04/10/2022

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LOWER EXTREMITIES
PREPARED BY:
MEYNARD Y. CASTRO, RRT ANATOMY

Bones of Foot Joints of Foot

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Sesamoid Bones Tarsals

• Embedded in tendons • Calcaneus
• Present near joints • Cuboid
• Plantar surface of foot • Cuneiforms (3)
• Navicular
• Talus

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Calcaneus

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Talus and Calcaneus Navicular, Cuneiforms, and Cuboid

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Arches of Foot Ankle Joint

• Longitudinal arch
• Transverse arch

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Lateral Ankle Position Ankle Joint (Axial View)

Distal fibula over posterior half of tibia on a true lateral

Posterior Anterior

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Ankle Anatomy Review

AP mortise projection
AP ankle projection

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Anatomy Review Anatomy Review

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Tibia and Fibula (Anterior View) Tibia and Fibula (Lateral View)
• Anterior crest • Articular facets (tibial
• Articular facets (tibial plateau) (10°-20°)
plateau)
• Apex of styloid process
• Body of fibula
• Fibular notch (of tibia) • Body (shaft) of fibula
• Intercondylar eminence • Body (shaft) of tibia
(medial and distal • Fibular head
intercondylar tubercles)
• Lateral condyle • Lateral malleolus
• Lateral malleolus • Medial malleolus
• Medial condyle • Fibular neck
• Tibial tuberosity • Tibial tuberosity

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Femur (Anterior View) Femur (Posterior View)

• Longest and • Note 5°-7° angle as
strongest bone shown at distal medial
• Patella ½ inch (1.25 and lateral condyles
cm) above joint

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Distal Femur and Patella Patella

Lateral view Inferior view

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Knee Joint (Oblique View) Knee Joint (Anterior View)

• Femorotibial and
patellofemoral joints
• Four major ligaments:
– Posterior cruciate
– Anterior cruciate
– Fibular collateral
– Tibial collateral

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Menisci (Superior and Sagittal Articular Capsule

Views)
Knee arthrogram

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Anatomy Review Anatomy Review

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Anatomy Review 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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RADIOGRAPHIC TOES
POSITIONING

AP/AP AXIAL PROJECTION AP/AP AXIAL PROJECTION

PP: Supine/seated; AP Axial (15o)
separate feet about 6 Open IP joints & reduces
inches (15 cm); knee foreshortening
flexed; 15o foam wedge
under foot
RP: 3rd MTP joint
CR: ┴ (15o foam wedge)
or 15o posteriorly
SS: Phalanges & distal
portion of metatarsals

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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 AP OBLIQUE PROJECTION

Medial Rotation
PP: Supine/seated; knee Lateral Rotation
flexed; plantar surface 30-
45o from IR (lower leg & PP: Supine/seated; knee
foot rotated medially ) flexed; plantar surface 30- JUST REVERSE THE
RP: 3rd MTP joint 45o from IR (lower leg & PREVIOUS POSITION
foot rotated laterally) ☺☺☺
CR: ┴
SS: 2nd-5th MTP joint RP: 3rd MTP joint
spaces; 1st-3rd toes CR: ┴
• 1st MTP joint (not SS: 3rd-5th toes; MTP joints
always open) overlapped

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PA OBLIQUE PROJECTION LATERAL PROJECTION

Medial Rotation Mediolateral/Lateromedial
PP: Lateral recumbent Projection
(affected side down); PP: Lateral recumbent
affected limb partially (unaffected side down); toe in
extended; ball of foot 30o to true lateral; use 4x4 gauze pad
or tape (to separate the toes)
horizontal
RP: IP joint (1st toe); proximal
RP: 3rd MTP joint IP joint (2nd-4th toes)
CR: ┴ CR: ┴
SS: 2nd-5th MTP joint spaces; SS: Phalanges in profile; open
1st-3rd toes IP joints spaces
• 1st MTP joint (not always • Lateromedial: 1st-2nd toes
open) • Mediolateral: 3rd-5th toes

LATERAL PROJECTION LATERAL PROJECTION

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LATERAL PROJECTION

SESAMOIDS

LEWIS METHOD HOLLY METHOD

(TANGENTIAL PROJECTION) (TANGENTIAL PROJECTION)
PP: Seated (more
PP: Prone; dorsiflex great comfortable); plantar
toe; ankle elevated; ball of surface 75o to IR; toe
foot ┴ to IR flexed & hold w/ strip
RP: 1st MTP joint gauze bandage; medial
border of foot ┴ to IR
CR: Perpendicular
RP: 1st MTP head
SS: MT head & sesamoids
in profile CR: ┴
SS: MT head & sesamoids
in profile

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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

AP/AP AXIAL PROJECTION

PP: Supine; knee flexed;

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

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AP/AP AXIAL PROJECTION AP OBLIQUE PROJECTION

ER: Medial Rotation

PP: Supine; knee flexed; leg
• For localizing foreign rotated medially; plantar
bodies surface of foot 30o to IR
• Location of fragments in rd
RP: 3 MTP base
fx of metatarsals & CR: ┴
anterior tarsals SS:
• Cuboid in profile
• General surveys of • Sinus tarsi (well
bones of the foot demonstrated)
10o Angulation: reduces • Interspaces b/n:
foreshortening of – cuboid & calcaneus;
– cuboid & 4th & 5th MT
metatarsals – 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

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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 GRASHEY METHOD

(PA OBLIQUE PROJECTION)
Lateromedial Projection Medial and Lateral
(more difficult to assume)
Rotation
PP: LPO/RPO (affected side
up); medial surface against PP: Prone; foot elevated;
IR; plantar surface of foot ┴ dorsal surface against IR;
to IR heel rotated medially 30o;
RP: 3rd MTP base heel rotated laterally 20
CR: Perpendicular RP: 3rd MTP base
SS: True lateral projection of
foot CR: Perpendicular
• MT more superimposed
than mediolateral

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GRASHEY METHOD GRASHEY METHOD

(PA OBLIQUE PROJECTION) (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)

WEIGHT-BEARING METHOD WEIGHT-BEARING METHOD

(LATERAL PROJECTION) (LATERAL PROJECTION)
Longitudinal Arch
PP: Upright (natural SS: Structural status of
position); feet elevated longitudinal arch (pes
(use blocks); IR b/n feet; planus); Bohler’s critical
weight equally distributed angle (b/n 20-40o);
on each foot calcaneal fracture (<20o)
RP: Point above 3rd MTP Bohler’s Critical Angle:
base angle b/n superior apex of
CR: Horizontal mid-calcaneus to anterior
process of calcaneus

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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 WEIGHT-BEARING COMPOSITE

METHOD METHOD
AP AXIAL PROJECTION
PP: Upright; 2 exposures Second Exposure:
• First Exposure: unaffected foot step
unaffected foot step forward; tube behind;
backward (to prevent exposure factor increase
superimposition of leg (increase CR angulation &
shadow on ankle joint) thickness of part)
tube in front – For hindfoot (talus &
– For exposure of forefoot calcaneus)
(phalanges & MT)

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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
TALIPES EQUINOVARUS
• 3 DEVIATIONS:
– PLANTAR FLEXION &INVERSION OF CALCANEUS (EQUINUS)

CONGENITAL – MEDIAL DISPLACEMENT OF THE FOREFOOT (ADDUCTION)

– ELEVATION OF THE MEDIAL BORDER OF THE FOOT
(SUPINATION)
CLUBFOOT 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

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KITE METHOD KITE METHOD

(AP PROJECTION) (AP PROJECTION)

SS:
PP: Supine; hips & knees • Degree of forefoot
flexed; foot flat on IR; adduction & calcaneus
ankles slightly extended; inversion (equinus)
legs are vertical • 15o Angulation: places CR
┴ to tarsals
RP: Tarsals
• Importance of ┴ CR: to
CR: 15o posteriorly project the true
relationship of the bones
and ossification centers

KITE METHOD KITE METHOD

(LATERAL PROJECTION) (LATERAL PROJECTION)

Mediolateral
PP: Lateral recumbent; SS:
uppermost limb flexed & • Anterior talar
draw forward subluxation
RP: Midtarsal area • Degree of plantar
CR: Perpendicular flexion (equinus)

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KANDEL METHOD KANDEL METHOD

(DORSOPLANTAR AXIAL PROJECTION) (DORSOPLANTAR AXIAL PROJECTION)

SS: Suroplantar projection

PP: Bending forward of congenital clubfoot
position; plantar surface (same as taking calcaneus)
against IR • Freiberger-Hersh-
RP: Lower leg Harrison: CR 35o, 45o &
CR: 40o anteriorly 55o for demonstration
of sustentaculum talar
joint fusion

AXIAL PROJECTION

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

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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

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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 WEIGHT BEARING METHOD

LATEROMEDIAL OBLIQUE
PROJECTION
PP: Upright; leg SS: Calcaneal tuberosity
perpendicular to IR; ER: Useful in diagnosing
calcaneus center to IR stress fractures of
RP: Lateral malleolus calcaneus or tuberosity
CR: 45o caudad (medially)

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PA AXIAL OBLIQUE PROJECTION)

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

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

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BRODEN METHOD BRODEN METHOD

(AP AXIAL OBLIQUE PROJECTION) (AP AXIAL OBLIQUE PROJECTION)

Lateral Rotation
PP: Supine; leg & foot
rotated 45o laterally; SS: Posterior articulation
dorsiflex foot; foot rested ER: To determine the
against 45o foam wedge presence of joint
RP: 2 cm distal & 2 cm involvement in cases of
anterior to medial comminuted fx
malleolus
CR: 15o cephalad

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ISHERWOOD METHOD ISHERWOOD METHOD

(FEIST-MANKIN METHOD) (FEIST-MANKIN METHOD)
(LATEROMEDIAL OBLIQUE PROJECTION) (AP AXIAL OBLIQUE PROJECTION)

Medial Rotation Foot Medial Rotation Ankle

PP: Semisupine; foot & leg PP: Seated or semi-lateral
rotated 45o medially; knee recumbent (more
flexed; 45o foam wedge comfortable); leg, foot &
ankle rotated 30o medially;
under elevated leg dorsiflex foot; 30o foam
RP: 1 in. distal & 1 in. wedge
anterior to lateral malleolus RP: 1 in. distal & 1 in.
CR: ┴ anterior to lateral malleolus
SS: Anterior subtalar CR: 10o cephalad
articular surface SS: Middle subtalar articular
surface & “end on”
• Oblique projection of projection of sinus tarsi
tarsals

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
ANKLE
malleolus
CR: 10o cephalad
SS: Posterior subtalar
articular surface

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AP PROJECTION LATERAL PROJECTION

PP: Supine; leg & foot Mediolateral Projection
vertical & rotated 5o PP: Semisupine; lateral
medially (places malleoli surface of foot against IR;
equidistant) dorsiflex foot (prevent
RP: Point midway between lateral rotation of the ankle)
malleoli RP: Medial malleolus
CR: ┴ to ankle joint CR: ┴ to ankle joint
SS: Ankle joint & tibiotalar SS: True lateral projection of
joint space lower third of tibia & fibula,
• True AP: inferior ankle joint & tarsals
tibiofibular & talofibular • 5th metatarsal base
articulations not in profile (identify Jones fx)
(normal) • Tibiotalar joints (well
visualized)

LATERAL PROJECTION AP OBLIQUE PROJECTION

Lateromedial Projection Medial Rotation
PP: Semisupine; medial PP: Supine; leg & foot
surface of foot against IR; rotated 45o laterally;
dorsiflex foot dorsiflex foot
RP: 0.5 in. superior to lateral RP: Point midway b/n
malleolus
malleoli
CR: ┴ to ankle joint
CR: ┴ to ankle joint
SS: Lateral projection of
lower third of tibia & fibula, SS: Distal ends of tibia &
ankle joint & tarsals fibula (often
Exact positioning of ankle is more superimposed over talus)
easily & more consistently obtained
• tibiofibular articulation

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MORTISE JOINT
AP OBLIQUE PROJECTION
(AP OBLIQUE PROJECTION)
Lateral Rotation Medial Rotation
PP: Supine; leg & foot PP: Supine;
rotated 45o laterally;
dorsiflex foot • Leg & foot rotated 15-
20o medially
RP: Point midway b/n
malleoli (intermalleolar line // to
IR); plantar surface right
CR: ┴ to ankle joint
angle to leg
SS: Superior aspect of
calcaneus; subtalar joint
ER: Useful in determining
fxs

MORTISE JOINT
(AP OBLIQUE PROJECTION)
RP: Point midway b/n
malleoli
CR: ┴ to ankle joint
SS: Mortise joints (three
sides must be visualized)

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STRESS METHOD WEIGHT-BEARING METHOD

(AP PROJECTION) (AP PROJECTION)
Taken after an inversion & eversion PP: Upright; heels against
injury
PP: Seated; foot forcibly the IR; IR vertical; toes
turned toward the pointing toward the x-ray
opposite side; tube
RP: Ankle joint RP: Midway at level of
CR: ┴ ankle joint
ER: To evaluate the CR: Horizontal
presence of ligamentous ER: Identify ankle joint
tear & joint separation space narrowing; side-to-
(widening of the joint side comparison of joint
space)

AP PROJECTION

PP: Supine; femoral

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

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LATERAL PROJECTION AP OBLIQUE PROJECTION

Mediolateral Projection
PP: Supine; RPO/LPO;
patella ┴ to IR; femoral
condyles ┴ to IR; Medial/Lateral Rotation
RP: Midshaft PP: Supine; leg & foot
CR: ┴ rotated 45o medially or
laterally
SS: Tibia & fibula; ankle &
knee joints RP: Midshaft
CR: ┴
Cross-table lateral if patient cannot
be positioned in supine

AP OBLIQUE PROJECTION

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

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AP PROJECTION
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

PA PROJECTION LATERAL PROJECTION

PP: Prone; femoral Mediolateral Projection

epicondyles // to IR; leg 5o PP: Lateral recumbent; knee
inward (places flexed 20-30o (relax muscle
& shows maximum volume
interepicondylar line // to of joint cavity) or flexed <10o
IR) (for new or unhealed
RP: 0.5 in. inferior to patellar fx); femoral
patellar apex epicondyles ┴ to IR
RP: 1 in. distal to medial
CR: 5-7ocaudad epicondyle
SS: Knee joint space CR: 5-7o cephalad
SS: Knee joint space

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AP OBLIQUE PROJECTION AP OBLIQUE PROJECTION

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

WEIGHT-BEARING METHOD
AP OBLIQUE PROJECTION
(AP BILATERAL PROJECTION)
PA OBLIQUE LEACH-GREGG-SIBER
PP: Upright; knee fully extended;
PP: knee flexed 10 weight equally distributed on
both feet; IR vertical
degrees (Holmblad; for RP: 0.5 in. inferior to patellar
lateral rotation) apex
CR: Horizontal
RP: 0.5 in inferior to SS: Knee joint spaces
patellar apex ER:
CR: Perpendicular • To reveal narrowing of knee
joint space
SS: opposite of previous • To evaluate varus & valgus
deformities & degenerative
joint disease

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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
INTERCONDYLAR
patellar apex
CR: Horizontal or 10o caudad FOSSA
ER: Useful for evaluating
joint space narrowing &
demonstrating articular
cartilage disease

HOLMBLAD METHOD HOLMBLAD METHOD

(PA AXIAL PROJECTION) (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

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CAMP-COVENTRY METHOD CAMP-COVENTRY METHOD

(PA AXIAL PROJECTION) (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

BECLERE METHOD BECLERE METHOD

(AP AXIAL PROJECTION) (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

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PA PROJECTION

PP: Prone; heel 5-10o

laterally (places patella //
to IR)
PATELLA RP:
depression
Midpopliteal

CR: Perpendicular
SS: Sharper image of
patella (closer OID)

LATERAL PROJECTION PA OBLIQUE PROJECTION

PP: Lateral recumbent;

unaffected knee & hip
flexed; unaffected foot in Medial Rotation
front; affected knee flexed PP: Prone; knee flexed 5-
5-10o or flexed not >10 (for 10o; knee 45-55o medially
new or unhealed patellar RP: Patella
fx); femoral epicondyles &
patella ┴ to IR; RP: CR: ┴
Midpatellofemoral joint SS: Medial portion of
CR: ┴ patella free of femur
SS: Patella & patellofemoral
joint space

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KUCHENDORF METHOD
PA OBLIQUE PROJECTION
(PA AXIAL OBLIQUE PROJECTION)
Lateral Rotation
Lateral Rotation PP: Prone; hip elevated 2-
PP: Prone; knee flexed 5- 3 in.; knee flexed 10o
10o; knee 45-55o laterally (relax the muscles); knee
RP: Patella rotated 35-40o laterally
CR: ┴ RP: Joint space b/n patella
& femoral condyles
SS: Lateral portion of
patella free of femur CR: 25-30ocaudad
SS: Oblique patella free
superimposition of femur

KUCHENDORF METHOD HUGHSTON METHOD

(PA AXIAL OBLIQUE PROJECTION) (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

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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 SETTEGAST METHOD

(TANGENTIAL PROJECTION) (TANGENTIAL PROJECTION)
Disadvantage: Extreme flexion SS: Patella; patellofemoral
PP: Supine or prone joint
(preferable); knee acutely
flexed until patella ┴ to IR;
ER:
loop bandage around ankle or • Useful for
foot to hold the leg in position demonstrating vertical
RP: Joint space b/n patella & fractures
femoral condyles • Useful for investigating
CR: Perpendicular (if joint is articulating surfaces of
┴); 15-20o cephalad (if joint
isn’t ┴) patellofemoral
• Angulation depends on
articulation
knee flexion

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SETTEGAST METHOD SUNRISE METHOD

(TANGENTIAL PROJECTION) (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

AP PROJECTION

PP: Supine
• Distal femur (knee
included): leg rotated 5o
inward ( places limb in
FEMUR 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)

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LATERAL PROJECTION
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

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

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