Lower Extremity Critiques -- File 01
AP and Lateral (Cleaves unilateral) Hip
Image #20 & Image # 20A File # 01
Critique: While the AP projection includes the anatomical structures comprising the
“anatomical hip,” the cassette should be positioned only 1" superior to the iliac crest. In cases
of suspected hip fracture, which is the usual case, the cassette and CR must be centered to the
hip joint, which would would include more of the proximal femur. Compare to page 343 - Vol I.
The lateral (unilateral Cleaves) demonstrates the femoral neck and is correctly centered and
positioned. Note the usual depiction of the femoral neck, acetabulum, inferiorly positioned
lesser trochanter, superiorly positioned greater trochanter and the medially-inferiorly positioned
ischial tuberosity. Compare to pages 366 - 369, Vol I .
AP Hip
Image # 35 File # 01
Critique: Note the failure to invert the feet/lower leg ≈ 15-20 0 which results in anteversion of
the proximal femur, which is evidenced by the clear appearance of the lesser trochanter. This
error is probably due to the severe arthritic changes present in the hip, which the radiographer is
often unable to control.
In this projection, the lesser trochanter is minimally, at best, demonstrated – an important
landmark in assessing proper inversion of the feet/lower leg. Also note the greater trochanter is
not truly in profile. Compare to page 366 - 367 - Vol I.
Lateral Knee
Image # 37 File # 01
Critique: Patient rotated posteriorly as evidenced by the lack of super- imposition of the medial
condyle (anteriorly, posteriorly and inferiorly) with subsequent encroachment upon the joint
space. Also note increased knee flexion would be desirable. Compare to page 312 - 313 Vol I .
Complete Femur Series
Criteria: (Image 1) AP proximal femur
(Image 2) AP mid and distal femur
(Image 3) Lateral (Cleaves)
(Image 4) Lateral mid and distal femur
Image # 13 A
Image # 13 B
Image # 13 C
Image # 13D
File # 01
File # 01
File # 01
File # 01
All images correctly positioned with proper CR and cassette alignment and centering. Note the
inferiorly placed medial condyle due to the CR centering at the diaphysis portion of the femur,
as it should be. Compare to page 336, 337, 338 , 339 - Vol. I.
Lateral Knee
Image # 36 File # 01
Critique: Anterior rotation of the knee as evidenced by the posterior placement of the medial
condyle, which obscures the knee joint. Compare to 312 - 313 - Vol. I.
Lateral Ankle
Image # 38 File # 01
Critique: Lack of dorsiflexion. Could be due to orthopedic alignment/reduction plate. Compare
to page 2292 - 293 - Vol I.
Lateral Ankle
Image # 9
File # 01
Critique: Incorrectly positioned lateral ankle, which is evidenced by the posterior placement of
the distal fibula. However, there is appropriate dorsiflexion. Compare to page 292 - 293 - Vol I.
AP and Oblique Ankle
Image # 39 File # 01
Critique: AP ankle demonstrates minimal foot inversion and insufficient dorsiflexion with
subsequent failure to open ankle mortis joint. Oblique demonstrates lack of dorsiflexion causing
the lateral malleolus to encroach upon the talus.
Comments regarding minimal foot inversion on AP ankle projections are intended to
suggest that the intermalleolar line is not with the plane of the film/table. Hence, there is
rotation from the normal anatomical position.