Film Critique

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Film Critique 1 st year 5 th class

description

Film Critique. 1 st year 5 th class. Toes Standard views. *AP *Oblique (medioblique) *Lateral (mediolateral/lateromedial). Structures shown. - PowerPoint PPT Presentation

Transcript of Film Critique

Page 1: Film Critique

Film Critique

1st year 5th class

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ToesStandard views

*AP

*Oblique (medioblique)

*Lateral (mediolateral/lateromedial)

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Structures shown AP projection of the phalanges of the foot

(*1st toe only has 2 phalanges the 2nd-5th have 3 phalanges) ***We need from distal phalanx to the distal end metatarsal.

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AP Right 1st Toe

Sesamoids

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Check the film for: No rotation of phalanges Interphalangeal and

metatarsophalangeal joint spaces open (no bent toes)

Toes should be separated from each other so there is no soft tissue overlap

Soft tissue and bony trabeculation (this is to check for a good technique)

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AP

Rotation of toe

Soft tissue overlap

AP left 1st toe

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Oblique Toes

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Oblique left 1st toe

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Structures shown **** We do a medioblique:

An oblique projection of the phalanges

The Interphalangeal joints and 2nd -5th metatarsophalangeal joints open

***Distal phalanx to the distal end of the metatarsal

Toes should be separated from each other

Both soft tissue and bony trabeculation should be seen (techn)

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Oblique left 2nd toe

Cadaver bone

LT

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Lateral left 1st toe

Might need tape, straw or tongue depressor to separate toes

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Lateral toes

Do lateromedial (1st-3rd) and mediolateral (3rd-5th) to get the toe closest to the film

lateromedial Mediolateral

Lateral left 2nd toe Lateral left 3rd toe

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Structures shown: Lateral toe A lateral projection of the phalanges: Phalanges in profile

(toenail should appear lateral)

The interphalangeal joints spaces open. The MTP joints will be overlapped but may be seen in some patients.

***The distal phalanx to the distal ends of the metatarsals

Phalanx, without superimposition of adjacent toes. When superimposition cannot be avoided, the proximal phalanx must be demonstrated.

Toes should be separated from each other

Soft tissue and bony trabeculation (techn)

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Lateral left 1st toe

Lateral left 2nd toe

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Tongue depressor

Lateral Left 2nd toe

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Foot Standard views

*AP

* AP Oblique (medioblique)

*Lateral (mediolateral)

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Base of the 5th

Common area for a foot fracture base of 5th Jones fracture

AP Right Foot

Intermediate

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AP Right foot

**In this view you Will not see theCalcaneus!!

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Structures shown: Dorsoplanter (AP) projection of the

tarsals anterior to the talus, the metatarsals,and the phalanges

You will not see the whole calcaneus on this view. Why?

Some people angle 10 degrees toward the heel on this view

***You want all of the phalanges, metatarsals and tarsals distal to the talus on your image

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Check film for:

Motion

Rotation: there will be overlap of second- fifth metatarsal bases

Open joint space between medial and intermediate cuneiform

No overlap of toes

Density- are the toes burned out

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Oblique Right foot

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Oblique Right Foot

medioblique

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Structures shown: AP medioblique projection of the

phalanges and metatarsals Interspaces open between the cuboid

and calcaneus, the cuboid and the 4th and 5th metatarsals, the cuboid and the lateral cuneiform and the talus and the navicular

Cuboid is in profile Sinus tarsi, calcaneus, navicular,&

base of the fifth are seen

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Oblique Left Foot

Calcaneus?

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Check for: Enough rotation when the 3rd – 5th

metatarsals bases are free from superimposition

The lateral tarsals with less superimposition than in the AP

Joint spaces open Base of the fifth metarsal is seen Density: are the toes seen and are

the tarsal seen Tip of toes to calcaneus on the image

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Lateral Right Foot

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Lateral Right Foot

mediolateral

R

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Structures shown: Mediolateral projection of the entire

foot. ***You need distal ends of the tib/fib, ankle joint, calcaneus to the distal phalanges.

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Bad lateral foot

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Check for: Tip of toes to calcaneus and distal

tib/fib on the image

Metatarsals nearly superimposed

Density to see toes, metatarsals and tarsals

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Good Positioning

Poor : knee elevated

Poor : heel not flat

Poor : foot not flat

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NO!

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CALCANEUS Standard views

*AP axial (plantodorsal)

*Lateral (mediolateral)

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Sustentaculumtali

tuberosity

Trochlear process

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Structures shown: An axial projection of the calcaneus

***from the tuberosity to the sustentaculum tali and trochlear process

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AP Axial Right Calcaneus

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Check for: Calcaneus should be visualized to

include the talocalcaneal joint No rotation of calcaneus (check the

first or fifth metatarsals) Density to see joint without burn out

of tuberosity (two films if not using DR or CR)

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Rotation / foot flexion

GoodRotation : can see 4th & 5th metatarsals

Too much flexionCan’t see joint space

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Structures shown: Lateral projection of the ankle joint

and the calcaneus and adjacent tarsals.

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Lateral Left calcaneus

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Check for: No rotation of the calcaneus Density can you see soft tissue and

bone Sinus tarsi seen Ankle joint and adjacent tarsals

should be on the film

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Ankle

Standard views

*AP

*OBL (mortise)

*Lateral (mediolateral)

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AP Right Ankle

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Structures shown AP projection of the ankle joint,

***distal ends of tib/fib and the proximal portion of the talus

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Dorsal flexAP Left ankle

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Check for: Talotibial joint space should be seen

Ankle joint should be centered

Moderate over lapping at the tibiofibular articulation is normal

***Area from the distal tibia and fibula to the talus should be included

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Oblique Left Ankle

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Structures shown: Distal ends of the tib/fib with the

entire ankle mortise joint demonstrated in profile.(all three sides of the mortise joint should be open.)

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AP OBLIQUE ANKLE The entire ankle mortise joint should be

demonstrated in profile. We oblique 15-20 degrees to open all three joints.

AP Toomuch

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Oblique Right Ankleis it open?

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Don’t just dorsiflex the foot, roll the leg

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Check for: Entire ankle mortise joint No overlap of the anterior tubercle of

the tibia and the superolateral portion of the talus with the fibula

Talofibular joint space in profile Talus demonstrated with proper

density

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Lateral Right Ankle

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Lateral ankle (mediolateral) A true lateral image of the lower

third of the tib/fib, the ankle joint and the tarsals including the base of the 5th metatarsal

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Lateral Right AnklePoor positioningDorsiflex the foot

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Check for: Ankle joint should be centered Talotibial joint should be well

visualized Fibula should be over the posterior

half of the tibia Density of ankle should be sufficient

to see the outline of the distal portion of the fibula

Fifth metatarsal should be seen to check for a Jones fracture