Projection radiography of the ankle; the views used for different indications vary between medical imaging departments
Keywords:Imaging procedures, Ankle X-rays, Projection radiography
Plain radiographs are used for initial evaluation of many conditions of the ankle. Many different radiographic views are described in positioning textbooks but evidence on which views to use, in which case, is scarce. The aim of this study was to map imaging procedures related to four indications for ankle projection radiography. A questionnaire was sent to all medical imaging departments in Iceland with questions about acquisition technique for ankle radiography views and which views were used for selected indications. Answer was received from 14 of the 28 departments. All departments gave very similar descriptions of the four most common views. In the case of trauma, all but one department used four views but for control of trauma or operation, four different combinations of views were found using from two to four images. For detrition and osteomyelitis, four views were more common in the larger departments but there was not a statistically significant difference. Eight different combinations of the number of views for the four indications were found. The study indicates that there is a need for standardization in image acquisition protocols. More studies are needed to support decisions about how many views are necessary for the most common ankle radiography indications.
Doody, O. and M.A. Hopper. Imaging of the foot and ankle. Orthopaedics and Trauma, 2014. 28(5): p. 339-349. https://doi.org/10.1016/j.mporth.2014.02.003
Krähenbühl, N., et al. Imaging of the subtalar joint: A novel approach to an old problem. J Orthop Res, 2019. 37(4): p. 921-926. https://doi.org/10.1002/jor.24220
Bontrager, K.L. and J. Lampignano. Bontrangers textbook of radiographic positioning and related Anatomy. 10 ed. 2021: Elsevier.
Whitley, A.S., et al. Clark's Positioning in Radiography. 13. ed. 2015: CRC.
Ballinger, P.W. and E.D. Frank. Merrill's atlas of radiographic positions and radiologic procedures. 8 ed. 1999, St. Louis: Mosby.
Campeau, F. and J. Fleitz, Limited radiography. 4 ed. 2016, Boston: Cengage learning.
Movin, A. and U. Karlsson. Skelettröntgenundersökningar, handbok för röntgenpersonal. 1987, Stockholm: Scandinavian university books, Esselte studium.
Jesse, M.K., K.J. Hunt, and C. Strickland. Postoperative Imaging of the Ankle. American Journal of Roentgenology, 2018. 211(3): p. 496-505. https://www.ajronline.org/doi/10.2214/AJR.18.19600
Mandell, J.C., et al. Osteomyelitis of the lower extremity: pathophysiology, imaging, and classification, with an emphasis on diabetic foot infection. Emerg Radiol, 2018. 25(2): p. 175-188. https://doi.org/10.1007/s10140-017-1564-9
Brandser, E.A., et al. Contribution of individual projections alone and in combination for radiographic detection of ankle fractures. AJR Am J Roentgenol, 2000. 174(6): p. 1691-7. https://www.ajronline.org/doi/10.2214/ajr.174.6.1741691
Szymański, T. and U. Zdanowicz. Comparison of routine computed tomography and plain X-ray imaging for malleolar fractures-How much do we miss? Foot Ankle Surg, 2021. https://doi.org/10.1016/j.fas.2021.03.025
Sharma, B., I.S. Reddy, and C. Meanock. The adult Tillaux fracture: one not to miss. BMJ Case Rep, 2013. 2013. http://dx.doi.org/10.1136/bcr-2013-200105
Hvasshovd, Þ.K. Myndgátin handbók í röntgenmyndgerð. 2009, Reykjavík.
Lampignano, J. and L.E. Kendrick. Bontrager's Textbook of Radiographic Positioning and Related Anatomy. 9. ed. 2016: Elsevier.
Flintham, K., B. Snaith, and L. Field. Review and optimisation of foot radiography technique. Radiography, 2021. 27(2): p. 284-288. https://doi.org/10.1016/j.radi.2020.08.008
Bontranger, K.L. Textbook of radiographic positioning and related Anatomy, 5th ed. 2001: Mosby.
Almén, A. et. al. Establishing paediatric diagnostic reference levels using reference curves – A feasibility study including conventional and CT examinations. Physica Medica, 2021. 87: p. 65-72. https://doi.org/10.1016/j.ejmp.2021.05.035 .
ACR. ACR–SPR–SSR Practice parameter for the perfomance of radiography of the extremeties. 2018; Available from: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Rad-Extremity.pdf
Landspítali Háskólasjúkrahús. 3.02.01 Ökkli. Rmynd-165 [icelandic], 3rd ed. 07.09.2020.
Moeller T.B. and E. Reif. Pocket atlas of radiographic positioning. 2nd ed. 2009. Thieme.
Snaith, B., et al. Variation in pelvic radiography practice: Why can we not standardise image acquisition techniques? Radiography, 2019. 25(4): p. 374-377. https://doi.org/10.1016/j.radi.2019.05.005
Mussmann, B.R., M. Hardy, and J. Jensen. There's nothing plain about projection radiography! A discussion paper. Radiography, 2021. 27(4): p. 1227-1230. https://doi.org/10.1016/j.radi.2021.07.002
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