Ankle - Stress Projections

Radiographic Positioning

Adult

Other related pages of interest Applied Radiography Radiographic Anatomy Radiographic Protocols

Name of projection	Ankle - Stress Projections (Forced Inversion + Forced Eversion)
Area Covered	Ankle - distal third of the tibia and fibula, proximal half of the metatarsals, lateral and medial malleoli, talus
Pathology shown	Ankle joint for evaluation of joint separation and ligament tear or rupture under inversion and eversion stresses.
Radiographic Anatomy	Ankle Radiographic Anatomy
IR Size & Orientation	24cm x 30cm Landscape, divided in two usually fits two ankle projections, use lead masking for unused area
Film / Screen Combination	Detail (CR and DR as recommended by manufacturer)
Bucky / Grid	No
Filter	No
Exposure	60 kVp 3.2 mAs
FFD / SID	100cm
Central Ray	CR directed to the midpoint between the malleoli, in line with the medial malleolus (to show the tibiotalar joint space open) Perpendicular to the IR
Collimation	To lateral skin margins and to include the distal third of the tibia and fibula and proximal half of the metatarsals
Markers	Distal and lateral Marker orientation AP
Shielding	Gonadal (check your department's policy guidelines)
Respiration	Not applicable
Positioning	Patient's leg fully extended on the table Place IR under the ankle Place the lower leg in the AP position The foot is dorsiflexed so that the plantar surface is perpendicular to the table The lateral and medial malleoli will not be equidistant from the IR (the lateral malleoli will be closer to the IR) Centre to the midpoint between the malleoli Ankle is then manually stressed with both inversion and eversion stresses Lead protection (apron + gloves) is required for the individual applying the stress to the ankle
Critique PACEMAN	Positioning A true AP position is achieved with no rotation The appearance of the joint space may vary greatly depending on the severity of ligament damage Area Covered Distal third of the tibia and fibula, proximal half of the metatarsals, lateral and medial malleoli, talus, soft tissues Collimation Centre: The midpoint between the malleoli Shutter A: Open to include thelateral skin margins Shutter B: Open to include thedistal third of the tibia and fibula and the proximal half of the metatarsals Exposure Bony trabecular patterns and cortical outlines are sharply defined Soft tissues are visualised No motion artifacts
Special Notes