Film Critique of the Lower Extremity
AP Toe
 Soft tissue structures of the toe and 1/3 to 1/2 of the metatarsals should be included
 The cortex and trabeculae should be visualized and clear
 The long axis of the foot should be parallel to the long axis of the film
 PIP and MTP joints should be open and well demonstrated
 The proximal phalanges should exhibit symmetrical curvatures on the medial and lateral
sides
Oblique
 Soft tissue structures of the toe and 1/3 to 1/2 of the metatarsals should be included
 The cortex and trabeculae should be visualized and clear
 The long axis of the foot should be parallel to the long axis of the film
 PIP and MTP joints should be open and well demonstrated
 The lateral aspect of the proximal phalanges should exhibit greater concavity than the
medial side
Lateral
 Soft tissue structures of the affected toe, MTP joint, and distal metatarsal should be
included
 The cortex and trabeculae should be visualized and clear
 The long axis of the foot should be parallel to the long axis of the film
 The IP joint should be open and well demonstrated
AP Foot
 Soft tissue structures of all toes and tarsals should be included in the collimated area
 The cortex and trabeculae should be visualized and clear
 The long axis of the foot should be parallel to the long axis of the film
 The PIP joints, MTP joints, medial cuneiform, and navicular should be well demonstrated
 The metatarsals should exhibit symmetrical curvatures on the medial and lateral sides
Oblique Foot
 Soft tissue structures of all toes and tarsals should be included in the collimated area
 The cortex and trabeculae should be visualized and clear
 The long axis of the foot should be parallel to the long axis of the film
 The bases of the 1st and 2nd metatarsals should be superimposed while the bases of the 3rd,
4th, and 5th should be free or nearly free of superimposition
 The lateral intertarsal joints, cuboid, lateral cuneiform, and sinus tarsi should be well
demonstrated
 The lateral aspect of the metatarsals should exhibit greater concavity than the medial side
Lateral
 Soft tissue structures of all toes and tarsals should be included in the collimated area
 The cortex and trabeculae should be visualized and clear
 The long axis of the foot should be parallel to the long axis of the film (or diagonally
placed on film if patient’s size prohibits parallel placement)
 The metatarsals should be almost superimposed with the base of the 5th metatarsal
extending slightly more inferiorly due to the transverse arch of the foot
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The fibula should be under the posterior aspect of the tibia
Axial Calcaneous
 Soft tissue structures of the calcaneous and subtalar joint should be included
 Cortex and trabeculae should be visualized and clear; density and penetration
should be sufficient to visualize subtalar joint
 Long axis of the calcaneous should be parallel to the long axis of the film
 Metatarsals should not be visualized lateral to the foot
Lateral
 Soft tissue structures of the calcaneous, talus, and navicular, and 1 inch of distal
tib/fib should be included
 Cortex and trabeculae of calcaneous, talus, and navicular should be visible and clear
 Long axis of the lower leg should be parallel with long axis of film
 Fibula should be superimposed by posterior aspect of tibia
AP Ankle
 Soft tissue structures of distal tib/fib and proximal talus should be included
 Cortex and trabeculae should be visible and clear
 Long axis of the lower leg should be parallel with the long axis of the film
 Distal fibula and distal tibia should be slightly superimposed
Internal oblique
 Soft tissue structures of distal tib/fib and proximal talus should be included
 Cortex and trabeculae should be visible and clear; distal tibia and proximal talus should
be well penetrated
 Long axis of the lower leg should be parallel with the long axis of the film
 When the leg is rotated 15-20 degrees, the mortise joint between the proximal talus and
the distal tibia and fibula should be well demonstrated
 When the leg is rotated 45 degrees, the tibiofibular joint should be well demonstrated
Lateral Ankle
 Soft tissue structures of distal tib/fib and proximal talus should be included
 Cortex and trabeculae should be visible and clear; distal tibia and proximal talus should
be well penetrated
 Long axis of the lower leg should be parallel with the long axis of the film
 The fibula should be demonstrated over the posterior portion of the tibia
AP Tib Fib
 Soft tissue structures of the lower leg and at least 1 inch of the distal femur and proximal
talus should be included
 Cortex and trabeculae should be visible and clear
 Long axis of the lower leg should be parallel to long axis of the film; unless using a film
diagonally in order to include both joints
 Both proximal and distal tibia and fibula should be superimposed while the shafts remain
separated
 The medial and lateral condyles of the femur should be symmetrical
Lateral Tib Fib
 Soft tissue structures of the lower leg and at least 1 inch of the distal femur and proximal
talus should be included
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Cortex and trabeculae should be visible and clear
Long axis of the lower leg should be parallel to long axis of the film; unless using a film
diagonally in order to include both joints
Both proximal and distal tibia and fibula should be superimposed while the shaft of the
tibia will be anterior and separate from the fibula
AP Knee
 Soft tissue structures of the distal femur and proximal lower leg should be included
 Cortex and trabeculae should be visible and clear; distal femur and patella should be
penetrated
 Long axis of the leg should be parallel to the long axis of the film
 Both proximal tibia and proximal fibula should be slightly superimposed
 The medial and lateral condyles of the femur should be superimposed
Lateral Knee
 Soft tissue structures of the distal femur and proximal lower leg should be included
 Cortex and trabeculae should be visible and clear; distal femur and patella should be
penetrated
 Long axis of the leg should be parallel to the long axis of the film
 The patella should be projected anterior to the distal femur
 There should be a 150-160 degree angle between the lower let and the femur
 Femoral condyles should be superimposed
Medial Oblique
 Soft tissue structures of the distal femur and proximal lower leg should be included
 Cortex and trabeculae should be visible and clear; distal femur and patella should be
penetrated
 Long axis of the leg should be parallel to the long axis of the film
 Approximately one third to one half of the patella should be projected medial to the distal
femur
 The proximal tibiofibular joint should be well visualized
AP Femur
 Soft tissue structures of the femur and 1-2 inches beyond associated joints should be
included
 Cortex and trabeculae should be visible and clear; proximal femur should be penetrated
 Long axis of the leg parallel to the long axis of the film
 Mid to distal femur – medial and lateral condyles should be symmetrical
 Proximal femur – greater trochanter should be seen in profile laterally; lesser trochanter
should be difficult to visualize medially
Lateral Femur
 Soft tissue structures of the femur and 1-2 inches beyond associated joints should be
included
 Cortex and trabeculae should be visible and clear; proximal femur should be penetrated
 Long axis of the leg parallel to the long axis of the film
 Mid to distal femur – medial and lateral condyles should be superimposed
 Proximal femur – greater trochanter should be superimposed over femoral neck; lesser
trochanter should be seen in profile