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WorksheetsLower Extremity Positioning: Toes, Sesamoids, and Foot
Total questions: 60
Worksheet time: 30mins
For an AP toes projection, how should the central ray be directed relative to the image receptor?
Perpendicular to the IR
Angled 10 degrees cephalic
Angled 15 degrees caudal
Perpendicular to the third MTP
In an AP axial toes projection, what tube angulation is used?
15 degrees cephalic toward heel
10 degrees cephalic toward toes
20 degrees caudal toward heel
5 degrees caudal toward toes
The centering point for an AP axial toes projection is at which joint?
Third MTP joint
First IP joint
Second PIP joint
Fifth MTP joint
Which structures are best demonstrated on AP axial toes?
Fourteen phalanges and distal metatarsals
Calcaneus and sinus tarsi profile
Talus dome and tibial plafond
Navicular tuberosity and cuneiforms
For a medial oblique toes view, the part rotation should be approximately which range?
30 to 45 degrees
10 to 15 degrees
50 to 60 degrees
5 to 10 degrees
In a lateral toe projection of the great toe, where is the central ray directed?
To the IP joint of the great toe
To the first MTP joint
To the base of third metatarsal
To the calcaneocuboid joint
For lateral projections of toes two through five, the central ray is perpendicular to which joint?
PIP joint of affected toe
DIP joint of affected toe
MTP joint of affected toe
IP joint of great toe
The Lewis and Holly methods are specialized for imaging which bones?
Sesamoids at first MTP
Metatarsal shafts two to five
Talar dome and trochlea
Navicular and cuneiforms
What is the patient position for the Lewis method of sesamoids?
Prone with dorsiflexed toes
Seated with plantar flexion
Supine with knee flexed
Lateral recumbent foot
For the Holly method of sesamoids, the patient is typically positioned how?
Seated with plantar surface on IR
Prone with toes dorsiflexed
Standing on cassette weight-bearing
Supine with knee externally rotated
In sesamoid projections, how is the central ray directed relative to the first MTP joint?
Perpendicular and tangential to the joint
Angled 10 degrees cephalic to joint
Perpendicular to the third metatarsal
Angled 15 degrees caudal to joint
For an AP foot projection, where should the central ray be directed?
Perpendicular to base of third metatarsal
Perpendicular to second cuneiform
10 degrees caudal to first MTP
15 degrees cephalic to navicular
An AP axial foot uses which central ray description?
Angled 10 degrees cephalic entering base of third metatarsal
Perpendicular to the talar dome entering ankle mortise
Angled 15 degrees caudal entering navicular tuberosity
Perpendicular to first MTP entering sesamoids
Which advantage is gained by the AP axial foot over a non-angled AP foot?
Better demonstration of tarsometatarsal joints
Improved view of ankle mortise only
Reduction of medial cuneiform overlap
Isolated profile of the cuboid bone
For an AP axial weight-bearing foot, what is the preferred SID?
48 inches preferred
40 inches standard
72 inches always
36 inches minimum
In a medial oblique foot view, how much rotation is typically required?
30 degrees from IR medially
20 degrees from IR laterally
45 degrees from IR laterally
10 degrees from IR medially
Which structures are best seen on a medial oblique foot projection?
Lateral tarsal joint spaces and cuboid profile
Medial cuneiforms without overlap
Talus fully superimposed on tibia
Sesamoids elongated without distortion
During a lateral foot projection, which foot position helps open the ankle joint?
Dorsiflex the foot
Plantar flex the foot
Invert the forefoot
Evert the hindfoot
For a standard lateral foot projection, the central ray is directed where?
Perpendicular to base of the third metatarsal
Angled 10 degrees cephalic to the ankle
Perpendicular to the first MTP joint
Angled 40 degrees to the calcaneus
What additional information can be assessed on bilateral weight-bearing lateral feet?
Structural status of the longitudinal arch
Integrity of the tibial plafond cartilage
Position of the fibular head in knee
Range of motion of the subtalar joint
For an axial calcaneus projection, which central ray direction is used to best visualize the subtalar joint?
Perpendicular to calcaneus from plantar surface
15 degrees cephalad to ankle mortise
40 degrees cephalad through plantar surface
10 degrees caudad to medial malleolus
In a lateral calcaneus projection, where should centering be directed?
At the lateral malleolus center point
One inch distal to medial malleolus at subtalar joint
Midway between the malleoli anteriorly
Base of the fifth metatarsal proximally
Which structure is demonstrated in profile on a true lateral calcaneus view?
Anterior talofibular ligament complex
Ankle mortise joint with clear tibial plafond
Ankle joint and calcaneus in lateral profile
Tibial plafond and fibular notch superimposed
For an AP ankle projection, what part position is required to minimize rotation?
Foot plantarflexed slightly downward
Foot pointing straight up, dorsiflexed
Foot everted fifteen degrees laterally
Foot inverted thirty degrees medially
The central ray for an AP ankle should pass:
Perpendicular through ankle joint midway between malleoli
Angled 5 degrees cephalad to tibial plafond
Centered at base of fifth metatarsal head
Perpendicular to medial malleolus apex
Which structures are best shown on a proper AP ankle?
Distal tibia and fibula with proximal talus
Entire calcaneus with subtalar joint space
Metatarsal heads and tarsometatarsal joints
Proximal tibia and fibula including knee
For a medial oblique ankle view, the leg is rotated:
15 degrees medially for mortise
25 degrees laterally for syndesmosis
45 degrees medially from AP position
10 degrees medially with plantarflexion
The ankle mortise joint is profiled when the limb is:
Rotated 15 to 20 degrees medially with dorsiflexion
Rotated 45 degrees medially with eversion
Rotated 20 degrees laterally with plantarflexion
Kept AP with toes pointed downward
For the mortise view, the central ray should be:
Perpendicular to ankle joint entering midway between malleoli
Angled 10 degrees cephalad to tibial plafond level
Centered at lateral malleolus posterior border
Perpendicular to the base of the fifth metatarsal
Which positioning error most commonly closes the lateral mortise in a mortise ankle view?
Insufficient medial rotation of the leg
Excessive dorsiflexion of the foot
Insufficient plantarflexion distally
Centering too distal to malleoli
For a lateral ankle projection, where is the central ray directed?
Perpendicular to medial malleolus entry
Perpendicular midway between malleoli anteriorly
Angled 5 degrees caudad to tibiotalar joint
Perpendicular to base of first metatarsal
Which structures are demonstrated on a lateral ankle image when properly positioned?
Ankle joint, tarsals, lower third tibia and fibula
Calcaneus with sustentaculum tali en face
Entire tibia and fibula with both joints
Mortise joint with equal clear spaces
For an AP tibia/fibula projection, the part should be positioned with:
Femoral condyles parallel with IR, foot dorsiflexed
Femoral condyles perpendicular and knee flexed
Patella rotated medially with foot everted
Knee flexed 30 degrees and ankle plantarflexed
The central ray for an AP tibia/fibula is directed:
Perpendicular to center of leg on IR
Angled 10 degrees cephalad to knee joint
Perpendicular to medial malleolus level
Perpendicular to patellar apex center
A lateral tibia/fibula requires the patella to be:
Parallel to IR with epicondyles parallel
Perpendicular to IR with condyles superimposed
Angled 15 degrees to IR with toe up
Aligned to ASIS with knee extended
On the lateral tibia/fibula, where is the central ray aimed?
Perpendicular to midpoint of leg
Angled to medial malleolus entry
Centered at tibial tuberosity level
Perpendicular to fibular head region
Which SID is commonly used for tibia/fibula to include both joints on one image?
30 inches for magnification control
48 inches to include both joints
72 inches to reduce distortion
40 inches standard extremity SID
During a medial oblique ankle, what anatomy becomes superimposed over the talus?
Distal tibia and fibula with tibiofibular overlap
Bases of metatarsals and cuneiform alignment
Distal tibia and fibula parts superimposed over talus
Fibula free of tibial superimposition laterally
Which patient position best describes a lateral ankle projection?
Supine with leg extended and foot dorsiflexed
Turned on affected side, leg and ankle lateral
Prone with knee flexed and foot everted
Seated with knee flexed and foot inverted
To obtain a true AP ankle, which malleolar relationship should be achieved?
Medial malleolus posterior to lateral malleolus
Malleoli equidistant to IR with no rotation
Lateral malleolus anterior to medial malleolus
Medial mortise open with fibula posterior
Which tube angulation is commonly used for an AP knee to account for patient habitus when the ASIS-to-tabletop measurement suggests a thin patient?
5 degrees caudal to the knee joint
5 degrees cephalic to the knee joint
10 degrees caudal to the knee joint
0 degrees perpendicular to the knee joint
For a lateral knee projection, which structure should appear superimposed when the knee is correctly positioned?
Tibial plateaus superimposed exactly
Femoral condyles perfectly superimposed
Patellar apex free of superimposition
Fibular head completely superimposed
Which knee projection best evaluates degenerative joint disease under physiologic load?
Non-weight-bearing AP knee
Cross-table lateral knee
Bilateral weight-bearing AP knees
PA axial Holmblad knee
In the PA axial Holmblad method for the intercondylar fossa, the knee is flexed approximately how much from full extension?
30 degrees from full extension
45 degrees from full extension
60 degrees from full extension
70 degrees from full extension
During the Holmblad method, where should the central ray enter to demonstrate the intercondylar fossa?
Midpoint between femoral condyles
Anterior surface of patella
Superior aspect of the popliteal fossa
Inferior margin of the patellar apex
For the PA axial Camp Coventry method, which central ray description is correct?
40 degrees cephalic to the knee joint
Perpendicular to the femoral shaft
Perpendicular to the long axis of the lower leg
Parallel to the tibial plateau surface
What typical tube angle is used for the Camp Coventry method to project the intercondylar fossa?
20 degrees caudal
30 degrees caudal
40 degrees caudal
50 degrees caudal
For the AP axial Beclere method, what is the relationship between the long axis of the femur and the tibia?
Femur 30 degrees to tibia axis
Femur 45 degrees to tibia axis
Femur 60 degrees to tibia axis
Femur 75 degrees to tibia axis
In a true PA patella projection, how should the patella relate to the image receptor?
Parallel with the IR surface
Perpendicular to the IR
At 15 degrees to the IR
Slightly oblique to the IR
Where is the central ray directed for a PA patella?
To the tibial tuberosity
Perpendicular to the midpopliteal area
Perpendicular to the patellar apex
To the mid patellofemoral joint
For a lateral patella, what knee flexion is recommended to open the patellofemoral joint space while maintaining stability?
0 to 2 degrees flexion
5 to 10 degrees flexion
20 to 30 degrees flexion
45 to 60 degrees flexion
Which landmark alignment indicates a true lateral patella position?
Femoral condyles superimposed
Tibial spines symmetric
Patellar apex centered
Fibular head overlapped
Which method is a tangential projection designed to evaluate vertical patellar fractures and the patellofemoral joint surfaces?
Holmblad method
Settegast method
Beclere method
Camp Coventry method
For the Settegast method, which statement about tube angulation is most accurate?
Fixed 10 degrees cephalic is required
No set angle; typically 15–20 degrees if needed
Always 30 degrees caudal to joint
Always perpendicular regardless of knee flexion
In the AP femur distal projection, how is the affected extremity rotated to place femoral epicondyles parallel with the IR?
Externally rotated 15 degrees
Internally rotated 5 degrees
Internally rotated until epicondyles parallel
No rotation with foot neutral
For the AP femur proximal projection, which rotation best profiles the femoral necks?
Externally rotate 5–10 degrees
Internally rotate 15–20 degrees
No rotation with toes up
Flex the hip 30 degrees
Which centering is appropriate for AP femur imaging to include both joints when possible?
Perpendicular to mid femur and IR center
Perpendicular to knee joint line
Angled 5 degrees to greater trochanter
Centered to the femoral neck
For a lateral distal femur, approximately how much should the knee be flexed?
15 degrees flexion
30 degrees flexion
45 degrees flexion
60 degrees flexion
When positioning for the lateral proximal femur, how should the pelvis be adjusted to prevent superimposition of the proximal femur?
Rotate pelvis 5 degrees anteriorly
Rotate pelvis 10–15 degrees posteriorly
Keep pelvis in true lateral
Tilt pelvis 20 degrees toward table
Which structure set should be clearly demonstrated on a correctly performed lateral femur?
Entire femur and both joints
Lateral projection of three-fourths of femur and adjacent joint
Only distal femur and knee joint
Only proximal femur and hip joint
