Radiographic Positioning Distal Feet (2023)

This article discusses radiographic positioning to show the tarsals and distal feet for the Radiologic Technologist (X-Ray Tech).

Foot AP Axial

Purpose and Structures Shown Localizing foreign bodies. Determining location of fragments in fractures of metatarsals and anterior tarsals. Talus, metatarsals, and phalanges.

Position of patient Supine position. Knee of affected side flexed, enough to rest sole of foot firmly on IR.

Position of part IR under patient’s foot flat centered on IR. Entire plantar surface rests on IR; take precautions against IR slipping. Ensure that no foot rotation occurs.
Central ray CR at base of third metatarsal and either 10 degrees toward heel to base of third metatarsal or Perpendicular to IR.

Radiographic Positioning Distal Feet (1)

Foot AP Axial (Weight-bearing method – Standing)

Radiographic Positioning Distal Feet (2)

Purpose and Structures Shown To get an accurate evaluation and comparison of tarsals and metatarsals. Both feet.

Position of patient Standing upright position.

Position of part IR on floor, patient standing on IR with feet centered on each side. Pull patient’s pants up, if necessary. Place right and left markers and upright marker on IR. Patient’s weight is distributed equally on each foot.

Central ray 10 degrees toward heel is optimal. Minimum of 15 degrees necessary to have enough room to position tube and allow patient to stand. CR pointing between feet and at level of base of third metatarsals.

Foot AP Axial (Weight-bearing Composite)

Radiographic Positioning Distal Feet (3)Radiographic Positioning Distal Feet (4)

Purpose and Structures Shown Full outline of foot, free of the leg. Bones of the foot.

(Video) Radiographic Positioning of the Toes, Foot and Ankle.

Position of patient Standing upright position. Patient should attempt carefully maintain position of affected foot, they may need something to lean on.

Position of part Affected foot on top of IR. Have patient place opposite foot one step backward for exposure of forefoot and one step forward for exposure of calcaneus to prevent superimposition of leg shadow.

Central ray For first exposure, tube 15 degrees caudal, CR at base of third metatarsal. For second exposure, anterior angulation of 25 degrees with CR at posterior surface of ankle so that CR emerges on plantar surface at level of lateral malleolus.

Foot AP Oblique (Medial Rotation)

Radiographic Positioning Distal Feet (5)

Purpose and Structures Shown To show interspaces between the following: cuboid and calcaneus; cuboid and fourth and fifth metatarsals; cuboid and lateral cuneiform; and talus and navicular bone. A greater rotation can be helpful in demonstrating joint spaces of the foot. Cuboid is shown in profile. Sinus tarsi is also well demonstrated.

Position of patient Supine. Knee of affected side flexed. Plantar surface of foot resting firmly on radiographic table.

Position of part Rotate leg medially until plantar surface of foot forms an angle of 30 degrees to plane of IR. If angle of foot is increased more than 30 degrees, lateral cuneiform tends to be thrown over other cuneiforms.

Central ray Perpendicular to IR at base of third metatarsal.

Radiographic Positioning Distal Feet (6)

Foot AP Oblique (Lateral Rotation)

Radiographic Positioning Distal Feet (7)

Purpose and Structures Shown Interspaces between first and second metatarsals, medial and intermediate cuneiforms. First and second metatarsals. Medial and intermediate cuneiforms.

Position of patient Supine. Flex knee of affected side enough for plantar surface to rest firmly on table.

(Video) RADS.110 General Anatomy and Radiographic Positioning Terminology

Position of part IR under patient’s foot, parallel with its long axis, and center it to midline of foot at level of base of third metatarsal. Rotate leg laterally until plantar surface of foot forms an angle of 30 degrees to IR. Support elevated side of foot on a 30 degrees foam wedge to ensure consistent results.

Central ray Perpendicular to IR at base of third metatarsal.

Foot PA Oblique Grashey Methods (Medial or Lateral Positions)

Radiographic Positioning Distal Feet (8)

Purpose and Structures Shown Foot interspaces of the proximal ends of the metatarsals.

Position of patient Prone position. Elevate affected foot on sandbags.

Position of part Adjust elevation of patient’s foot to place its dorsal surface in contact with IR. Position IR under foot, parallel with its long axis; center it to base of third metatarsal. Demonstration of interspaces between first and second metatarsals: rotate heel medially about 30 degrees. Demonstration of interspaces between second and third, third and fourth, and the fourth and fifth metatarsals: adjust foot so heel is rotated laterally about 20 degrees .

Central ray Perpendicular to IR at base of third metatarsal.

Foot PA Oblique (Medial Rotation)

Radiographic Positioning Distal Feet (9)

Purpose and Structures Shown Bones of the foot. Articulations between cuboid and adjacent bones (the calcaneus, lateral cuneiform, and fourth and fifth metatarsals). Articulations between talus and navicular bone; navicular bone and cuneiforms; and sustentaculum tali and talus. Cuboid is shown in profile.

Position of patient Lateral recumbent position on affected side. Fully extend leg. Turn patient toward prone position until plantar surface of foot forms an angle of 45 degrees to plane of IR. Flex knees.

Position of part Center IR opposite base of fifth metatarsal, midline should be parallel with long axis of foot. Rest dorsum of foot against a foam wedge. The general survey study – made with the foot at an angle of 45 degrees to obtain uniform results.

Central ray Perpendicular to IR at midline of foot at level of base of fifth metatarsal.

(Video) Lower Limb Positioning 1

Foot Lateral (Mediolateral)

Radiographic Positioning Distal Feet (10)

Purpose and Structures Shown To get clear image of entire foot, ankle joint, and distal ends of tibia and fibula. Entire foot in profile. Ankle joint. Distal ends of tibia and fibula.

Position of patient Lying on effected side.

Position of part Plantar surface of foot perpendicular to IR. Lateral side of foot flat on IR. Dorsiflex foot to form a 90-degree angle with lower leg.

Central ray Perpendicular to IR at the base of third metatarsal.

Radiographic Positioning Distal Feet (11)

Foot Lateral (Lateromedial)

Radiographic Positioning Distal Feet (12)

Purpose and Structures Shown To demonstrate foot, ankle joint, and distal ends of tibia and fibula.

Position of patient Patient lying on unaffected side.

Position of part Plantar surface of foot perpendicular to IR. Medial side of foot flat on IR. Dorsiflex foot to form a 90-degree angle with lower leg.

Central ray Perpendicular to IR at the base of third metatarsal.

Longitudinal Arch Lateral – Lateromedial (Weight-bearing Standing)

Radiographic Positioning Distal Feet (13)

(Video) Radiographic Positioning of Lower Leg and Knee (A)

Purpose and Structures Shown To show bones of foot with weight-bearing. Structural status of longitudinal arch. Right and left sides are often examined for comparison.

Position of patient Upright position on a low riser that has an IR groove or using a specialized device for foot x-ray. Patient should have something to help balance.

Position of part IR in the IR groove of stool or between blocks. Patient standing in a natural position, one foot on each side of IR, with weight of body equally distributed on both feet. Adjust IR so that it is centered to base of third metatarsal. After exposure, replace IR and position new one to image the opposite foot. If possible, place a lead shield behind cassette to shield foot from excess exposure.

Central ray Perpendicular to IR at a point just above base of third metatarsal.

Radiographic Positioning Distal Feet (14)

Video Credit : klhellens

Read more about this and other subjects and get 2 Category A ARRT CE Credits in the X-Ray CE Course “Radiography of the Leg, Knee, and Ankle”

Radiographic Positioning Distal Feet (15)

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(Video) Radiography Positioning Principles

Get more information about radiographic positioning here.

FAQs

What is the proper way of positioning a patient for radiography? ›

Position of patient Standing erect – left or right (usually left lateral is shown). The patient should be leaning slightly forward with the shoulder resting firmly against the grid. The hands should be locked behind the back to rotate the shoulders posteriorly or arms should be raised in front or above the head.

Which metatarsal should be centered to the base in an AP axial foot radiograph? ›

Center of four-sided collimation field (CR) should be at the base of the third metatarsal with collimation borders, including the soft tissue surrounding the foot. The MTP joints generally should appear open.

How should the foot be rotated for an oblique projection of the foot? ›

Patient position
  1. the patient may be supine or upright depending on comfort.
  2. the affected leg must be flexed enough that the plantar aspect of the foot is resting on the image receptor.
  3. the foot is medially rotated until the plantar surface sits at a 45° angle to the image receptor.
Sep 19, 2021

What is the proper method to orient an AP projection of the foot? ›

When performing the AP toe exam, the foot is placed in the lateral foot position and the toe will be in the AP position, this is the best way to reduce distortion. For the AP Knee, the patient is placed in the same position as they are for the AP Lower Leg Position.

What is the 15 rule in radiography? ›

The 15% Rule in x-ray radiography comes from the fact that (1.15)^5 ~2. This means that a 15% increase in the kVp will lead an exposure approximately 2 times higher at the image receptor (e.g. the detector or film).

What are the three basic rules of radiography? ›

ALARA means avoiding exposure to radiation that does not have a direct benefit to you, even if the dose is small. To do this, you can use three basic protective measures in radiation safety: time, distance, and shielding.

Where do you center for an AP foot? ›

Foot AP Oblique (Lateral Rotation)

Position of patient Supine. Flex knee of affected side enough for plantar surface to rest firmly on table. Position of part IR under patient's foot, parallel with its long axis, and center it to midline of foot at level of base of third metatarsal.

What is the angle for an AP foot xray? ›

Three separate images are usually taken to make sure they get all views. The technologist will take one image from the side, one image from the front and one image at a 45-degree angle between the front and side views. Let your technologist know if you're experiencing any pain.

Is the metatarsal head distal or proximal? ›

Structure. The five metatarsals are dorsal convex long bones consisting of a shaft or body, a base (proximally), and a head (distally).

Why are my feet rotated outwards? ›

Out-toeing, or being duck-footed, is a condition marked by feet that point outward instead of straight ahead. It's most common in toddlers and young children, who typically outgrow it by age 8. Adults can also become duck-footed as the result of a sedentary lifestyle, poor posture, injury, or other causes.

How should the foot be positioned to demonstrate the ankle mortise? ›

Aligning the 5th toe to the center of the calcaneus is a practical way to gauge optimal internal rotation needed to demonstrate the mortise joint. Another way to ensure correct positioning is by rotating the leg internally until the central line of the collimation field is in line with the 5th metatarsal.

What is external rotation of the foot? ›

Toe out is also popularly referred to as “Duck feet”, where the foot rotates out laterally upon landing. In other words, the foot is externally rotated during the stance phase of your running. Rotation angle of less than 10 degrees is quite common, and it is mostly harmless.

How many degrees should you rotate the leg and foot for AP of ankle? ›

Ankle AP Oblique Medial Rotation

Position of part Rotate leg and foot medially 30 degrees, use a foam wedge if needed. Place support under knee if needed. If patient is recumbent, place another under greater trochanter.

Why do we medially the rotate leg and feet 15 20 degrees for AP view of the pelvis? ›

The distance from tabletop to each anterior superior iliac spine (ASIS) should be equal. The feet are placed in approximately 15°-20° of internal (medial) rotation. This is done to overcome the normal anteversion of the femoral necks and to place their longitudinal axes parallel to the film.

How many degrees and in which direction should the foot and leg be rotated to best demonstrate the mortise joint for the AP oblique projection of the ankle? ›

At the medial malleolus. How many degrees and in which direction should the foot and leg be rotated for the best demonstration of the mortise joint for the AP oblique projection of the ankle? 15-20 degrees medially.

What is the 28 day rule in radiology? ›

If pregnancy cannot be excluded the 28 day rule applies

The vast majority of routine diagnostic examinations fall into the category of a low dose procedure. If pregnancy cannot be excluded but the menstrual period is not overdue according to the 28 day rule proceed with the examination.

What is the 10 day rule in radiology? ›

What is the 10-day rule? The 10-day rule was established by the International Commission on Radiological Protection to minimize the potential for performing x-ray exams on pregnant women. The basis of the rule was to do abdominal and pelvic x-ray exams only during the 10 days following the onset of menstruation.

What is the 2 kVp rule? ›

-2-kVp/cm: Increase/decrease kVp by 2 for every cm increase/decrease in part thickness. -15% rule. -doubling or halving mAs for every 5 cm of subject thickness. Explain how a variable kilovoltage system works. kVp is varied due to body part thickness, mAs is held constant.

What are the two rules of radiography? ›

These rules are:- 1- Two views: One view is too few; 2- Two joints: Above and below the injured bone; 3- Two sides: Compare with the other normal side; 4- Two abnormalities:Find a second abnormality; 5- Two occasions: Compare the current x-ray with a previous one (especially in CXR); 6- Two visits: Repeat after an ...

What are the 6 steps of manually processing a radiograph? ›

Drying and mounting of film.
  • i. Developing the film. • The exposed film is immersed in the developing solution until the image emerges. ...
  • ii. Rinsing in water. • ...
  • iii. Fixing of film. • ...
  • iv. Washing of film. • ...
  • v. Drying and mounting of film. •
Apr 11, 2016

What are the two types of radiography? ›

There are two kinds of radiography: Diagnostic radiography, which is the use of radiation to investigate a patient's illness or injury, and: Therapeutic radiography, which is the use of various kinds of radiation to treat an illness or injury.

How can you tell the difference between AP and PA view? ›

Key points
  1. Posterior-Anterior (PA) is the standard projection.
  2. PA projection is not always possible.
  3. Both PA and AP views are viewed as if looking at the patient from the front.
  4. PA views are of higher quality and more accurately assess heart size than AP images.

Where is the central ray directed for the AP foot? ›

Where is the central ray directed for the AP projection of the ankle? 15° to 20° until inermalleolar line is parallel to IR.

What is a normal foot progression angle? ›

The average foot progression angle increased with age to 7.3 degrees at age 16 (1 STD = 4.4 degrees). Univariate analysis of these data found that age, tibial alignment, arch index, and the ratio of body weight to body height significantly affected foot progression angle.

What is foot inclination angle? ›

The calcaneal inclination angle is the angle between the inferior surface of the calcaneus and the supporting surface [14] (Figure ​ 5). The calcaneal-first metatarsal angle is the angle formed by the inferior surface of the calcaneus and a line parallel to the dorsum of the mid-shaft of the first metatarsal.

What is metatarsal angle? ›

Metatarsal Break Angle (MBA) is the angle subtended by one line from the centre of the head of First Metatarsal to the centre of the head of the Second Metatarsal and another from the centre of the head of the Second Metatarsal to the centre of the head of Fifth Metatarsal.

Where is the distal part of the foot? ›

The distal phalanges (foot) are located at the end of each toe. Three phalangeal bones make up each digit, articulating with each other at bending joints. The distal phalanges come at the end, right below the toenail.

Are the feet distal to the head? ›

Inferior: below (ex: feet are inferior to the head). Cephalic: relative term meaning nearer to the head (ex: collar bone is cephalic to the sternum).

Is the Tarsals distal or proximal? ›

The tarsal bones (basipodium) compose the first row of the skeleton of the pes. The tarsal bones are arranged from proximal to distal into 3 rows: Proximal (crural) row: composed by tibial tarsal bone (talus) and fibular tarsal bone (calcaneus). It articulates with the tibia to form the tarsocrural joint.

Should feet be straight when walking? ›

Try to keep your legs in line with your hips and toes pointing forward, not inward (pigeon-toed) or outward (duck-toed). as if they were running. Even if it makes you feel self-conscious, this is the most efficient way to walk—especially at higher speeds.

How do you reverse foot pronation? ›

Toe raises
  1. Stand with both feet on the floor.
  2. Press the right big toe into the floor and lift the other toes of the right foot.
  3. Hold for 5 seconds.
  4. Next, press the four smaller toes into the floor and raise the big toe for 5 seconds.
  5. Repeat each exercise 5–10 times.
  6. Change and repeat with the other foot.
Feb 17, 2022

How do you fix pronation outwards? ›

The best ways to correct overpronation include:

Stretching every day. Wearing supportive shoes. Using orthotic inserts. Maintaining a healthy body weight.

How should the foot be positioned for an anteroposterior projection of the ankle? ›

Patient position
  1. the patient may be supine or sitting upright with their leg straighten on the table.
  2. the foot is in dorsiflexion.
  3. the toes will be pointing directly toward the ceiling.
Jan 13, 2023

What is the optimal ankle position? ›

Clinical relevance: This study has shown the ideal position of fusion of the ankle to be neutral flexion, slight (zero to 5 degrees) valgus angulation of the hind part of the foot, and 5 to 10 degrees of external rotation.

How many degrees should you rotate the foot internally for ankle mortise? ›

For the ankle mortise view, the long axis of the foot is internally rotated 15 to 20 degrees to have the intermalleolar line parallel to the tabletop. For the lateral ankle view, the patient is in a lateral recumbent position on the table with the foot dorsiflexed 90 degrees.

What are the 4 movements of the foot? ›

The movements that occur at the ankle joint are plantarflexion, dorsiflexion, inversion, and eversion. The muscles of the leg divide into anterior, posterior, and lateral compartments.

What is internal rotation of the foot? ›

What is in-toeing? In-toeing is when the feet turn inward instead of pointing straight ahead. In-toeing is most commonly linked to one of three factors: a bean-shaped foot (metatarsus adductus), an internal twist in the lower leg (internal tibial torsion), or an internal twist of the femur (femoral anteversion).

What is inversion and eversion of the foot? ›

eversion: Tilting of the foot so the sole faces away from the midline. inversion: Tilting of the foot so the sole faces into the midline. dorsiflexion: Movement of the foot upwards towards the lower leg.

Why is patient positioning important in radiography? ›

A good positioning technique is of great importance in radiology in order to obtain accurate diagnostic information and reduce the patient's X-ray exposure.

What are the 4 patient positions? ›

Patient Positions in Medical Bed
  • Supine position. In supine position, patient lies flat on back,legs may be extended or slightly bent with arms up or down. ...
  • Prone position. In prone position, patient lies on stomach with head turned to the side and the hips are not flexed. ...
  • Lateral position. ...
  • Sims position. ...
  • Fowler's position.
May 10, 2022

What are the principles of positioning the patient? ›

Patient positioning involves properly maintaining a patient's neutral body alignment by preventing hyperextension and extreme lateral rotation to prevent complications of immobility and injury. Positioning patients is an essential aspect of nursing practice and a responsibility of the registered nurse.

How should the patient be positioned when taking bitewing radiographs? ›

Seat the patient, in an upright position in the dental chair. Place the lead apron and thyroid collar on appropriately. Ensure that the patient's head is stabilized against the headrest and that their occlusal plane is parallel to the floor, in the closed position. Preparing the film/sensor.

What is the second rule of radiographic positioning? ›

Second rule of radiographic positioning: Number of projections. -Joint need 3 (AP/PA, lateral, oblique) -Long bones need 2 (AP/PA, lateral) Projection and Position can sometimes be used interchangeably.

What is Trendelenburg position used for? ›

The Trendelenburg position allows a surgeon greater access to pelvic organs, helpful for procedures like colorectal, gynecological, and genitourinary surgery. As with all surgical positions, risks must be assessed prior to positioning a patient in Trendelenburg position.

How do you know a patient needs help with positioning? ›

When is Positioning used?
  1. A patient has impaired mobility and / or sensibility.
  2. A patient has deformities, spasticity or pain.
  3. A patient has pressure ulcers or risks of pressure ulcers.
  4. A patient has cognitive impairment.
  5. A patient is restless or unstable.
  6. A patient receives hygiene or dressing procedures in bed.

What do the 4 P's stand for nursing? ›

Attention will be focused on the four P's: pain, peripheral IV, potty, and positioning. Rounds will also include an introduction of the nurse or PCT to the patient, as well as an environmental assessment.

What are the 4 P's in nursing care? ›

The four Ps (predictive, preventive, personalized, participative) [3] (Box 21.1) represent the cornerstones of a model of clinical medicine, which offers concrete opportunities to modify the healthcare paradigm [4].

What position requires the patient's head to be higher than their feet? ›

In the Trendelenburg position, the body is lain supine, or flat on the back on a 15–30 degree incline with the feet elevated above the head. The reverse Trendelenburg position, similarly, places the body supine on an incline but with the head now being elevated.

What are the 5 common positioning strategies? ›

What are the 5 common positioning strategies?
  • Customer service positioning strategy.
  • Convenience-based positioning strategy.
  • Price-based positioning strategy.
  • Quality-based positioning strategy.
  • Differentiation strategy.
Aug 25, 2021

What are the 3 positioning strategies? ›

There are three standard types of product positioning strategies brands should consider: comparative, differentiation, and segmentation. Through these strategies, brands can help their product stand out by targeting the right audiences with the best message.

What are the 7 positioning strategies? ›

The seven basic types of positioning strategies are:
  • Product characteristics or consumer benefits. In using this strategy for positioning, the focus is on quality. ...
  • Pricing. ...
  • Use or application. ...
  • Product process. ...
  • Product class. ...
  • Cultural symbols. ...
  • Competitors (relation to)
Feb 4, 2020

Which of the following is the preferred technique for most radiographs? ›

The paralleling technique is used for both periapical and bitewing radiographs and is the most accurate technique for taking these projections.

How do you not overlap on Bitewings? ›

Bitewing troubleshooting

Our primary goal is to have open contacts for these images, so proper positioning is critical. The central x-ray beam should be parallel to the interproximal spaces. This will eliminate the chances of overlap and ensure open contacts.

What is the difference between a bitewing and a periapical? ›

Bitewings are used to detect decay between teeth and changes in bone loss caused by periodontal (gum and bone) disease. Periapical (PA) Radiographs show the whole tooth from the crown to 2-‐3mm beyond the end of the root to where the tooth is surrounded by alveolar bone.

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