Podiatry X-ray Positioning

This page contains podiatry X-ray positioning ----------- work in progress --------------

Weight Bearing Dorsoplantar (DP) view Dorso-plantar projection or Anterior-Posterior (AP) weightbearing The patient stands erect on the cassette in the normal and base of gait Use a single 10x12 for both feet - two on one Central Ray Directed at base of 3rd metatarsal 20-25° posteriorly (towards the heel)-anything less will get tube pushing against pt. FFD 100 - 115 cm (40 inches) Bones visualised Phalanges, metatarsals, navicular, cuneiforms and cuboid Joints visualised Midtarsal Joint, Lisfranc Jointt, Metatarsal Phalageal Jointst, Interphalangeal Joints

Medial Oblique View The patient stands erect on the cassette in the normal and base of gait make sure pt is standing - foot of interest on a 10x12 and the other foot just next to it to evenly distribute weight. Central Ray Directed at base of the 3rd metatarsal Tube angled at 35 degrees FFD 100 - 115 cm (40 inches) Bones visualised Cuboid and navicular are clearly seen, but the cuneiforms are superimposed upon each other. All other bones distal to the midfoot are clearly visualised Joints visualised: Talonavicular, navicularcuneiform, cuboidnavicular, cuboid-lateral cuneiform, calcaneocuboid, Lisfranc's joint. All Metatarsal phalangeal Joints

Lateral Weightbearing View The patient stands on an Orthoposer box, that elevates the foot enough so that the X-ray beam can be angled 90° from vertical, and the central ray directed to the base of the metatarsals. The cassette is inserted into a slot in the orthoposer to hold it in position. - no devise like this one here, laterals shot medial-lateral instead, with cassette up against bucky. Central Ray Centered to the base of the metatarsals Perpendicular to IR FFD 100 - 115 cm (40 inches) Bones visualised talus, calcaneus, cuboid, navicular, medial cuneiform, 1st metatarsal. Joints visualised: Midtarsal Joint, Subtalar Joint, 1st metatarsal-cuneiform, navicular-1st cuneiform.

Axial calcaneal weightbearing Also known as Harris and Beath (Coalition View) The patient stands erect on the cassette in the normal and base of gait DR LATT - will order these, always do both heels. Have pt bend knee to get in almost a squat position-open up collimation you must see light over calf - this will give them the tib/fib shot they need to measure - ALSO CALLED ALIGNMENT VIEW. Central Ray Central beam angled 45 deg toward the midline of the heel FFD 100 - 115 cm (40 inches) Bones visualised Medial and Lateral malleoli, talus, calcaneus Joint visualised Subtalar Joint, ankle Joint

Axial calcaneal The patient lays supine on the X-ray table with the cassette under the heel, have pt pull back toes as much possible with a bandage strip - this will get the joint visualized. Central Ray Central beam angled 45 deg toward the midline of the heel FFD 100 - 115 cm (40 inches) Bones visualised Plantar-posterior aspect of the calcaneus Joints visualised No joints visualised

Axial sesamoid nonweightbearing Patient is positioned prone on the X-ray table with the cassette placed beneath the foot Central Ray Central ray aimed at the midline of the foot. FFD 100 - 115 cm (40 inches) Bones visualised Sesamoids and Sagittal plane relationship of metatarsal heads Joint visualised Sesamoid-1st metatarsal

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