LOWER EXTREMITIES

ANATOMY
 Bones of Foot

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 Joints of Foot

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 Sesamoid Bones
• Embedded in tendons
• Present near joints
• Plantar surface of foot

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 Tarsals
• Calcaneus
• Cuboid
• Cuneiforms (3)
• Navicular
• Talus

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 Calcaneus

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 Talus and Calcaneus

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 Navicular, Cuneiforms, and Cuboid

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 Arches of Foot
• Longitudinal arch
• Transverse arch

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Ankle Joint

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 Lateral Ankle Position

Distal fibula over posterior half of tibia on a true lateral

Posterior Anterior

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 Ankle Joint (Axial View)

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 Ankle

AP ankle projection AP mortise projection

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 Anatomy Review

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 Anatomy Review

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Anatomy Review

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Tibia and Fibula (Anterior View)
• Anterior crest
• Articular facets (tibial
plateau)
• Body of fibula
• Fibular notch (of tibia)
• Intercondylar eminence
(medial and distal
intercondylar tubercles)
• Lateral condyle
• Lateral malleolus
• Medial condyle
• Tibial tuberosity

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Tibia and Fibula (Lateral View)
• Articular facets (tibial
plateau) (10°-20°)
• Apex of styloid process
• Body (shaft) of fibula
• Body (shaft) of tibia
• Fibular head
• Lateral malleolus
• Medial malleolus
• Fibular neck
• Tibial tuberosity

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 Femur (Anterior View)
• Longest and
strongest bone
• Patella ½ inch (1.25
cm) above joint

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 Femur (Posterior View)
• Note 5°-7° angle as
shown at distal medial
and lateral condyles

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 Distal Femur and Patella

Lateral view Inferior view

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 Patella

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 Knee Joint (Oblique View)
• Femorotibial and
patellofemoral joints
• Four major ligaments:
– Posterior cruciate
– Anterior cruciate
– Fibular collateral
– Tibial collateral

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 Knee Joint (Anterior View)

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Menisci (Superior and Sagittal Views)

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 Articular Capsule

Knee arthrogram

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Anatomy Review

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Anatomy Review

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Anatomy Review

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 Joints of Lower Limb

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 Surfaces of Foot
• Dorsiflexion
• Plantar flexion
• Inversion (varus)
• Eversion (valgus)

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 Motions of Foot and Ankle

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PATHOLOGY
1.) Congenital Clubfoot
• Talipes equinovarus
• Abnormal twisting of the foot usually inward & downward
2.) Pott’s Fx
• Avulsion fx of the medial malleolus with loss of the ankle mortise
3.) Jones Fx
• Avulsion fx of the base of the fifth metatarsal
4.) Gout
• Hereditary form of arthritis in which uric acid is deposited in joints
5.) Osgood-Schlatter Disease
• Incomplete separation or avulsion of the tibial tuberosity
6.) Giant Cell Tumor
• Osteoclastoma
• Lucent lesion in the metaphysic usually at the distal femur
7.) Chondromalacia Patellae
• Runner’s knee
• Softening of the cartilage under the patella
8.) Joint Effusion
• Accumulation of fluid in the joint cavity
9.) Lisfranc Injury
• Abnormal separation in the base of 1st & 2nd metatarsal & cuneiform
10.) Reiter Syndrome
• Erosions of sacroiliac joints & lower limbs
11.) Hallux Valgus
• Congenital abnormality of hallux
• Lateral deviation of great toe

ROUTINE
1.) Bony Injuries – AP, APO & Lateral
2.) Bony Pathology – AP & APO
3.) Foreign Body Localization – AP & Lateral

DIVISIONS OF FOOT
1.) Hindfoot – calcaneus & talus
2.) Midfoot – cuboid, navicular & cuneiform
3.) Forefoot – metatarsals & phalanges
RADIOGRAPHIC
POSITIONING
TOES
 AP/AP AXIAL PROJECTION
PP: Supine/Seated; knee
flexed; 15o foam wedge
under foot
RP: 3rd MTP joint
CR: ┴ (15o foam wedge) or
15o posteriorly
SS: Phalanges & distal
portion of metatarsals
AP Axial (15o): Open IP
joints & reduces
foreshortening
AP/AP AXIAL PROJECTION
AP/AP AXIAL PROJECTION
 PA PROJECTION

PP: Prone (IP joints // to

CR); dorsal aspect against
IR
RP: 3rd MTP joint
CR: ┴
SS: MTP & IP joint spaces
are well visualized
• The x-ray beam
coincides closely with
the position of the toes
 AP OBLIQUE PROJECTION
Medial Rotation
PP: Supine/seated; knee
flexed; plantar surface 30-
45o from IR (lower leg &
foot rotated medially )
RP: 3rd MTP joint
CR: ┴
SS: 2nd-5th MTP joint
spaces; 1st-3rd toes
• 1st MTP joint (not always
open)
 AP OBLIQUE PROJECTION

Lateral Rotation
PP: Supine/seated; knee
flexed; plantar surface 30- JUST REVERSE THE
45o from IR (lower leg & PREVIOUS POSITION
foot rotated laterally) 
RP: 3rd MTP joint
CR: ┴
SS: 3rd-5th toes; MTP joints
overlapped
 PA OBLIQUE PROJECTION
Medial Rotation
PP: Lateral recumbent
(affected side down);
affected limb partially
extended; ball of foot 30o to
horizontal
RP: 3rd MTP joint
CR: ┴
SS: 2nd-5th MTP joint spaces;
1st-3rd toes
• 1st MTP joint (not always
open)
 LATERAL PROJECTION
Mediolateral/Lateromedial
Projection
PP: Lateral recumbent
(unaffected side down); toe in
true lateral; use 4x4 gauze pad or
tape (to separate the toes)
RP: IP joint (1st toe); proximal IP
joint (2nd-4th toes)
CR: ┴
SS: Phalanges in profile; open IP
joints spaces
• Lateromedial: 1st-2nd toes
• Mediolateral: 3rd-5th toes
LATERAL PROJECTION
LATERAL PROJECTION
LATERAL PROJECTION
SESAMOIDS
 LEWIS METHOD
(TANGENTIAL PROJECTION)

PP: Prone; dorsiflex great

toe; ankle elevated; ball of
foot ┴ to IR
RP: 1st MTP joint
CR: Perpendicular
SS: MT head & sesamoids
in profile
 HOLLY METHOD
(TANGENTIAL PROJECTION)

PP: Seated (more

comfortable); plantar
surface 75o to IR; toe
flexed & hold w/ strip
gauze bandage; medial
border of foot ┴ to IR
RP: 1st MTP head
CR: ┴
SS: MT head & sesamoids
in profile
 CAUSTON METHOD
(TANGENTIAL PROJECTION)

PP: Lateral recumbent

(unaffected side down);
knees flexed; limb partially
extended; foot in lateral
position; 1st MTP joint ┴ to
IR
RP: Prominence of 1st MTP
joint
CR: 40o toward the heel
SS: Sesamoids projection
axiolaterally with slight
overlap
FOOT
 AP/AP AXIAL PROJECTION

PP: Supine; knee flexed;

plantar surface against IR
RP: 3rd MTP base
CR: ┴ or 10o posteriorly
SS: MT & Tarsal (┴); TMT
joint (10o)
 AP/AP AXIAL PROJECTION

ER:
• For localizing foreign
bodies
• Location of fragments in
fx of metatarsals &
anterior tarsals
• General surveys of
bones of the foot
10o Angulation: reduces
foreshortening of
metatarsals
 AP OBLIQUE PROJECTION

Medial Rotation
PP: Supine; knee flexed; leg
rotated medially; plantar surface
of foot 30o to IR
RP: 3rd MTP base
CR: ┴
SS:
• Cuboid in profile
• Sinus tarsi (well demonstrated)
• Interspaces b/n:
– cuboid & calcaneus;
– cuboid & 4th & 5th MT
– Talus & navicular bone
 AP OBLIQUE PROJECTION

Lateral Rotation
PP: Supine; knee flexed; leg
rotated laterally; plantar surface
of foot 30o to IR
RP: 3rd MTP base
CR: ┴
SS:
• Navicular in profile
• Interspaces b/n:
– 1st & 2nd MT
– Medial & intermediate
cuneiforms
• Separates 1st-2nd MT bases
 LATERAL PROJECTION

Mediolateral Projection
(more comfortable for patient)

PP: Dorsiflex foot (┴ to lower

leg); leg & foot in lateral
position; lateral side of foot
against IR;
RP: 3rd MT base
CR: Perpendicular
SS: Entire foot in profile
ER:
• For localizing foreign body
• Degree of anterior &
posterior displacement of fx
 LATERAL PROJECTION

Lateromedial Projection
(more difficult to assume)

PP: LPO/RPO (affected side

up); medial surface against
IR; plantar surface of foot ┴
to IR
RP: 3rd MTP base
CR: Perpendicular
SS: True lateral projection of
foot
• MT more superimposed
than mediolateral
 GRASHEY METHOD
(PA OBLIQUE PROJECTION)
Medial and Lateral
Rotation
PP: Prone; foot elevated;
dorsal surface against IR;
heel rotated medially 30o;
heel rotated laterally 20
RP: 3rd MTP base
CR: Perpendicular
 GRASHEY METHOD
(PA OBLIQUE PROJECTION)
SS: Interspaces at the
proximal ends of
metatarsal
• 1st and 2nd MT (30o
medially)
• Interspaces b/n 2nd-3rd,
3rd-4th & 4th-5th MT (20o
laterally)
 GRASHEY METHOD
(PA OBLIQUE PROJECTION)
 WEIGHT-BEARING METHOD
(LATERAL PROJECTION)

Longitudinal Arch
PP: Upright (natural
position); feet elevated
(use blocks); IR b/n feet;
weight equally distributed
on each foot
RP: Point above 3rd MTP
base
CR: Horizontal
 WEIGHT-BEARING METHOD
(LATERAL PROJECTION)

SS: Structural status of

longitudinal arch (pes
planus); Bohler’s critical
angle (b/n 20-40o);
calcaneal fracture (<20o)
Bohler’s Critical Angle:
angle b/n superior apex of
mid-calcaneus to anterior
process of calcaneus
 WEIGHT-BEARING METHOD
(AP AXIAL PROJECTION)

PP: Upright; both feet

against IR; weight equally
distributed on each foot
RP: b/n feet at 3rd MT base
level
CR: 10o or 15o posteriorly
SS: Accurate evaluation &
comparison of MT &
tarsals
• Hallux valgus & lishfranc
injury
 WEIGHT-BEARING COMPOSITE METHOD

AP AXIAL PROJECTION
PP: Upright; 2 exposures
• First Exposure:
unaffected foot step
backward (to prevent
superimposition of leg
shadow on ankle joint)
tube in front
– For exposure of forefoot
(phalanges & MT)
 WEIGHT-BEARING COMPOSITE METHOD

Second Exposure:
unaffected foot step
forward; tube behind;
exposure factor increase
(increase CR angulation &
thickness of part)
– For hindfoot (talus &
calcaneus)
 WEIGHT-BEARING COMPOSITE METHOD

RP: 3rd MTP base (1st

exposure); level of lateral
malleolus (2nd exposure)
CR: 15o posteriorly (1st
exposure); 25o anteriorly
(2nd exposure)
SS: Full outline of the foot
free of the leg
CONGENITAL
CLUBFOOT
 CONGENITAL CLUBFOOT
TALIPES EQUINOVARUS
• 3 DEVIATIONS:
– PLANTAR FLEXION &INVERSION OF CALCANEUS (EQUINUS)
– MEDIAL DISPLACEMENT OF THE FOREFOOT (ADDUCTION)
– ELEVATION OF THE MEDIAL BORDER OF THE FOOT
(SUPINATION)

PRIMARY OBJECTIVE: No attempt be made to change the abnormal

alignment of the foot when placing it on the IR
Rationale: even slight rotation of the foot can result in marked alteration
in the radiographically projected relation of the ossification centers
 KITE METHOD
(AP PROJECTION)

PP: Supine; hips & knees

flexed; foot flat on IR;
ankles slightly extended;
legs are vertical
RP: Tarsals
CR: 15o posteriorly
 KITE METHOD
(AP PROJECTION)

SS:
• Degree of forefoot
adduction & calcaneus
inversion (equinus)
• 15o Angulation: places
CR ┴ to tarsals
• Importance of ┴ CR: to
project the true
relationship of the bones
and ossification centers
 KITE METHOD
(LATERAL PROJECTION)

Mediolateral
PP: Lateral recumbent;
uppermost limb flexed &
draw forward
RP: Midtarsal area
CR: Perpendicular
 KITE METHOD
(LATERAL PROJECTION)

SS:
• Anterior talar
subluxation
• Degree of plantar
flexion (equinus)
 KANDEL METHOD
(DORSOPLANTAR AXIAL PROJECTION)

PP: Bending forward

position; plantar surface
against IR
RP: Lower leg
CR: 40o anteriorly
 KANDEL METHOD
(DORSOPLANTAR AXIAL PROJECTION)

SS: Suroplantar projection

of congenital clubfoot
(same as taking calcaneus)
• Freiberger-Hersh-
Harrison: CR 35o, 45o &
55o for demonstration of
sustentaculum talar
joint fusion
CALCANEUS
 Calcaneus

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 Talus and Calcaneus

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 AXIAL PROJECTION

Plantodorsal Projection
PP: Supine/Seated; leg
fully extended; dorsiflex
foot w/ strip of gauze; foot
┴ to IR
RP: 3rd MT base
CR: 40o cephalad to long
axis of foot
SS: Calcaneus & subtalar
joint
 AXIAL PROJECTION

Dorsoplantar Projection
PP: Prone; ankle elevated;
dorsiflex ankle; foot ┴ to
IR; IR vertical
RP: Dorsal surface of ankle
joint
CR: 40o caudad
SS: Calcaneus, subtalar
joint & sustentaculum tali
CT is usually used to demonstrate
calcaneus
 LILIENFELD METHOD
(DORSOPLANTAR AXIAL PROJECTION)

WEIGHT-BEARING
COALITION POSITION
PP: Upright; posterior
surface of heel at edge of
IR; unaffected foot one
step forward (to prevent
superimposition of leg
shadow)
RP: Level of 5th MT base
CR: 45o anteriorly
SS: Calcaneotalar coalition
 LATERAL PROJECTION

Mediolateral Projection
PP: Supine; patient turn
toward affected side;
plantar surface // to IR
RP: 1 in distal to medial
malleolus (at subtalar
joint)
CR: ┴
SS: Calcaneus & ankle
joint; sinus tarsi
 WEIGHT BEARING METHOD

LATEROMEDIAL OBLIQUE
PROJECTION
PP: Upright; leg
perpendicular to IR;
calcaneus center to IR
RP: Lateral malleolus
CR: 45o caudad (medially)
 WEIGHT BEARING METHOD

SS: Calcaneal tuberosity

ER: Useful in diagnosing
stress fractures of
calcaneus or tuberosity
SUBTALAR JOINT
 PA AXIAL OBLIQUE PROJECTION)

Lateral Rotation
PP: Lateral position;
patient lie on affected side
in; heel elevated 1.5 in.
(3.8 cm) from exact lateral
position; ball of foot
(metatarsophalangeal
area) angled 25o forward
RP: Ankle joint
 PA AXIAL OBLIQUE PROJECTION)

RP: Ankle joint

CR: 5o anterior & 23o
caudad
SS: Middle and posterior
articulation
 BRODEN METHOD
(AP AXIAL OBLIQUE PROJECTION)
Medial Rotation
PP: Supine; leg & foot rotated
45o medially; dorsiflex foot (to
obtain right angle flexion); foot
rested against 45o foam wedge;
RP: 2-3 cm caudoanteriorly to
lateral malleolus
CR: 10o, 20o, 30oor 40o cephalad
SS: Posterior articulation
• Anterior portion (40o)
• Posterior portion (10o)
• Talus & sustentaculum tali
articulation (20-30o)
 BRODEN METHOD
(AP AXIAL OBLIQUE PROJECTION)

Lateral Rotation
PP: Supine; leg & foot
rotated 45o laterally;
dorsiflex foot; foot rested
against 45o foam wedge
RP: 2 cm distal & 2 cm
anterior to medial
malleolus
CR: 15o cephalad
 BRODEN METHOD
(AP AXIAL OBLIQUE PROJECTION)

SS: Posterior articulation

ER: To determine the
presence of joint
involvement in cases of
comminuted fx
 ISHERWOOD METHOD
(FEIST-MANKIN METHOD)
(LATEROMEDIAL OBLIQUE PROJECTION)

Medial Rotation Foot

PP: Semisupine; foot & leg
rotated 45o medially; knee
flexed; 45o foam wedge
under elevated leg
RP: 1 in. distal & 1 in.
anterior to lateral malleolus
CR: ┴
SS: Anterior subtalar articular
surface
• Oblique projection of
tarsals
 ISHERWOOD METHOD
(FEIST-MANKIN METHOD)
(AP AXIAL OBLIQUE PROJECTION)

Medial Rotation Ankle

PP: Seated or semi-lateral
recumbent (more
comfortable); leg, foot & ankle
rotated 30o medially; dorsiflex
foot; 30o foam wedge
RP: 1 in. distal & 1 in. anterior
to lateral malleolus
CR: 10o cephalad
SS: Middle subtalar articular
surface & “end on” projection
of sinus tarsi
 ISHERWOOD METHOD
(FEIST-MANKIN METHOD)
(AP AXIAL OBLIQUE PROJECTION)

Lateral Rotation Ankle

PP: Supine/seated; leg,
foot & ankle rotated 30o
laterally; dorsiflex foot
RP: 1 in. distal medial
malleolus
CR: 10o cephalad
SS: Posterior subtalar
articular surface
ANKLE
 AP PROJECTION
PP: Supine; leg & foot
vertical & rotated 5o medially
(places malleoli equidistant)
RP: Point midway between
malleoli
CR: ┴ to ankle joint
SS: Ankle joint & tibiotalar
joint space
• True AP: inferior
tibiofibular & talofibular
articulations not in profile
(normal)
 LATERAL PROJECTION
Mediolateral Projection
PP: Semisupine; lateral surface
of foot against IR; dorsiflex foot
(prevent lateral rotation of the
ankle)
RP: Medial malleolus
CR: ┴ to ankle joint
SS: True lateral projection of
lower third of tibia & fibula,
ankle joint & tarsals
• 5th metatarsal base (identify
Jones fx)
• Tibiotalar joints (well
 LATERAL PROJECTION
Lateromedial Projection
PP: Semisupine; medial
surface of foot against IR;
dorsiflex foot
RP: 0.5 in. superior to lateral
malleolus
CR: ┴ to ankle joint
SS: Lateral projection of
lower third of tibia & fibula,
ankle joint & tarsals
Exact positioning of ankle is more
easily & more consistently obtained
 AP OBLIQUE PROJECTION
Medial Rotation
PP: Supine; leg & foot
rotated 45o laterally;
dorsiflex foot
RP: Point midway b/n
malleoli
CR: ┴ to ankle joint
SS: Distal ends of tibia &
fibula (often
superimposed over talus)
• tibiofibular articulation
 AP OBLIQUE PROJECTION
Lateral Rotation
PP: Supine; leg & foot
rotated 45o laterally;
dorsiflex foot
RP: Point midway b/n
malleoli
CR: ┴ to ankle joint
SS: Superior aspect of
calcaneus; subtalar joint
ER: Useful in determining
fxs
 MORTISE JOINT
(AP OBLIQUE PROJECTION)
Medial Rotation
PP: Supine;
• Leg & foot rotated 15-
20o medially
(intermalleolar line // to
IR); plantar surface right
angle to leg
 MORTISE JOINT
(AP OBLIQUE PROJECTION)
RP: Point midway b/n
malleoli
CR: ┴ to ankle joint
SS: Mortise joints (three
sides must be visualized)
 STRESS METHOD
(AP PROJECTION)
Taken after an inversion & eversion
injury
PP: Seated; foot forcibly
turned toward the opposite
side;
RP: Ankle joint
CR: ┴
ER: To evaluate the
presence of ligamentous
tear & joint separation
(widening of the joint
space)
 WEIGHT-BEARING METHOD
(AP PROJECTION)
PP: Upright; heels against
the IR; IR vertical; toes
pointing toward the x-ray
tube
RP: Midway at level of
ankle joint
CR: Horizontal
ER: Identify ankle joint
space narrowing; side-to-
side comparison of joint
LEG
 AP PROJECTION

PP: Supine; femoral

condyles // to IR; foot in
vertical position;
RP: Midshaft
CR: ┴
SS: Tibia & fibula; ankle &
knee joints
 LATERAL PROJECTION

Mediolateral Projection
PP: Supine; RPO/LPO;
patella ┴ to IR; femoral
condyles ┴ to IR;
RP: Midshaft
CR: ┴
SS: Tibia & fibula; ankle &
knee joints

Cross-table lateral if patient cannot

be positioned in supine
 AP OBLIQUE PROJECTION

Medial/Lateral Rotation
PP: Supine; leg & foot
rotated 45o medially or
laterally
RP: Midshaft
CR: ┴
 AP OBLIQUE PROJECTION

SS:
Medial rotation:
• Proximal and distal
tibiofibular articulation
• maximum interosseous
space b/n tibia and
fibula
Lateral Rotation: Fibula
superimposed by lateral
portion of tibia
KNEE
 AP PROJECTION

PP: Supine; femoral epicondyles //

to IR; leg 5o inward (places
interepicondylar line // to IR)
RP: 0.5 in. inferior to patellar apex
CR: depending on the
measurement b/n ASIS & table top
• 3-5ocaudad (<19 cm; thin
pelvis)
• ┴ (19-24 cm)
• 3-5ocephalad ( >24 cm; large
pelvis)
SS: Knee joint space
AP PROJECTION
 PA PROJECTION

PP: Prone; femoral

epicondyles // to IR; leg 5o
inward (places
interepicondylar line // to
IR)
RP: 0.5 in. inferior to
patellar apex
CR: 5-7ocaudad
SS: Knee joint space
 LATERAL PROJECTION

Mediolateral Projection
PP: Lateral recumbent; knee
flexed 20-30o (relax muscle &
shows maximum volume of
joint cavity) or flexed <10o
(for new or unhealed patellar
fx); femoral epicondyles ┴ to
IR
RP: 1 in. distal to medial
epicondyle
CR: 5-7o cephalad
SS: Knee joint space
 AP OBLIQUE PROJECTION

Medial Rotation
PP: Supine; leg rotated 45o
medially; hip of affected side
elevated
RP: 0.5 in. inferior to patellar apex
CR: depending on the
measurement b/n ASIS & table top
• 3-5ocaudad (<19 cm)
• Perpendicular (19-24 cm)
• 3-5ocephalad (>24 cm)
SS: Proximal tibiofibular joint;
fibular head
• Lateral femoral condyle
 AP OBLIQUE PROJECTION

Lateral Rotation
PP: Supine; leg rotated 45o
medially; hip of unaffected
side elevated
RP: 0.5 in inferior to
patellar apex
CR: 5o cephalad
SS: Tibial plateaus; medial
femoral & tibial condyles
 PA OBLIQUE PROJECTION

PA OBLIQUE
PP: knee flexed 10
degrees (Holmblad; for
lateral rotation)
RP: 0.5 in inferior to
patellar apex
CR: Perpendicular
SS: opposite of previous
 WEIGHT-BEARING METHOD
(AP BILATERAL PROJECTION)
LEACH-GREGG-SIBER
PP: Upright; knee fully extended;
weight equally distributed on
both feet; IR vertical
RP: 0.5 in. inferior to patellar apex
CR: Horizontal
SS: Knee joint spaces
ER:
• To reveal narrowing of knee
joint space
• To evaluate varus & valgus
deformities & degenerative
joint disease
 ROSENBERG METHOD
(PA WEIGHT-BEARING)
STANDING FLEXION
PP: Upright; facing vertical
IR; anterior surface of flexed
knee against IR; femur 45o to
IR
RP: 0.5 in. inferior to patellar
apex
CR: Horizontal or 10o caudad
ER: Useful for evaluating
joint space narrowing &
demonstrating articular
cartilage disease
INTERCONDYLAR
FOSSA
 HOLMBLAD METHOD
(PA AXIAL PROJECTION)
TUNNEL VIEW
PP: Anterior surface of knee
against IR; knee 60-70o from IR
(20o difference from CR)
3 positions:
• Standing; knee flexed & rested
on a stool
• Standing at side of table; knee
flexed & rested over the IR
• Kneeling on table; knee over
the IR (Holmblad Method)
RP: Popletial depression
CR: ┴
SS: Intercondylar fossa
 HOLMBLAD METHOD
(PA AXIAL PROJECTION)
 CAMP-COVENTRY METHOD
(PA AXIAL PROJECTION)
PP: Prone; knee flexed 40-50o from IR;
femur against IR; with support under
foot
RP: Popletial depression
CR: 40o (knee flexed 40o) or 50o (knee
flexed 50o) caudally
SS: Intercondylar fossa
ER:
• To detect loose bodies “joint mice
• To evaluate split & displaced
cartilage in osteochondritis
• To evaluate flattening or
underdevelopment of lateral
femoral condyles in congenital
slipped patella
CAMP-COVENTRY METHOD
(PA AXIAL PROJECTION)
 BECLERE METHOD
(AP AXIAL PROJECTION)
PP: Supine; knee flexed;
femur 60o to long axis of
tibia; curved cassette is
used
RP: 0.5 in. inferior to
patellar apex
CR: ┴ to long axis of lower
leg
SS: Intercondylar fossa,
intercondylar eminence,
knee joint & tibial plateau
 BECLERE METHOD
(AP AXIAL PROJECTION)
PATELLA
 PA PROJECTION

PP: Prone; heel 5-10o

laterally (places patella //
to IR)
RP: Midpopliteal
depression
CR: Perpendicular
SS: Sharper image of
patella (closer OID)
 LATERAL PROJECTION

PP: Lateral recumbent;

unaffected knee & hip
flexed; unaffected foot in
front; affected knee flexed 5-
10o or flexed not >10 (for
new or unhealed patellar fx);
femoral epicondyles &
patella ┴ to IR; RP:
Midpatellofemoral joint
CR: ┴
SS: Patella & patellofemoral
joint space
 PA OBLIQUE PROJECTION

Medial Rotation
PP: Prone; knee flexed 5-
10o; knee 45-55o medially
RP: Patella
CR: ┴
SS: Medial portion of
patella free of femur
 PA OBLIQUE PROJECTION

Lateral Rotation
PP: Prone; knee flexed 5-
10o; knee 45-55o laterally
RP: Patella
CR: ┴
SS: Lateral portion of
patella free of femur
 KUCHENDORF METHOD
(PA AXIAL OBLIQUE PROJECTION)
Lateral Rotation
PP: Prone; hip elevated 2-
3 in.; knee flexed 10o
(relax the muscles); knee
rotated 35-40o laterally
RP: Joint space b/n patella
& femoral condyles
CR: 25-30ocaudad
SS: Oblique patella free
superimposition of femur
 KUCHENDORF METHOD
(PA AXIAL OBLIQUE PROJECTION)
 HUGHSTON METHOD
(TANGENTIAL PROJECTION)
PP: Prone; anterior surface of
knee against IR; knee flexed
50-60o; foot rested against
collimator/support
RP: Patellofemoral joint
CR: 45o cephalad
SS: Patella; patellofemoral joint
ER:
• To demonstrate subluxation
of patella & patellar fx
• It allows assessment of
femoral condyles
 MERCHANT METHOD
(TANGENTIAL PROJECTION)
PP: Supine; both knee flexed
40o or b/n 30-90o (to
demonstrate various patellar
disorders); IR resting on
patient’s shins; uses IR holding
device & axial viewer device
RP: Midway b/n patellae at
level of patellofemoral joint
CR: 30o caudad from horizontal
SS: Femoral condyle;
intercondylar sulcus &
magnified nondistorted
patellae
 SETTEGAST METHOD
(TANGENTIAL PROJECTION)
Disadvantage: Extreme flexion
PP: Supine or prone
(preferable); knee acutely
flexed until patella ┴ to IR; loop
bandage around ankle or foot
to hold the leg in position
RP: Joint space b/n patella &
femoral condyles
CR: Perpendicular (if joint is ┴);
15-20o cephalad (if joint isn’t ┴)
• Angulation depends on knee
flexion
 SETTEGAST METHOD
(TANGENTIAL PROJECTION)
SS: Patella; patellofemoral
joint
ER:
• Useful for
demonstrating vertical
fractures
• Useful for investigating
articulating surfaces of
patellofemoral
articulation
 SETTEGAST METHOD
(TANGENTIAL PROJECTION)
 SUNRISE METHOD
(TANGENTIAL PROJECTION)
MOUNTAIN/SKYLINE
VIEW
PP: Supine/Sitting; knee
flexed 40-45o
RP: Patellofemoral joint
CR: 30o from horizontal
ER: Joint space b/n patella
& femoral condyles
FEMUR
 AP PROJECTION

PP: Supine
• Distal femur (knee
included): leg rotated 5o
inward ( places limb in true
anatomic position)
• Proximal femur (hip
included): leg rotated 10-15o
inward (places femoral neck
in profile)
RP: Midfemur
CR: ┴
SS: Femoral neck & hip joint
(10-15o); knee joint (5o)
 LATERAL PROJECTION
Mediolateral Projection
PP: Lateral recumbent; affected side
against IR
• Distal femur (knee included):
unaffected limb draw forward;
pelvis in true lateral position;
affected knee flexed 45o; femoral
epicondyles ┴ to IR;
• Proximal femur (hip included):
unaffected limb draw posteriorly;
pelvis rolled 10-15o posteriorly ; IR
lvl of ASIS
RP: Midfemur
CR: ┴
SS: ¾ of femur & adjacent joints
LATERAL PROJECTION
 TRANSLATERAL PROJECTION

CROSSTABLE LATERAL
PP: Dorsal decubitus; IR
placed vertically against
medial/lateral surface of
femur;
RP: Medial side of midfemur
CR: Horizontal
SS: Entire femur & knee joint
ER: For patient who can’t
tolerate routine lateral
position because of fractures
or destructive disease