Determine if the following are true or false regarding the PATELLA

largest and most constant sesamoid bone

located on the superior, anterior femur

develops in the quad tendons between ages 10-12

Apex points toward the head; base is at the top

Match the preparation:

Remove artifacts within area of interest

Affected extremity on the IR placed on the tabletop

Use Bucky tray for larger parts

No need to transfer from stretcher to table

Categorize the AP Tib-Fib & Lateral Tib-Fib

Remove radiopaque objects from the anatomy of interest

Source-to-Image Distance (SID): 40 inches

Grid: Based on facility protocol

Collimation: 1” on sides & 1.5” beyond both joints.

Flex the affected knee and rotate the lower leg laterally

Flex the ankle, centering the lower leg on the image receptor

Categorize the AP knee projections:

Source-to-Image Distance (SID): 40 inches

IR- 10 × 12 inches & lengthwise

Tabletop or Bucky, depending on the size of the patient's knee and protocol

Collimation: 8 x 10” ; 1” on sides.

Remove radiopaque objects from the anatomy of interest

Keep the leg straight, ensuring the femoral condyles are parallel with the image receptor

Extend the knee, centering the knee on the image receptor

Keep the leg extended rotating the knee laterally 45°

Keep the leg extended rotating the knee medially 45°

Categorize the knee projections:

X-ray Tube:Based on pelvic measure: <19 cm: 3 – 5° caudad 19 – 24 cm: 0° >24 cm: 3 – 5° cephalad

70 (+/- 5) Non-Grid / 85 kVp (+/- 5) Grid

Shielding- Based on facility protocol

Image Evaluation- free of motion

Image Eval- symmetric femoral condyles and an open femorotibial joint space

Image Eval- Visualization of the tibia intercondylar eminence

Central Ray Directed to a point 1/2 inch inferior to the patellar apex

Image Eval- tibia laterally superimposed by the fibula

Image Eval- Visual of tibial plateaus, medial femoral & tibial condyles, & an open knee joint

Categorize the patella projections:

Source-to-Image Distance (SID): 40 inches

Adjust leg so patella is parallel to IR (requires 5-10° lateral heel rotation)

Flex knee until patella is perpendicular to the image receptor

Central Ray (CR) Perpendicular to midpopliteal area Exits patella

IR & Collimation for Intercondylar Fossa projections: (*= second choice)

*Image receptor lengthwise, tabletop

*Collimation: 8 x 10 inches ; 1” beyond sides

Image receptor lengthwise, tabletop

Collimation: 8 x 10 inches ; 1” beyond sides

Image receptor lengthwise, bucky or tabletop

Categorize the POSITIONING for the patella projections:

Choose safe position- stand, knee on stool; knee flex on IR; knee over IR

Place the anterior knee surface on the IR.

Flex knee 70° from full extension.

Flex knee 40° or 50°, with foot supported.

Keep leg aligned without rotation.

Rest the patient on the table, affected leg lying over a raised sandbag

Flex knee over the IR; long axis of femur forms 60° angle to long axis of tibia

Categorize the CENTRAL RAY for the patella projections:

Perpendicular to the tibia-fibula

Enters superior to the popliteal fossa and exits at the patellar apex.

Enters at the popliteal fossa and exits at the patellar apex

X-ray Tube: Tube angle 40° caudad for 40° flexion or 50° caudad for 50° flexion

X-ray Tube: Tube angle to be perpendicular to the long axis of the lower leg

Categorize the IMAGE EVALUATIONS for the patella projections: (*=2nd answer)

Open intercondylar fossa and knee joint

Tibial plateaus and intercondylar eminence in profile.

No patellar apex superimposition or rotation.

* Open intercondylar fossa and knee joint

*Tibial plateaus and intercondylar eminence in profile

*No patellar apex superimposition or rotation

Anatomy demonstrated of the open intercondylar fossa

Visualization of the intercondylar eminence and knee joint

Categorize the Knee Projections:

Tabletop or Bucky, depending on the size of the patient's knee and protocol

Central Ray Directed to the knee joint 1 inch distal to the medial epicondyle

Technical Factors 70 (+/- 5) Non-Grid / 85 kVp (+/- 5) Grid

Position- Stand with back against a vertical grid, Center knees to IR

Position- Toes pointing fwd, feet apart for balance, Knees extended, weight evenly on both feet

IR centered ½ inch below patellar apices

Central Ray (CR) Horizontal and perpendicular to center of IR

CR Enters at a point ½ inch below patellar apices

Categorize the FEMUR projections:

Top of the image receptor at the level of the ASIS

Collimation: 1” on sides ; 17” in length

Supine, pelvis free from rotation

CR perpendicular to IR & midshaft of femur

Technical Factors: 87.5 kVp (+/- 5)

Rotate the femur internally 10° - 15°, keeping the femoral neck in profile

Allow the femur to relax, turning externally while keeping the epicondyles parallel with the IR

Categorize the FEMUR projections:

Collimation: 1” on sides ; 17” in length

Technical Factors: 87.5 kVp (+/- 5)

CR perpendicular to IR & midshaft of femur

Top of the image receptor at the level of the ASIS

Turn the patient to the affected side, rotating the pelvis and the affected leg laterally

Flex the knee, rotating the affected knee to the lateral side

Bottom of image receptor 2” below knee joint

Which collimation for each projection?

AP Knee & PA Axial (Holmblad & Camp C)

What projection is this?

AP Oblique Knee (Lateral rotation)

What projection is this?

AP Oblique Knee (Lateral rotation)

What projection is this?

AP Oblique Knee (Lateral rotation)

What projection is this?

AP Oblique Knee (Lateral rotation)

What projection is this?

AP Oblique Knee (Medial rotation)

PA Axial Intercondylar fossa (Holmblad Method)

Lower Extremities 2

Authored by Natasha Williams

Other

Professional Development

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CATEGORIZE QUESTION

10 mins • 1 pt

Categorize the characteristics of the TIBIA & FIBULA

Groups:

(a) TIBIA

(b) FIBULA

weight bearing

2nd largest bone in the body

NON weight bearing bone

located on the medial side

located on the lateral side, slightly posterior

MULTIPLE CHOICE QUESTION

10 mins • 1 pt

TRUE OR FALSE- The tibia is characterized as a LONG bone.

TRUE

FALSE

DROPDOWN QUESTION

10 mins • 1 pt

Proximal end features of the tibia: (a) and lateral
condyles; (b) surfaces articulate with the (c)

medial

superior

femur

posterior

fibula

CATEGORIZE QUESTION

10 mins • 1 pt

Categorize the TIBIAL TUBEROSITY and the ANTERIOR CREST

Groups:

(a) TIBIAL TUBEROSITY

(b) ANTERIOR CREST

attachment point for muscles

sharp ridge on the anterior surface of the tibial body

located on the anterior surface, just below the condyles

starts at the tibial tuberosity

MATCH QUESTION

10 mins • 1 pt

Match the DISTAL TIBIA features

Palpable landmark at the distal end

Distal Tibiofibular Joint

Onthe anterolateral surface, overlap fib

Medial Malleolus

depression for articulation w/distal fib

Fibular Notch

Slightly movable (amphiarthrotic)

Anterior Tubercle

DRAG AND DROP QUESTION

10 mins • 1 pt

Fibula- long, slender, (a) bone; the head ( (b) end) articulates with the tibia's (c) at the proximal (d) joint.

nonweight bearing

proximal

lateral condyle

tibiofibular

weight bearing

posterior

CATEGORIZE QUESTION

10 mins • 1 pt

Categorize the FIBULA features:

Groups:

(a) APEX

(b) LATERAL MALLEOLUS

cone shaped projection on the lateral, posterior head

distal end, part of the ankle mortise

extends lower than the media malleolus

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Lower Extremities 2

Categorize the characteristics of the TIBIA & FIBULA

TRUE OR FALSE- The tibia is characterized as a LONG bone.

Proximal end features of the tibia: (a) and lateral
condyles; (b) surfaces articulate with the (c)

Categorize the TIBIAL TUBEROSITY and the ANTERIOR CREST

Match the DISTAL TIBIA features

Fibula- long, slender, (a) bone; the head ( (b) end) articulates with the tibia's (c) at the proximal (d) joint.

Categorize the FIBULA features:

The knee joint is the (a) joint.
T/F:
1. Formed by the femoral condyles and tibial plateaus (b)
2. Smallest joint in the body (c)
3. (d) modified- hinge joint (e)
*is second TRUE

Label the ligaments in the knee joint:

The (a) in the knee joint (b) & cushion the knee; they are located in the tibial (c) and include the (d) and (e) meniscus.

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Lower Extremities 2

Categorize the characteristics of the TIBIA & FIBULA

TRUE OR FALSE- The tibia is characterized as a LONG bone.

Proximal end features of the tibia: ​ (a) and ​ lateralcondyles; ​ (b) surfaces articulate with the ​ (c)

Categorize the TIBIAL TUBEROSITY and the ANTERIOR CREST

Match the DISTAL TIBIA features

Fibula- long, slender, ​ (a) bone; the head (​ (b) end) articulates with the tibia's ​ (c) at the proximal ​ (d) joint.

Categorize the FIBULA features:

The knee joint is the ​​ ​ (a) joint.T/F:1. Formed by the femoral condyles and tibial plateaus ​ (b) 2. Smallest joint in the body ​ (c) 3. ​ (d) modified- hinge joint ​ (e) *is second TRUE

Label the ligaments in the knee joint:

The ​ (a) in the knee joint ​ (b) & cushion the knee; they are located in the tibial ​ (c) and include the ​ (d) and ​ (e) meniscus.

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Proximal end features of the tibia: (a) and lateral
condyles; (b) surfaces articulate with the (c)

Fibula- long, slender, (a) bone; the head ( (b) end) articulates with the tibia's (c) at the proximal (d) joint.

The knee joint is the (a) joint.
T/F:
1. Formed by the femoral condyles and tibial plateaus (b)
2. Smallest joint in the body (c)
3. (d) modified- hinge joint (e)
*is second TRUE

The (a) in the knee joint (b) & cushion the knee; they are located in the tibial (c) and include the (d) and (e) meniscus.