Radiography anatomy. Osun state university students. Group leader - Ayomisola Lecturer in charge - Dr Bakre

1. Radiographic Anatomy of the
Lower Limbs
Course code: RAD 301
Course Lecturer: : Honourable A.F.K Bakare
Group: Group 2
Department: Radiography and radiation
sciences

2. Outline
• Introduction
• Radiographic density
• Lower limbs anatomy
• Visible anatomical parts on a radiograph
• Obscure structures of the lower limbs
• Salient points on the lower limb radiograph
• Uses of the lower limbs x-ray
• Basic lower limbs x-ray views/projections
• Preparation for lower limb x-ray examination
• Indication for lower limbs x-ray
• Basic lower limbs x- ray pathologies
• References

3. Introduction
• In conventional radiography, x-rays passed
through the human body are absorbed, which
causes attenuation of the incident beam. The
uniform x-ray beam emitted from the source is
modulated as it passes through the human body
and these changes are recorded on the film.
• The lower limbs mostly undergo conventional
radiography except in special cases where
contrast agents are used e.g angiography of the
lower limbs

4. Radiographic density
Radiographic density is the degree of blackening or
opacity of an area in a radiograph due to the
accumulation of black metallic silver following exposure
and processing of a film. There are 5 basic densities on a
radiograph. They range from black to white with air being
the most radiolucent (Black) and metal the most radio
opaque (white)
• Gas/air
• Fat
• Water(soft tissues)
• Bone
• Metals

5. Lower limbs anatomy
Since the radiographic anatomy of the lower limbs involves the viewing
of the denser parts of the lower limbs, we’ll be explaining the anatomy
of the lower limbs briefly. There are 30 bones in the lower limbs and
they can divided into;
• Femur
• Patella
• Tibia
• Fibula
• Tarsal bones (7)
• Metatarsals (5)
• Phalanges (14)
The lower limb also contains muscles, fascia, blood vessels, lymphatics
and nerves. Most of these structures can’t be seen visibly on an x-ray
without the use of contrast agents.

6. Visible anatomical parts on a
radiograph of the Lower limbs
AP radiograph of the lower limbs

7. Visible anatomical parts on a
radiograph of the Hip joint
AP radiograph of the hip joint

8. Visible anatomical parts on a
radiograph of the Knee joint
Lateral radiograph of the knee joint

9. Visible anatomical parts on a
radiograph of the Knee
Annotated antero-posterior radiograph of the knee

10. Visible anatomical parts on a
radiograph of the Tibia and fibula
Annotated antero-posterior radiograph of the tibia & fibula

11. Visible anatomical parts on a
radiograph of the Ankle joint
Annotated lateral radiograph of ankle

12. Visible anatomical parts on a
radiograph of the Ankle joint
Annotated antero-posterior radiograph of ankle.

13. Visible anatomical parts on a
radiograph of the Foot
Annotated dorsi-plantar radiograph of the foot

14. Visible anatomical parts on a
radiograph of the Foot
Annotated lateral radiograph of the foot

15. Obscure structures of the lower limbs
• Veins and some arteries
• Lymphatics
• Nerves

16. Salient points on the lower limb
radiograph
• The quadriceps femoris is seen as a light gray
shadow connected to the patella on a lateral
radiograph of the knee joint
• The other muscles and fascia of the lower
limbs are seen as white shadows on the lateral
sides of the bones
• The patella is seen as a white triangular
shadow on the Tibio-femoral junction on the
antero-posterior radiograph of the knee.

17. Uses of the lower limbs x-ray
• To discover fracture and dislocations
• To diagnose fractures and dislocations
• Diagnose pathological conditions
• Discover foreign objects (e.g. bullets)
• To determine accurate positioning of
prosthetic limbs and braces

18. Basic lower limbs x-ray
views/projections
Antero-posterior view(AP)
• This view is one of the standard views of lower limbs radiographic
procedures.
• The projection is performed with the patient standing with the posterior
aspect of the limb facing the detector.
• It can also be performed on patients that are lying in the supine position
with the cassette placed underneath the portion of the limb that needs to
be scanned
• The Antero-posterior projection is usually carried out on examination of
the ankle, tibia, fibula, knee joint, femur and hip joint.
Advantages
• It can also be performed on patients that are not capable of standing erect
• It is comfortable
Disadvantages
• It can increase dose to patient if x-ray beam collimation is impossible

19. Basic lower limbs x-ray
views/projections
Patient positioning for antero-posterior (AP) femur; CR
cassette directly under femur.

20. Basic lower limbs x-ray
views/projections
Lateral view
• The lateral view is another standard view of lower limbs
radiographic procedures.
• The projection is performed with the patient standing or lying down
with the medial or lateral aspect of the lower limb facing the
detector
• The lateral projection is usually carried out on examination of the
foot, calcaneus, ankle, tibia, fibula, knee joint and femur.
Advantages
• It can also be performed on patients that are not capable of
standing erect
Disadvantages
• Lateral projections might have uncomfortable positions

21. Basic lower limbs x-ray
views/projections
Patient positioning for lateral knee

22. Basic lower limbs x-ray
views/projections
Dorsi-plantar view
• This view is standard for radiographic
examinations of the foot.
• The x-ray beam enters the foot via the dorsal
aspect and leaves the foot via its planar aspect
before entering the cassette.
• The projection is performed with the patient
on the x-ray table with plantar aspect of the
foot on the detector

23. Basic lower limbs x-ray
views/projections
Patient positioning for dorsi-plantar (DP) foot

24. Basic lower limbs x-ray
views/projections
Postero-anterior view(PA)
• The projection is performed with the patient with
the anterior aspect of the limb facing the
detector
Patient positioning for Postero-anterior patellar projection

25. Preparation for lower limb x-ray
examination
X-rays are standard procedures. In most cases, you won't
need to take special steps to prepare for them. You can
eat and drink as normal beforehand and can continue
taking your usual medications. However there are some
physical preparations that are done before the
examination. These include:
• Undressing the lower limbs or the part of the limb that
needs examination (except underwear)
• Removal of jewellery and adornments (anklets, waist
beads etc.) around area of examination as they can
show up on an X-ray
• Wearing of gonad shields when necessary

26. Indication for lower limbs x-ray
• Bone disease
• Bone cancer
• Suspected metastasis
• Arthritis
• Osteoporosis
• Trauma
• Chronic pain in lower limb
• Pre-employment medical screening
• Check position of bullets, prosthetic limbs and braces
etc
• Exclude radiopaque foreign bodies.

27. Basic lower limbs x- ray pathologies
• Bone cyst - Fluid-filled cyst with a wall of fibrous tissue
• Dislocation - Displacement of a bone from the joint
space
• Fracture - Disruption in the continuity of bone
• Pott fracture - Avulsion fracture of the medial
malleolus with loss of the ankle mortise
• Jones fracture - Avulsion fracture of the base of the
fifth metatarsal
• Calcaneal fracture – comminuted fracture of the
calcaneus
• Talar fracture – fracture of the talus

28. Basic lower limbs x- ray pathologies
• Gout - Hereditary form of arthritis in which uric acid is
deposited in joints
• Metastases - Transfer of a cancerous lesion from one area
to another
• Osgood-Schlatter disease - Incomplete separation or
avulsion of the tibial tuberosity
• Osteoarthritis or degenerative joint disease - Form of
arthritis marked by progressive cartilage deterioration in
synovial joints and vertebrae
• Osteomalacia or rickets - Softening of the bones owing to
vitamin D deficiency
• Osteomyelitis - Inflammation of bone owing to a pyogenic
infection

29. Basic lower limbs x- ray pathologies
• Osteoporosis - Loss of bone density
• Tumor - New tissue growth where cell proliferation is uncontrolled
• Chondrosarcoma - Malignant tumor arising from cartilage cells
• Anterior metatarsalgia – pain in metatarsal portion of foot
• Osteosarcoma - Malignant, primary tumor of bone with bone or
cartilage formation
• March fracture - It is a stress fracture, usually of the necks of the
2nd and 3rd metatarsals, due to unaccustomed walking, sometimes
seen in new army recruits.
• Congenital abnormalities - Developmental abnormalities include
limb defects, such as overgrowth and fusion, as well as congenital
dislocation of the hip and bilateral coxa and genu vara and valga.

30. Basic lower limbs x- ray pathologies
Osteoarthritis of the hip

31. Basic lower limbs x- ray pathologies
A normal knee Osteoarthritis of the knee

32. Basic lower limbs x- ray pathologies
AP radiograph of femur, hip down,
showing fracture of upper femoral shaft
Axial projection of calcaneus, showing a
comminuted fracture. The calcaneus is
often fractured as a result of axial
loading, typically from a fall from a
height.

33. Basic lower limbs x- ray pathologies
Congenital hip dislocation occurs as a result of developmental dysplasia of
the hip (DDH). It occurs when the Acetabulum is shallow as a result of failure
to develop properly in uterus

34. Basic lower limbs x- ray pathologies
Acquired dislocations of the hip joint. These are relatively
uncommon, owing to the strength and stability of the joint.

35. Basic lower limbs x- ray pathologies
Osgood-schlatter disease Neck fracture of the femur

36. References
• Clark's Positioning in Radiography 13th Ed.pdf
• https://www.google.com/url?sa=t&source=web&
rct=j&url=https://sites.google.com/site/thehistor
yofxray/projects/density&ved=2ahUKEwiKwvL-
nN78AhVmgv0HHTbHB4wQFnoECA4QAQ&usg=A
OvVaw0HAuWyfYd_wXVdYTJ9h5d5
• https://www.imaios.com/en/e-anatomy/lower-
limb/radiography-lower-extremity