Projection radiography of the ankle; the views used for different indications vary between medical imaging departments

Jónína Guðjónsdóttir,Silja Haraldsdóttir

doi:10.7577/radopen.4629

Abstract

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.

Highlights

Plain radiographs are used for initial evaluation of many conditions of the ankle [1]
An Icelandic book on radiographic positioning, which has been an important source for radiographers the last three decades, describes four ankle views: AP, mortise, lateral and oblique lateral, but directions about when to use each view are not provided [13]
The results of this study show a small variation in the image acquisition technique for each view, but the technique was generally consistent with positioning textbooks [3,4,5, 7, 14]

Summary

Introduction

Plain radiographs are used for initial evaluation of many conditions of the ankle [1]. Eight standard views of the ankle and subtalar joints have been described, for optimal visualization of different parts of anatomy: antero-posterior [AP] view, mortise view, subtalar view and four different Broden views) [2]. Control after operation, degenerative disease, and osteomyelitis are possible indications for ankle radiography [1, 8, 9]. The literature provides more studies on ankle radiography for fracture diagnosis than other indications. It has been acknowledged that standard views may not clearly show some fractures [12]. An Icelandic book on radiographic positioning, which has been an important source for radiographers the last three decades, describes four ankle views: AP, mortise, lateral and oblique lateral, but directions about when to use each view are not provided [13]

Objectives

Methods

Results

Conclusion