Learning outcomes of the laboratory sessions

• To develop and enhance your radiographic and patient

management skills through simulated exercises and self and peer‐
evaluation exercises.
• To develop and enhance your understanding of the effect of exposure
factors, image recorder systems and radiographic positioning on the
radiograph.
• To provide an opportunity for you to practice some non‐routine
(non‐walk‐in patient / “trauma” radiographic techniques.
• To develop and enhance your skills in evaluating phantom and
clinical radiographs.
• To maximise your learning in the laboratory it is expected that you
will have familiarised yourself with the simulated positioning
exercises.

Compiled by Assoc Prof Madeleine Shanahan, University of Canberra | Radiography of the Digits, foot 2
and ankle
MRS LABORATORY RULES
GENERAL
The MRS Laboratory will be used to develop pre‐clinical skills and undertake
other medical imaging practicals. The lab is to be thought of a “clinical
environment” and student behaviour must reflect this.
Students MUST obey the directions of supervising staff at all times. Failure to
follow staff directions will result in the student being immediately REMOVED
from the lab and the student will not be given an opportunity to complete any
unfinished lab exercise. That student may also be reported to the Associate
Dean Education of the Faculty of Health for potential misconduct action.
1. Closed in shoes MUST be worn in the lab.
2. Name ID labels MUST be visible and be attached to a clothing item.
3. Eating and drinking are NOT permitted in any area of the lab.
4. Personal items/bags etc. MUST be placed either in the secure lockers in
the lab corridor or in the lab pigeonholes adjacent to the x‐ray rooms.
5. MI student clinical uniforms must be worn for skills assessments.

PERSONAL RADIATION MONITORS (OLSD’S)

1. Students MUST wear their OLSD while in the lab complex.
2. OLSD’s MUST NOT be removed from the lab but MUST be returned to
the storage facility at the end of each practical session.
3. The ONLY time an OLSD is to be removed from the MRS Lab is when
students go on clinical placement.
4. Following clinical placement, students MUST return their OLSD to the lab
in the first week back on campus.
5. OLSD’s are initially provided at no cost to the student. However, if the
OLSD is lost, the student will be charged for a replacement.

X‐RAY ROOMS
1. A maximum of 6 students plus an instructor will be allowed in an x‐ray
room during an x‐ray exposure, if assessed as safe to do so.
2. All personnel in the x‐ray room at the time of exposure MUST be behind
the radiation barrier or, on very rare occasions, UNDER STAFF
DIRECTION, wearing appropriate lead equivalent protective equipment,
e.g. a lead apron and thyroid protector.
3. X‐ray exposures must only be made under the DIRECT SUPERVISION of a
staff member.
Compiled by Assoc Prof Madeleine Shanahan, University of Canberra | Radiography of the Digits, foot 3
and ankle
 Radiographic Imaging 1/ 1G Schedule
2022

Compiled by Assoc Prof Madeleine Shanahan, University of Canberra | Radiography of the Digits, foot 4
and ankle
Radiography of the Digits, foot and
ankle
Preparatory Exercises
These exercises must be completed PRIOR to attending your
scheduled laboratory
For the following, sketch the resultant radiographic image you would expect to
see. Include short notes to identify the key positioning criteria.

AP (DP) forefoot
showing the effect of patient’s toes not parallel to the IR (how commonly
do you think this would occur?)

What could the radiographer do to minimise this effect?

AP oblique foot:
showing the effect of under-rotation

Compiled by Assoc Prof Madeleine Shanahan, University of Canberra | Radiography of the Digits, foot 5
and ankle
AP Mortise ankle:
showing the effect of insufficient internal (medial) rotation

Lateral ankle:
What anatomic landmarks do you use to position the ankle for a
lateral?
Now draw your sketch showing
(i) A well-positioned lateral (ii) the effect of over-rotation

Compiled by Assoc Prof Madeleine Shanahan, University of Canberra | Radiography of the Digits, foot 6
and ankle
 Projections to be performed in Laboratory

Toes: AP and oblique of the forefoot

Foot: AP, oblique and lateral
Ankle: AP (US), AP Mortise (UK-AP), and lateral (US and
UK)
Calcaneum: Axial

• For all projections the appropriate side marker must be used.

• Attention to radiation protection is mandatory.
• For all projections appropriate collimation must be utilised
• If using CR cassette, center the ROI to the region of cassette (e.g. half)
being used.

For our laboratory: with a base exposure

Area SID kVp mAs
Toes 100cm 55 1.6
Foot 100cm 55 2.5
Ankle 100cm 55 3.2
Axial calcaneum 100cm 55 6.0

What patient preparation is required for radiography of the lower limb?

Compiled by Assoc Prof Madeleine Shanahan, University of Canberra | Radiography of the Digits, foot 7
and ankle
Positioning

Toes
1. AP (DP)
Patient seated on table with legs extended. Flex the knee of the side of interest
and place sole of foot on the IR. Place long axis of foot parallel to edge of IR.
Toes may be elevated onto a 15° foam wedge. Stabilise position so IR/foot does
not slip.

Central Ray
Region of Interest
Vertical (perpendicular) to the 3rd MTP joint (or
if single toe to MTP and include digit either
side)

Technical
SID 100 cm.

Evaluation Criteria
Refer to prescribed textbooks and list key
positioning evaluation criteria

What does DP mean?

What does MTP mean?

Why is it common to include the adjacent toe if imaging a single

toe?

2. Oblique
From AP position, rotate the foot 45°medially. Immobilise with foam wedge.

Central Ray
Region of Interest
Vertical (perpendicular) to the 3rd MTP.

Technical
SID 100 cm.

Evaluation Criteria
Refer to prescribed textbooks and list key
positioning evaluation criteria

When might the radiographer rotate the forefoot / toes laterally?

Compiled by Assoc Prof Madeleine Shanahan, University of Canberra | Radiography of the Digits, foot 8
and ankle
 Foot
1. AP (DP)
Patient seated on table with legs extended. Flex the knee of the side of interest and
place sole of foot on the IR. Place long axis of foot parallel to edge of IR. Stabilise
position so IR/foot does not slip.

Region of Interest
Central Ray
Approx. 10-15° toward the heel at the 3rd MT
base.

Technical
SID 100 cm.

Evaluation Criteria
Refer to prescribed textbooks and list key
positioning evaluation criteria

What does MT mean?

Why is CR angled toward the heel in a standard AP (DP) foot?

If no angulation of CR was used, what effect would this have on the

image?

A patient presents with pes planus (flat foot) – what effect, if any,
would this have on the way the AP foot is performed?

When might the radiographer take weight-bearing AP feet?

2. Oblique
From AP position, rotate the foot 45°medially. Immobilise with foam wedge. Stabilise
position so IR/foot does not slip.

Region of Interest
Central Ray
Vertical (perpendicular) at the 3rd MT base.

Technical
SID 100 cm.

Evaluation Criteria
Refer to prescribed textbooks and list key
positioning evaluation criteria.

Compiled by Assoc Prof Madeleine Shanahan, University of Canberra | Radiography of the Digits, foot 9
and ankle
Some workplaces use a lesser rotation of 30°, what assessment criteria
would this change?

Why might a radiographer take an oblique foot using lateral rotation?

3. Lateral
From AP position, flex/move the knee until the plantar surface of the foot is
perpendicular to the IR. Place long axis of foot parallel to edge of IR. Immobilise
the foot. Stabilise position so IR/foot does not slip.

Central Ray
Region of Interest
Vertical (perpendicular) at the 3rd MT base.

Technical
SID 100 cm.

Evaluation Criteria
Refer to prescribed textbooks and list key
positioning evaluation criteria

When the lateral foot is positioned with the patient’s lateral aspect of
the foot against the IR it is called a __________________

When the lateral foot is positioned with the patient’s medial aspect of
the foot against the IR it is called a __________________

Fractures around the base of the 5th MT are quite common. How can
the lateral foot projection be modified to better demonstrate this
region?

The lateral foot is not always a routine projection. What are two clinical
indications where a lateral foot (non-weight-bearing examples) is
always required?

When might a radiographer take weight-bearing lateral feet? What

equipment do you need to able to do this?

Compiled by Assoc Prof Madeleine Shanahan, University of Canberra | Radiography of the Digits, foot 10
and ankle
 Ankle
1. AP
Patient seated or lying supine on the table with legs extended. Position the long
axis of the tibia parallel to the IR edge. Adjust the ankle position until the foot is
pointing directly upwards. Dorsi-flex the foot so that long axis of foot is
perpendicular. Immobilise the foot/ ankle as needed.

Central Ray
Region of Interest
Vertical (perpendicular) at ankle joint

Technical
SID 100 cm.

Evaluation Criteria
Refer to prescribed textbooks and list key
positioning evaluation criteria

What does dorsi-flex mean?

How do you locate the ankle joint?

2. AP Mortise
From the AP ankle internally (medially) rotate the leg and foot until the medial
and lateral malleoli are equidistant to the IR. Immobilise the foot/ ankle as
needed.

Central Ray
Region of Interest
Vertical (perpendicular) at ankle joint

Technical
SID 100 cm.

Evaluation Criteria
Refer to prescribed textbooks and list key
positioning evaluation criteria

On most people ___° rotation is required for the AP Mortise?

What anatomy is well demonstrated in this projection?

When might a radiographer take a 45° medial rotation oblique?

Compiled by Assoc Prof Madeleine Shanahan, University of Canberra | Radiography of the Digits, foot 11
and ankle
 3. Lateral
From the AP ankle externally rotate the leg and foot until the malleoli are
superimposed (UK lateral). Dorsi-flex the foot so that long axis of foot is
perpendicular. Immobilise the foot/ ankle as needed.

Central Ray
Region of Interest
Vertical (perpendicular) at the ankle joint

Technical
SID 100 cm.

Evaluation Criteria
Refer to prescribed textbooks and list key
positioning evaluation criteria

What projection is this at right angles to?

An alternate lateral projection is positioned so it is 90 degrees to

the AP Ankle projection. This is the US lateral projection. How
would you check on the patient that you have achieved the correct
position?

Why is it common practice to include the base of the 5th MT on the

lateral projection?

Compiled by Assoc Prof Madeleine Shanahan, University of Canberra | Radiography of the Digits, foot 12
and ankle
 Calcaneum
Region of Interest

1. Axial
Patient is placed into the AP ankle position
(plantar surface of the foot perpendicular to the
IR). Position the long axis of the calcaneum
parallel to the IR edge.

Central Ray
40° toward the heel (lower leg) to the center of
the calcaneum.

Technical
SID 100 cm.

Evaluation Criteria

Refer to prescribed textbooks and list key positioning evaluation criteria

What is an alternate way you can obtain this projection on a walk-in

patient?

A lateral calcaneum projection is also taken:

Describe the patient position including CR and collimation for a

lateral calcaneum

Compiled by Assoc Prof Madeleine Shanahan, University of Canberra | Radiography of the Digits, foot 13
and ankle