Thursday, September 20, 2012

AP Stress Ankle Joint X-ray

Xray examination of ankle in AP stress projection includes Inversion and Eversion Position when performing this procedure proceed with utmost care with injured patient. When performing this projection patient's watchers or the physician must be present to hold the foot and ankle, or the patient may hold and pull the strap looped around the foot. If patient is in trauma, foot is too painful local anesthesis may be injected by the physician. In this position ankle joint separation due to ligament tear or rapture will be demonstrated.

Technical Factors:

ap stress ankle xray
AP Stress
IR size - 24 x 30 cm (10 x 12 inches)
Divide in half, crosswise
Detail screen
Digital IR - use lead masking
60 +- 5 kV range
mAs 6


Place lead shield over gonadal area of patient. Supply lead gloves and a lead apron for the individual who is applying stress if stress position are handled during exposures.

Patient Position:

Take radiograph with patient in the supine position; place pillow under head; leg should be fully extended, with support under knee.

Part Position:

AP stress Inversion

Center and align ankle joint to CR to long axis of potion of IR being exposed.
Dorsiflex the foot as near the right angle to the leg as possible.
Stress is applied with leg and ankle in position for a true AP with no rotation, wherein the entire plantar surface is turned medially for inversion and laterally for eversion (see Note).

Central Ray:

CR perpendicular to IR, directed to a point midway between malleoli.
Minimum SID of 40 inches (100 cm)


Collimate to lateral skin margins, including proximal matatasals and distal tibia-fibula.

CR or DR:

Close collimation and lead masking are important over unused portions of image plate to prevent fogging from scatter radiation to the hypersensitive image plate or receptor.

ap stress radiograph
AP stress (inversion)

Radiographic Criteria: AP Stress

Structure Shown and Position:

AP stress (Inversion) 

Ankle joint for evaluation of joint separation and ligament tear or rupture is shown. The appearance of the joint space may vary greatly depending on the severity of ligament damge.

Collimation and CR:

Mid-ankle joint should be in the center of the collimated field (CR)

Exposure Criteria:

No motion, as evidenced by sharp bony margins and trabecular patterns. Optimal exposure should visualize soft tissue, the lateral and medial malleoli, the talus, and the distal tibia and fibula.

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