anatomy of the lower extremity in computed tomography michael c. ficorelli, rt
TRANSCRIPT
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Anatomy of the Lower Extremityin Computed Tomography
Michael C. Ficorelli, RT
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Lesson Description
To explain the various exams pertaining to the lower extremity using computed tomography, incorporating cross sectional anatomy from images
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Lesson Description
• To be able to identify anatomy of the lower extremity. Understand the clinical indications for exams of the abdomen. To understand the methods of patient scanning, positioning, and protocols. To understand indications for contrast.
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CT of the Lower Extremity(Hip, Knee, Ankle, Foot)
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Ankle and Foot Bony Anatomy• 7 Tarsal Bones
– Talus – responsible with the calcaneus for bearing weight; wedge shaped body with upper surface (trochlea) which articulates with Tibia and Fibula
– Calcaneus – Largest tarsal, prominence of the heel, tuberosity which is insertion for ligaments and tendons (Achilles)
• Sustentaculum Tali – medial surface which supports the talus• Sinus Tarsi – canal from articulation between talus and calcaneous
– Navicular, Cuboid, Lateral Cuneiform, Intermediate Cuneiform, Medial Cuneiform
• 5 Metatarsals• 14 phalanges – 3 for each toe except hallux (2)• Distal Tibia – Medial malleoli• Distal Fibula – Lateral malleoli
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Ankle and Foot Anatomy
• Arches:– Longitudinal arch: Two parts – lateral and medial
– Provides firm base for support– Transverse arch: Distal row of tarsals (Cuboid, 3
cuneiforms) and bases of metatarsals creating dome – major weight bearing arch
• Important:– Retinacula – sheaths of tendons around the ankle– Fascia – thickened area on plantar surface
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Foot Anatomy
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Foot Anatomy
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Ankle Joint
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Knee Bony Anatomy
• Made up of:– Distal Femur – lateral and medial condyle and epicondyle
• Smooth anterior surface for articulation with the patella• Posterior - intercondylar fossa• Adductor tubercle – above medial epicondyle attachment for adductor
magnus– Tibia – widened proximal end with medial and lateral condyles
• Tibial Plateau – widened medial and lateral surfaces for articulation with femur
• Intercondylar eminence (Tibial Spine) – between the plateaus with two peaks (tubercles)
• Tibial Tuberosity – site of attachment of patellar ligament anteriorly– Fibula – long thin bone
• Head – apex, sharp and superior with surface that articulates with the lateral condyle of the tibia
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Knee Anatomy• Patella
– Largest sesamoid in the body– Flat triangular bone with base proximal and apex distal
• Joint – 2 separate articulations – Femorotibia and Patellofemoral– Capsule – strong, fibrous membrane reinforced by extracapsular
ligaments• Anteriorly blends with quadriceps tendon
– Synovial membrane is largest synovial cavity of the body– Menisci – (2) found between femoral condyles, connective tissue
• Medial – attached to MCL, less mobile• Lateral – closed ring
– Ligaments – External and Internal• External – MCL, Lateral Collateral, Patellar• Internal – ACL, PCL
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GROSS KNEE ANATOMY
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KNEE ANATOMY
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KNEE ANATOMY
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KNEE ANATOMY
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KNEE ANATOMY
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KNEE ANATOMY
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Ankle / Foot Protocol
• Lung nodules• Cancer• Vascular disease• Effusion and infiltration• Trauma• Pulmonary Parenchymal diseases• Hilar Masses
Parameters Single Slice 4 SLICE 16 SLICE
PATIENT FEET FIRST. SUPINE SAME SAME
SCANNING AREA
DEPENDS ON WHAT PART
SAME SAME
CONTRAST 100ML AT 1-2ML/SEC SAME SAME
DETECTOR COLLI NA 0.5MM 16X0.75
DFOV 14-18 SAME SAME
SLICE THICKNESS 16-20 MM SAME SAME
ANGLE NONE SAME SAME
TABLE FEED/ROT 3MM VARIES VARIES
PITCH 1 VARIES VARIES
ROT TIME 1 -2 SEC 0.75 SEC 1.5SEC
RECON STANDARD/BONE SAME SAME
WINDOW 450W/30L—2000W/200L
SAME SAME
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Coronal Foot
1 – Calcanous2 – Talus3 – Navicular4 – Medial Cuneiform5 – Base of 1st MT6 – 2nd MT7 – 2nd Prox Phalanx8 – 2nd Middle Phalanx9 – 2nd Distal Phalanx10 – 5th MTP Joint11- Navicular
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Coronal Foot
1 – Base of 5th MT2 – Cuboid3 – Calcaneus4 – Navicular5 – Medial Cuneiform6 – 1st MT7 – 1st Prox Phalanyx8 – 1st Distal Phalanyx9 – 2nd Middle Phalanyx10 – 4th MT Head
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AXIAL ANKLE
1
2 1- Fibula
2- Tibia
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AXIAL
12 3
1- Lateral malleolus
2- Tallus
3- Medical malleolus
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AXIAL
1
2
3
1- Talus
2- CALCANUS
3- NAVICULAR
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AXIAL
1
2
1- CUNEIFORM BONES
2- CUBOID BONE
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SAGITAL MPR
12
3
4
5
6
1- TALUS
2- SINUS TARUS
3- CALCANEUS
4- CUBOID
5- CUNEIFORM
6- NAVICULAR
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CORONAL MPR
1
2
3
4
5
1- LATERAL MALLEOLUS
2- TALAR JOINT
3- MEDICAL MALLEOLUS
4- TALLUS
5- CALCANEOUS
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CORONAL MPR
1
1- Calcaneous
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BONE VS SOFT TISSUE
BONE SOFT TISSUE
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KNEE
1
1- FEMUR
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KNEE
1
2
3
4
1- Medial condyle
2- Patella
3- Lateral condyle
4- intercondylar fossa
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KNEE
1
1- Tibial Plataeu
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KNEE1
2
1-Tibia
2- Head of fibula
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CORONAL KNEE
1
2
3
1- Intercondylar fossa
2- Tibial plateau
3- Condyle of femur
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PROTOCOL FOR HIP AND BONY PELVIS
• Lung nodules• Cancer• Vascular disease• Effusion and infiltration• Trauma• Pulmonary Parenchymal diseases• Hilar Masses
Parameters Single Slice 4 SLICE 16 SLICE
PATIENT FEET FIRST. SUPINE SAME SAME
SCANNING AREA CREST TO PUBISABOVE JOINT TO BELOW LESSER TUBEROSITY
SAME SAME
CONTRAST 100ML AT 2ML/SEC @ 30 SECOND DELAY
SAME SAME
DETECTOR COLLI NA 4 X 1MM 16 X 0.75
DFOV DEPENDS ON PATIENT FOR PELVIS/ 20 CM FOR HIP
SAME SAME
SLICE THICKNESS 5 MM SAME SAME
ANGLE NONE SAME SAME
TABLE FEED/ROT 3-5 MM VARIES VARIES
PITCH 1 OR 1.6 VARIES VARIES
ROT TIME 1- 2SEC 0.75 SEC 1 SEC
RECON STANDARD/BONE SAME SAME
WINDOW 450W/30L—1600W/600L SAME SAME
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HIPS
1
2
3
4
5
1- Head of Femur
2- Acetabulum
3- Fovea Capitis
4- Pubic Bone
5- Ischium
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HIPS
1- Pubic Ramus
2- Femoral Neck
3- Ischial Tuberosity
4- Greater Trochanter
1
2
34
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HIPS
1
2
1- Symphysis Pubis
2- Lesser Trochanter
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HIPS
11- Pubic Bone
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HIP CORONAL MPR
1
2
1- SYMPHYSIS PUBIS
2- PUBIC BONE
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HIP CORONAL MPR
1
2
3
4
1- Greater Trochanter
2- Acetabulum
3- Femoral Neck
4- Lesser Trochanter
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BONY PELVIS
1- Sacrum
2- Ilium
3- S.I. Joint1
2
3