region, the pelvis is typically included in the initial examination.
traumatic injury to the hip requires a
cross-table (axiolateral) lateral projection, as well as an AP projection of the entire pelvis. Both of these are performed using minimal manipulation of the affected extremity, reducing the possibility of further injury. A physician should perform any required manipulation of the traumatized hip.
The axiolateral, or horizontal beam, projection of the hip requires the cassette to be placed
1. in contact with the lateral surface of the body.
2. with top edge slightly above the iliac crest.
The cassette for a cross-table lateral projection of the hip is placed in a
vertical position. The top edge of the cassette should be placed directly above the iliac crest and adjacent to the lateral surface of the affected hip. The cassette is positioned parallel to the femoral neck; the central ray is perpendicular to the femoral neck and cassette.
The ankle mortise is formed by
the distal tibia and fibula and the talus. The distal tibia (the medial and larger bone) forms a club-shaped projection, the medial malleolus. The distal fibula's projection is the lateral malleolus. The distal articular surfaces of both the tibia and fibula articulate with the superior surface of the talus to form the ankle joint.
A 15° to 20° oblique is performed for the ankle mortise (joint) and would demonstrate
some superimposition of the distal tibia and fibula.
In the AP ankle
there is some superimposition of the fibula over the tibia and talus, thereby obscuring the medial aspect of the ankle mortise
Tangential axial projections of the patella can be obtained in which of the following positions?
1. supine flexion 45° (Merchant)
2. prone flexion 90° (Settegast)
3. prone flexion 55° (Hughston)
The tangential axial projections of the patella
are also often referred to as "sunrise" or "skyline" views.
The supine flexion 45° (Merchant) position requires
a special apparatus, and the patellae can be examined bilaterally. This position also requires patient comfort without muscle tension—muscle tension can cause a subluxed patella to be pulled into the intercondyler sulcus, giving the appearance of a normal patella.
The two prone positions differ according to
the degree of flexion employed. The 90° flexion (Settegast) position must not be employed with suspected patellar fracture
With the foot rotated medially
so that the plantar surface forms a 30° oblique with the image receptor, the sinus tarsi, the tuberosity of the fifth metatarsal, and several articulations should be demonstrated: the articulations between the talus and the navicular, between the calcaneus and the cuboid, between the cuboid and the bases of the fourth and fifth metarsals, and between the cuboid and the lateral (third) cuneiform.
In which of the following tangential axial projections of the patella is complete relaxation of the quadriceps femoris required for an accurate diagnosis?
Supine flexion 45° (Merchant)
in the lateral projection of the knee
the joint space is obscured by the magnified medial femoral condyle unless the central ray is angled 5° to 7° cephalad.
The degree of flexion of the knee is important when evaluating the knee for possible
transverse patellar fracture. In such a case, the knee should not be flexed more than 10°.
may be performed to demonstrate torn meniscus (cartilage), Baker's cyst, loose bodies, and ligament damage.
AP stress studies of the ankle may be performed
1. following inversion or eversion injuries.
2. to demonstrate a ligament tear.
After forceful eversion or inversion injuries of the ankle
AP stress studies are valuable to confirm the presence of a ligament tear. Keeping the ankle in an AP position, the physician guides the ankle into inversion and eversion maneuvers. Characteristic changes in the relationship of the talus, tibia, and fibula will indicate ligament injury. A fractured ankle would not be manipulated in this manner.
The relationship between the thigh, lower leg, patella, and central ray
should be noted. The central ray is directed parallel to the plane of the patella, thereby providing a tangential projection of the patella (patella in profile) and an unobstructed view of the patellofemoral articulation.
A "tunnel view" is required to demonstrate
the intercondyloid fossa and the articulating surfaces of the tibia and femur.
In the lateral projection of the knee, the central ray is angled 5° cephalad to prevent superimposition of which of the following structures on the joint space?
Medial femoral condyle
For the lateral projection of the knee,
the patient is turned onto the affected side. This places the lateral femoral condyle closest to the IR and the medial femoral condyle remote from the IR. Consequently, there is significant magnification of the medial femoral condyle and, unless the central ray is angled slightly cephalad, subsequent obliteration of the joint space.
Which of the following projections of the ankle would best demonstrate the distal tibiofibular joint?
Medial oblique 45°
To best demonstrate the distal tibiofibular articulation,
a 45° medial oblique projection of the ankle is required. Although the joint is well demonstrated in the 15° medial oblique, there is some superimposition of the distal tibia and fibula, and greater obliquity is required to separate the bones.
Which of the following are components of a trimalleolar fracture?
1. Fractured lateral malleolus
2. Fractured medial malleolus
3. Fractured posterior tibia
A trimalleolar fracture
involves three separate fractures. The lateral malleolus is fractured in the "typical" fashion, but the medial malleolus is fractured on both its medial and posterior aspects.
Arthritic changes in the knee
result in changes in the joint bony relationships. These bony relationships are best evaluated in the AP position. Narrowing of the joint spaces is readily detected more on AP weight-bearing projections than on recumbent projections.
In which of the following positions/projections will the talocalcaneal joint be visualized?
Plantodorsal projection of the os calcis
The talocalcaneal, or subtalar, joint
is a three-faceted articulation formed by the talus and the os calcis (calcaneus). The plantodorsal and dorsoplantar projections of the os calcis should exhibit sufficient density to visualize the talocalcaneal joint. This is the only "routine" projection that will demonstrate the talocalcaneal joint.
If evaluation of the talocalcaneal joint is desired,
special views (such as the Broden and Isherwood methods) are required.
The most superior aspect of the tibia is the
tibial plateau—formed by the tibial condyles just distal to it
The proximal tibia also presents the
tibial tuberosity on its anterior surface, just distal to the condyles.
The tarsals and metatarsals of the foot
are arranged so as to form two arches: the transverse and the longitudinal (which has two parts—lateral and medial). The arches function to support and distribute the body's weight over the body.
The ball of the foot usually accommodates
about 40 percent of the body's weight, and the heel about 60 percent.
In the AP projection of the ankle, the
1. plantar surface of the foot is vertical.
2. fibula projects more distally than the tibia.
To demonstrate the ankle joint space to best advantage,
the plantar surface of the foot should be vertical in the AP projection of the ankle. Note that the fibula is the more distal of the two long bones of the lower leg, and forms the lateral malleolus. The calcaneus is not well visualized in this projection because of superimposition with other tarsals.
In which projection of the foot are the sinus tarsi, cuboid, and tuberosity of the fifth metatarsal best demonstrated?
Medial oblique foot
To best demonstrate most of the tarsals
and intertarsal spaces (including the cuboid, sinus tarsi, and tuberosity of the fifth metatarsal), a medial oblique is required (plantar surface and IR form a 30° angle).
The lateral oblique demonstrates
the interspaces between the first and second metatarsals and between the first and second cuneiforms
Which of the following positions would best demonstrate the proximal tibiofibular articulation?
45° internal rotation
In the AP projection
the proximal fibula is at least partially superimposed on the lateral tibial condyle. Medial rotation of 45° will "open" the proximal tibiofibular articulation. Lateral rotation will obscure the articulation even more.
Which of the following is recommended to better demonstrate the tarsometatarsal joints in the dorsoplantar projection of the foot?
Angle the central ray 10° posteriorly
In the dorsoplantar projection of the foot,
the central ray may be directed perpendicularly or angled 10° posteriorly. Angulation serves to "open" the tarsometatarsal joints that are not well visualized on the dorsoplantar projection with perpendicular ray. Inversion and eversion of the foot do not affect the tarsometatarsal joints.
The proximal tibia has two condyles;
their superior surfaces are smooth, forming the tibial plateau.
following bony parts into order (A-D) from most proximal to most distal
(A) Fovea capitis
(B) Intertrochanteric crest
(C) Linea aspera
(D) Popliteal surface
An axiolateral inferosuperior projection of the femoral neck is particularly useful
1. when the axiolateral is contraindicated.
2. for patients with bilateral hip fractures.
3. for patients with limited movement of the unaffected leg.
traumatic injury to the hip requires
a cross-table (axiolateral) lateral projection. Occasionally, this projection may be contraindicated, for example, a patient with suspected bilateral hip fractures, or one who is unable to move the unaffected hip out of the way as required by the axiolateral. The patient is recumbent with lateral surface of affected side close to table/stretcher edge. The CR is directed almost horizontally to the affected femoral neck (inferosuperior), with a 15° posterior angulation. Correct placement and angulation of the grid cassette is essential to avoid grid cutoff.
axiolateral inferosuperior trauma projection (Clements-Nakayama method) can be employed when
a patient with suspected bilateral hip fractures, or one who is unable to move the unaffected hip out of the way as required by the axiolateral
The PA axial projection (Camp-Coventry method) of the intercondyloid fossa ("tunnel view")
The knee is flexed about 40°, and the central ray is directed caudally 40° and perpendicular to the tibia.
The patella and patellofemoral articulation are demonstrated in the
axial/tangential view of the patella.
The calcaneus (os calsis) serves as
the attachment for the Achilles tendon and articulates anteriorly with the cuboid bone
Articulating anteriorly with the navicular are
the three cuneiform bones: medial/first, intermediate/second, and lateral/third.
The fifth (most lateral) metatarsal projects laterally and presents a large tuberosity at its base making it very
susceptible to fracture.
In the lateral projection of the ankle, the
1. talotibial joint is visualized.
2. tibia and fibula are superimposed.
In the lateral projection of the ankle,
the tibia and fibula are superimposed and the foot is somewhat dorsiflexed to better demonstrate the talotibial joint. The talofibular joint is not visualized because of superimposition with other bony structures. It may be well visualized in the medial oblique projection of the ankle
Which of the following articulate(s) with the bases of the metatarsals?
1. The cuboid
2. The cuneiforms
The metatarsals and phalanges are miniature long bones; each has
a shaft, base (proximal), and head (distal).
Which of the following projections will best demonstrate the tarsal navicular free of superimposition?
AP oblique, medial rotation
The medial oblique projection
requires that the leg be rotated medially until the plantar surface of the foot forms a 30° angle with the cassette. This position demonstrates the navicular with minimal bony superimposition. The lateral oblique projection of the foot superimposes much of the navicular on the cuboid. The navicular is also superimposed on the cuboid in the lateral projections.
In the lateral projection of the knee, the
1. femoral condyles are superimposed.
2. patellofemoral joint is visualized.
3. knee is flexed about 20° to 30°.
To better visualize the joint space in the lateral projection of the knee,
20° to 30° flexion is recommended. The femoral condyles are superimposed so as to demonstrate the patellofemoral joint and the articulation between the femur and the tibia. The correct degree of forward or backward body rotation is responsible for visualization of the patellofemoral joint.
Cephalad tube angulation of 5° to 7° in the lateral knee is responsible for demonstrating
the articulation between the femur and the tibia (by removing the magnified medial femoral condyle from superimposition on the joint space).