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Radiographic Positioning


Adult
Other related pages of interest

Name of projection Ankle - Mortise
Area Covered Distal third of the tibia and fibula, proximal half of the metatarsals, lateral and medial malleoli
Pathology shownFractures, dislocations
Radiographic AnatomyAnkle Radiographic Anatomy
IR Size & Orientation 24 x 30cm
Landscape, divided in two usually fits two ankle projections, use lead masking for unused area
Film / Screen Combination Detail
(CR and DR as recommended by manufacturer)
Bucky / Grid No
FilterNo
Exposure 60 kVp
3.2 mAs
FFD / SID 100cm
Central Ray Midway between the malleoli
Perpendicular to the IR
Collimation
  • Centre: Tibiotalar joint
  • Shutter A: Open to include the distal 1/3 of the fibula and the proximal metatarsals
  • Shutter B: Open to include the lateral skin margins
Markers Distal and Lateral
markerMarker orientation AP
Shielding Gonadal (check your department's policy guidelines)
RespirationNot applicable
Positioning
  • Patient's leg fully extended
  • Lower leg in AP position, dorsiflex foot
  • Internally rotate entire leg and foot 15 degrees until the malleoli are equidistant to the IR, that is, they are parallel to the IR (this usually brings the little toe directly over the centre of the heel)

Critique

Positioning
  • The correct positioning is evidenced by
  1. The lateral and medial malleoli are shown in profile
  2. There is some minor imposition of the distal fibula over the tibia
  3. There lateral mortise space is open, as there is no superimposition of the talus over the fibula
  4. The tibiotalar joint space is open
Area Covered
  • Distal 1/3 of the fibula and tibia, lateral and medial malleoli, talus, proximal metatarsals, soft tissue and skin margins of the ankle
Collimation
  • Centre: Tibiotalar joint
  • Shutter A: Open to include the distal 1/3 of the fibula and the proximal metatarsals
  • Shutter B: Open to include the lateral skin margins
Exposure
  • Bony trabecular patterns and cortical outlines are sharply defined
  • Soft tissues are visualised
Special NotesThe effect of too little leg and foot rotation
  • The lateral mortise will be closed
  • The medial mortise will be open

The effect of too much leg and foot rotation
  • The image will look more like an Oblique Ankle view, that is
  • The medial mortise will be closed
  • The sinus tarsi will be shown