Perfect Lateral Knee X-ray (Lateral Notch at 4:00min mark)

Easily tell which is the medial and lateral condyle and how to reposition for a perfect lateral knee x-ray
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[@pgbear]

Brilliant video! A colleague shared this video with me today. I've been doing radiography in the UK since 1989 and I never knew it was possible to tell which condyle was which. I was told years ago that the sharper condyle is the one nearest the detector and the condyle furthest away is slightly less sharp - the penumbra effect. This is true, but very hard to see on an x-ray. Your method is far clearer. I'd never noticed or realised before that the the femoral condyles are slightly different shapes. Thank you so much. This is a game changer for me. Regarding the very last image, I think that a slightly caudal ( not cephalic) would help superimpose them. The medial condyle is already above the lateral condyle, so angling more cepahlic would make the medial condyle go up even more. Therefore the central ray needs a slight caudal tilt. Do you agree? (Assuming the image was taken with the lateral condyle nearest the detector).

[@4Kxray]

Thank you for the comment! For the last image I do believe a cephalic angle is needed. If we are looking at the same image (11:50) the medial condyle is lower than than the lateral. See min mark 2:50-3:40. Some of my students believe that angling will essentially move both condyles and still be in them situation... but with that mindset angling caudal will do the same thing in the reverse to both condyles. Too much of an angle will make that happen but 3-7 degrees is the sweet spot.

[@rune9055]

This video was incredible helpful, just what I've been looking for. Only suggestion on the last section "x-ray images" is to announce if whether those lateral knee images were medial-lateral Projection or x-table Lateral-medial projection. This is a Great video.

[@4Kxray]

Thank you for the comment and suggestion!

[@Influencepoetry]

Thank you so much ! Keep up the content. Any videos over pelvis/hips, T and L spine ?

[@biliibalaaa5747]

Perfect. Thanks!

[@zerozero5027]

Very nice 👍 been looking for this thanks….

[@togetherness2000]

Excellent video again.

[@LonjeMarie7]

Thank you 🙏🏾

[@andrearatkovic4048]

I always instruct techs to put mediolatetal or lateromedial on all x-tables.

[@4Kxray]

Great suggestion, wish that would be mandatory!

[@m.francis2774]

Thank you for doing this video. I have a question. How can you manipulate the X-ray tube to mimic external or internal rotation for a cross table lateral (shooting mediolateral or lateromedial)when the patient CAN NOT move?

[@4Kxray]

That is a very good question! Think of trauma views as shooting pool/billiards. Sometimes you have to angle the cue stick in different ways to get the ball in the pockets. Same with the xray tube. You often times have to have the tube in a cross table position but angle the tube up (towards the celling) When doing this you may also angle your IR to match. Remember for every 1" of OID you need to compensate by adding 7 inches more SID to avoid the magnification. It's also a good idea to cheat by tricking the patient with your wording. I the patient cannot rotate their leg inwards tell them to rotate/turn their body (in an oblique'ish) position. I say "I need you to turn on your left hip slightly and don't worry your leg will stay in the same position, I will help you". Its usually only 10 degrees needed. Hope this helps!

[@m.francis2774]

@@4Kxray thank you kindly for responding.

[@RED-ZONE11]

Hello, how are you? I have a question, please, what are the materials that x-rays cannot penetrate

[@4Kxray]

Xray cannot penetrate items with a high atomic number such as lead (82). Hope this help!

[@thevoiceharmonic]

There is no material that cannot be penetrated by xrays. Lead doesn't stop much if it is 0.1mm thick, but lead 1mm thick will stop a lot of xrays, and 10mm thick will stop almost all. Then again, there are low energy xrays that are more easily stopped, and high energy ones that are more able to penetrate anything.

[@gabys9197]

Would you do an angle on an x table lateral?

[@4Kxray]

Good question! It all depends on patient position. You can angle the IR and tube on cross tables so no angle is needed and sometimes I find myself doing a up/cephalad angle if they cannot rotate their leg in.

[@gabys9197]

Coming back because im struggling in clinic with this, specially cross table post op knee replacement. Our ortho surgeon wants a true lateral. We always shoot lateromedial. Now would you do a caudad angle if theyre unable to turn their leg in since its lateromedial?@@4Kxray

[@user-tj2jc1kn3o]

😅

[@pharosnearco1713]

撮影した画像を見てからの評価で判断するのでは、何度も再撮影の必要がある。撮影時にどうすれば完全な側面が撮影できるかコツがあるなら知りたい。

[@4Kxray]

コメントありがとうございます。膝を 20 ～ 30 度曲げ、頭側の角度を 5 ～ 7 度にするようにしてください。膝蓋骨を触って、中心光線に対して垂直であることを確認します。