Presentation on theme: "Chapter 18 Foot Radiography"— Presentation transcript:
1Chapter 18 Foot Radiography Fractures are characterized by involvement of the subtalar joint (75%) and not involving the subtalar joint.Stress fractures are common in runners but typically not seen on radiographs.Stress fractures , plantar fascitis or heel spurs are common repetitive use conditions.
2Foot or Heel Radiography Views of the foot and calcaneus are totally different.If a heel injury is suspected, take heel views and not foot views.A 30 degree medial oblique view can be useful. The oblique and lateral will demonstrate the subtalar joint.
3Foot RadiographyFoot view must include the tarsal bones, metatarsals and phalanges.A tube angle is used to open the tarsal bone articulations on the A-P view.If the patient is flat footed, no tube angle would be needed.
4Foot RadiographyThe medial oblique view is particularly useful. It provides:A clear view of the tarsal bone including the calcaneus.The 4th & 5th metatarsalsIntertarsal jointsDetail of the 5th metatarsal
5Foot RadiographyThe “basketball foot” is a traumatic medial subtalar dislocation resulting from landing on an inverted foot.The “Jones fracture is an avulsion fracture off the base of the 5th metatarsal.Stress fractures of the metatarsals are generally transverse resulting from marching or jumping.
6Toe Radiography Toe radiography can be particularly challenging. The natural curve of the toes toward the plantar surface of the foot results in foreshortening and closure of the interphalangeal joint spaces.Besides the A-P, an angled axial view is used to open the joint spaces.
718.4 Foot A-P Measure: A-P at base of third metatarsal Protection: ApronSID: 40” Table TopTube Angle: 10° cephaladFilm: 1/2 of 10” x 12 Extremity Cassette I.D. up
8Foot A-PPatient seated or lying on table with the long axis of the affected foot centered to table.Place cassette on table.Have patient place foot flat on cassette.Horizontal CR: base of third metatarsal
9Foot A-P Vertical CR: long axis of foot. Collimation Top to Bottom: distal tibia to tips of toes.Collimation Side to Side: soft tissue of footInstructions: Remain stillMake exposure and let patient relax
10Foot A-P FilmShould demonstrate toes , metatarsals and most of the tarsal bones. The talus and calcaneus will not be seen.The tube angle will help open the tarsal joint spaces.
1118.5Foot Oblique Measure: A-P at base of third metatarsal Protection: ApronSID: 40” Table TopNo Tube AngleFilm: 1/2 of 10” x 12 Extremity Cassette I.D. up
12Foot ObliquePatient seated or lying on table with the long axis of the affected foot centered to table.Place cassette on table.Have patient place foot flat on cassette.The foot is medially rotated 30 to 40°A sponge may be used under the plantar surface of the foot.
13Foot Oblique Horizontal CR: base of third metatarsal Vertical CR: long axis of foot.Collimation Top to Bottom: distal tibia to tips of toes.Collimation Side to Side: soft tissue of footInstructions: Remain stillMake exposure and let patient relax
14Foot Oblique FilmShould demonstrate toes , metatarsals and most of the tarsal bones. The talus and calcaneus will not be seen.The calcaneus will be well visualizedTarsal joint spaces should be open.
1518.6 Foot Lateral Measure: Lateral at base of first metatarsal Protection: Lead ApronSID: 40” Table TopNo Tube AngleFilm: 8” x 10” or 10” x 12” Extremity depending on foot size.
16Foot LateralPatient lies on the affected side with lower leg in lateral position.The foot should be dorsiflexed until the plantar surface is perpendicular to ankle.The plantar surface of foot is perpendicular to film.
17Foot LateralThe film may be turned diagonally or the foot placed diagonally on film to fit the entire foot on the film.Horizontal CR: base of 1st metatarsalVertical CR: base of first metatarsal
18Foot LateralCollimation Top to Bottom: to include ankle to plantar surface soft tissueCollimation Side to Side: to include from heel to tips of toes.Instructions: Remain stillMake exposure and let patient relax.
19Foot Lateral Film The foot and ankle should be in a lateral position. The metatarsals and toes will be superimposed.The distal fibula should overlie the distal tibia.The talotibial joint space should be open.
2018.7 Toes A-P & Axial A-PMeasure: A-P at 3rd metatarsal phalangeal joint or affected toeProtection: Lead ApronSID: 40” Table TopTube Angle A-P: noneTube Angle Axial A-P: 15° cephaladFilm: 1/4 of 10 x 12 Extremity
21Toes A-P & Axial A-P A-P : patient places foot flat on film. Horizontal & Vertical CR: 3rd M-P joint for all toes or M-P joint of the affected toe for individual toe series.A-P Axial tube angle: same as above but with 15° cephalad angle.
22Toes A-P & Axial A-PA-P Axial with Sponge: a 15° sponge is placed under toes instead of angling the tube. OrThe Sponge is placed under the cassetteHorizontal & Vertical CR: 3rd M-P joint for all toes or M-P joint of affected toe.
23Toes A-P & Axial A-PCollimation top to bottom: to include all M-P joints to tips of toes or M-P joint to tip of affected toe.Collimation Side to Side: soft tissue of foot or individual toe.Instructions: Remain StillExpose and let patient relax
24Toes A-P & Axial A-P Film A-P is upper right image.A-P Axial is upper left image. The phalangeal joints will be open on the axial view.Views must include all of the affected toe or toes.Note that collimation was too tight top to bottom.
2518.8 Toes Medial Oblique Measure: A-P at metatarsal-phalangeal joints Protection: ApronSID: 40” Table TopNo tube angleFilm: 1/4 of 10” x 12” or 8” x 10” Extremity Cassette
26Toes Medial ObliquePatient places distal foot on unexposed portion of cassette.Patient medially rotates lower leg until the plantar surface forms a 30 to 45° angle.Horizontal CR: 3rd MTP joint or the affected toe.
27Toes Medial ObliqueVertical CR: centered to long axis of foot or the affected toeCollimation top to bottom: Distal metatarsal to tips of toes or affected toeCollimation side to side: soft tissue of foot or affected toe.
28Toes Medial Oblique Patient instructions: Remain Still Make exposure and let patient relax.Note that a sponge may be placed under plantar surface of foot to control angle of view . It will also make it more comfortable for the patient.
29Toes Medial Oblique The joint spaces should be open. The distal metatarsal and tips of the toes should be visualized.
3018.8 Toes LateralMeasure: Lateral across the metatarsal-phalangeal joints For individual toe use A-P measurement.Protection: ApronSID: 40” Table TopNo tube angleFilm: 1/4 of 10” x 12” or 8” x 10” Extremity Cassette
311st Toe LateralPatient places distal foot on unexposed portion of cassette.For 1st through 3rd toesPatient medially rotates lower leg until the plantar surface forms a 90° angle.For 4th and 5th toesPatient laterally rotates foot until the plantar surface is perpendicular to film.
322nd Toe LateralFor individual toes, tape and tongue depressors are used to clear the other toes out of the view.Without the use of tape and tongue depressors, there will be too much superimposition
333rd Toe Lateral Horizontal CR: 3rd MTP joint or the affected toe. Vertical CR: centered to long axis of foot or the affected toeCollimation top to bottom: Distal metatarsal to tips of toes or affected toeCollimation side to side: soft tissue of foot or affected toe.
344th Toe Lateral Patient instructions: Remain Still Make exposure and let patient relax.Note that the lateral surface of the foot is next to the film.
355th Toe LateralNote that the lateral surface of the foot is next to the film.The toe need to remain parallel to the film.The 5th toe is the most challenging lateral toe view.
36Toes Lateral Film The joint spaces should be open. The distal metatarsal and tips of the toes should be visualized.The affected toe should be free of superimposition.
37Accessory TestingAccessories include the cassettes, grids outside the Bucky, Lead Aprons and gonadal protection.The cassettes and screens are the primary concern.Screens should be cleaned monthly with screen cleaner. Keeping the darkroom clean is also important for screen cleanliness.
3823.4 Screen Contact Testing Procedure:Clean screens and let them dry. Use screen cleaner design for the screen used.With a felt tip pen, write an identification number on the screen next to the I.D. and on the back of the cassette.Load cassettes.
39Screen Contact Testing Procedure:Set SID to 40” Table TopPlace cassette on table.Place wire mesh tool on cassette.Set collimation to film size.Make exposure and process film.
40Screen Contact Testing Procedure:Hang film on view box.Step back 72” from view box and view film.Areas of increased density or loss of resolution indicates poor contact or stained screens.
41Screen Contact Testing Procedure:The I.D. # will help you find a cassette that needs to be cleaned or taken from service.Frequency of tests: semiannual
42Poor Screen ContactThere is a loss of detail in the thoracic and lumbar spine due to poor screen contact.This was a new cassette.
43Poor Screen ContactNote the blurry image in the spine but sharp image of the ribs.The screens were not in proper contact in the middle of the cassette due to a bow in the cassette back.
44Screen Cleaning Materials needed: Screen Cleaner designed for type of screens used.4 x 4 gauze or cotton ballsTape & Pen
45Screen Cleaning Procedure: Unload cassette if contact is not being tested.Apply cleaner with gauze.Wipe excess off with dry gauze.
46Screen Cleaning Leave open to air dry. Make sure cassette # is still legible.After dry, reload cassette.
47Screen Cleaning Record date on tape and place on back of cassette. By having each cassette identified, selected cassette can be cleaned as needed.
48Screen CleaningCalifornia Department of Radiologic Health recommends cleaning screens monthly.Should definitely be done quarterly and sooner as needed when artifacts are identified on films.Never use alcohol or detergents not designed for cleaning screens.
49Cassette Care Methods to get the maximum life from cassettes: Avoid dropping the cassettesOpen only far enough the change filmsKeep outside of cassette clean and dry.Keep screens cleanStore on end.
50Dirty or Damaged Screens Dirty or damaged screen will cause white spots on the image.
51Dirty & Damaged Screens The white spots on this film are the result of damaged or worn out screens.Never use alcohol or detergents to clean screens.
52Speed Matching After looking for screen contact problems: Measure speed of cassettes by reading density with the Densitometer. The density of the exposed area should not vary more than ± 0.05 OD.As screen age, they loose speed.Always make sure the light spectrum of the screens and film are matched.
5323.5 Apron and Gonad Shield Testing Lead aprons and shields should be tested semiannually for defectsAprons with defective lead provide little protection for the patient.
54Apron and Gonad Shield Testing Tools needed:14” x 17” cassetteView BoxCoat Apron Procedure:Drape apron over BuckyPlace cassette in Bucky make exposures in upper and lower Bucky slots.
55Apron and Gonad Shield Testing Coat Apron Procedure:Note that this is the same test as used for grid alignment.Process filmsView films on view box:
56Apron and Gonad Shield Testing Half Apron and Small Shield Procedure:Place cassette on tableSet SID at 40”Place apron or shields on cassette.Make exposure and process the film.
57Apron and Gonad Shield Testing Viewing the test films:Note creases in the lead.Full holes will produce a black area on the film.If cracks or defects are in the area that should cover the gonads, replace apron.
58Care of Aprons Never fold aprons Store flat or hung on apron rack Use only aprons with the lead equivalency of 0.5mm for patient and staff protection.Do not use as lead blockers for extremity films.Protect from heat and direct sun light.
59Grid Uniformity Testing Procedure is the same as testing the Bucky Grid.Place homogenous phantom or lead apron over grid that is taped to the top of the cassette.Make exposure and look for density changes and grid damage.