LOWERLIMB

(LEG)
CHARY JAZTINE L. MANGACOP
AP PROJECTION
• For this projection, as well as the lateral and oblique projections described
in the following sections, the long axis of the IR is placed parallel with the
long axis of the leg and centered to the midshaft.
• Unless the leg is unusually long, the IR will extend beyond the knee and
ankle joints enough to prevent their being projected off the IR by the
divergency of the x-ray beam.
• The IR must extend from I to 1 1'2 (2.5 to 3.8 cm) inches beyond the
joints. When the leg is too long for these allowance and the site of the
lesion is not known, two images should be made.
• Diagonal use of a 35 X 43 cm IR is also an option if the leg is too long to fit lengthwise
and if such use is permitted by the faciIity.
Position of patient
• Place the patient in the supine position.
Position of part
• Adjust the patient's body so that the pelvis is not rotated.
• Adjust the leg so that the femoral condyles are parallel with the JR and the foot is
vertical.
• Flex the ankle until the foot is in the vertical position.
• If necessary, place a sandbag against the plantar surface of the foot to immobilize it in the
correct position.
• Shield gonads.
Central ray
• Perpendicular to the center of the leg
COMPUTED RADIOGRAPHY
• If one TR is used for two images, the unexposed side must be covered with
lead.
• Scattered radiation reaching the IP phosphor will produce an undiagnostic
image or computer artifacts on both sides.
• Image receptor:
18 x 43 cm or 35 X 43 cm for two images on one IR
SE
STRUCTURES SHOWN

• The resulting image shows the tibia, fibula, and adjacent joints.

EVALUATION CRITERIA
The following should be clearly demonstrated:
• Ankle and knee joints on one or more AP projections
• Ankle and knee joints without rotation
• Proximal and distal articulations of the tibia and fibula moderately
overlapped
• Trabecular detail and soft tissue for the entire leg
 LATERAL PROJECTION
MEDIOLATERAL
Image receptor:
• 18 x 43 cm or 35 X 43 cm for two images on one IR
Position of patient
• Place the patient in the supine position.
Position of part
• Tum the patient toward the affected side with the leg on the JR.
• Adjust the rotation of the body to place the patella perpendicular to the I R, and ensure that
a line drawn through the femoral condyles is also perpendicular.
• Place sandbag supports where needed for the patient's comfort and to stabilize the body
position
ALTERNATE METHOD

• When the patient cannot be turned from the supine position, the lateral
projection may be taken cross-table using a horizontal central ray.
• Lift the leg enough for an assistant to slide a rigid support under the
patient's leg.
• The IR may be placed between the legs and the central ray directed from
the lateral side
• Shield gonads.
CENTRAL RAY

• Perpendicular to the midpoint of the leg

COMPUTED RADIOGRAPHY
• If one IR is used for two images, the unexposed side must be covered with
lead.
• Scattered radiation reaching the IP phosphor will produce an undiagnostic
image or computer artifacts on both sides.
STRUCTURES SHOWN
• The resulting image shows the tibia, fibula, and adjacent joints
EVALUATION CRITERIA
The following should be clearly demonstrated:
• Ankle and knee joints on one or more images
• Distal fibula lying over the posterior half of the tibia
• Slight overlap of the tibia on the proximal fibular head
• Ankle and knee joints not rotated
• Possibly no superimposition of femoral condyles because of divergence of the beam
• Moderate separation of the tibial and fibular bodies, or shafts except at their articular ends
• Trabecular detail and soft tissue
AP OBLIQUE PROJECTIONS
MEDIAL AND LATERAL ROTATIONS
Image receptor:
• 18 x 43 cm or 35 X 43 cm for two exposures on one IR
Position of patient
• Place the patient in the supine position on the radiographic table.
Position of part
• Perform oblique projection of the leg by alternately rotating the limb 45 degrees medially
or laterally .For the medial rotation, ensure that the leg is turned inward and not just the
foot.
• For the medial oblique projection, elevate the affected hip enough to re t the medial side
of the foot and ankle against a 45-degree foam wedge, and place a support under the
greater trochanter.
• Shield gonads.
CENTRAL RAY

• Perpendicular to the midpoint of the IR

COMPUTED RADIOGRAPHY
If one IR is used for two images, ensure that the unexposed ide is
covered with lead. Scattered radiation reaching the IP phosphor
will produce an undiagnostic image or computer artifact , on both
ides.
Structures shown
• The resulting image shows a 45-degree oblique projection of the bones and oft
tissues of the leg and one or both of the adjacent joints
EVALUATION CRITERIA
The following should be clearly demonstrated:
Medial rotation
• Proximal and distal tibiofibular articulations
• Maximum interosseous space between the tibia and fibula
• Ankle and knee joint Lateral rotation
• Fibula superimposed by lateral portion of tibia
• Ankle and knee joint