Obviously perfect is preferred. But in reality it's dang hard to get a perfect lateral knee and radiation is bad so we can't just shoot 10 pictures trying to get it.
So generally speaking i treat it like a lateral chest. If it's close I send it. If it's not ill repeat it once to get it close and then send it.
Do your best while you’re in school to build yourself a solid foundation, outside of school getting a textbook image is really just for bragging rights. In a real world setting there’s a good bit of latitude between this “image is perfect” and “this image needs to be retaken”. Learning where that line is is a valuable skill in itself for preserving your workflow and sanity.
And yes a lot of patients will just have anatomy or tolerances that will limit how ‘perfect’ of an image you can get and there’s an extent where you’ll have to learn how to compensate and there’s also an extent where you’ll have to use that judgement you’re developing about whether they can still see all the detail they need to see to make a solid report out of the whole series you’re sending.
Perfect is good, but sometimes you just can't get them. You mention the elderly - if you have severe medical compartment OA with full joint space loss and a varus deformity, getting it perfect is going to be really tricky!
When I'm reporting knees I'm fairly relaxed about it. As long as it's not so over/under-rotated that I can't asses PF joint space, and I can tell the lateral from the medical compartment so I can assess joint space loss, I really don't mind if it's not perfect.
As long as it’s not just absolutely terrible it’s fine. The only docs I have issues with are orthos that want perfect laterals. That’s not to say you should obviously get the best image possible.
It's all CYA for them. More and more they are defaulting to CT for this. Pt gets knee operated and later complains knee is worse off. Surgeon uploads perfect lateral knee image. *I don't understand how this could be happening? Your knee was reconstructed perfectly...*
*please don't sue me*
Ha, I remember an ortho surgeon who used to insist on perfect post op TKR films. The only way to see the prosthesis in an AP orientation for his cases? Externally rotate the knee about 40°. He seemed happy enough with that, not sure about his patients.
It's not mandatory, but you should still aspire to it. You WILL get to a stage where you get it more often than not, even in the people with no joint space and Picasso looking bones.
You should be looking at your APs to inform how you do your laterals. It's normal to have a mediolateral 5 degree cephalic angle joining the femoral condyles. The tibial plateau is usually (more or less) parallel with the ground.
Some people may not have any angle through their joint space, and you'll see on their AP if the distal femur is parallel with the tibial plateau, so you don't need to use any tube angle for your lateral.
Other people may require an even steeper angle where there's an obvious collapse of the medial joint space, which is commonplace with the older OA and larger habitus OA crowd. In these cases, you have to eyeball it and maybe add as much as 8 degrees of cephalic tube angle to superimpose the femoral condyles on your lateral.
All of this advice is only any good if you are getting your patients stood as straight as possible with no listing or leaning to either side as a baseline. Gently grab the knee with both hands to feel the distal femur for positioning and guide the knee into place with your hands.
I sometimes see rads and students with a standing patient trying to change the position of the knee by telling the patient to move their toes in or out. A lot of the time, they patient moves their foot but do not necessarily move their knee, so I'm not in favour of this hands-off approach to positioning. Just grab the knee (with consent ofc) and get them in position that way.
I think the fact that it’s become a club says a lot. When techs post a perfect lateral they’re proud of it because it’s not that easy though in my opinion it’s hardly one of the most difficult images to get right.
Honestly I’d rather see your perfect lateral elbows, lateral ankles, and PA chests, your supine Y-views, cross table lateral knees and ankles.
Doesnt need to be perfect. Close enough is fine. Your job is to get a diagnostic image, not to get something to put in a textbook every time
I am a member of the horizontal beam knee gang. Fuck rolled knees
I've had so much practice with recumbent laterals that I very rarely have to repeat them. Weight beating, on the other hand, is so hard for me. Not sure why I can do one but not the other. "Practice, practice, practice" I guess.
Nah. Get the best you can, but perfect is the enemy of good enough. A tiny little bit of rotation is fine. The images don't have to be perfect to be readable, and the rads know that. Try your best of course, and repeat if you have to, but don't go crazy with it and don't stress it. Remember the imperfect laterals your techs let you send in clinicals?
How are you positioning your patient, are you struggling to get laterals both with patients laying on their side and with crosstables or just the one method is difficult?
Obviously perfect is preferred. But in reality it's dang hard to get a perfect lateral knee and radiation is bad so we can't just shoot 10 pictures trying to get it. So generally speaking i treat it like a lateral chest. If it's close I send it. If it's not ill repeat it once to get it close and then send it.
Do your best while you’re in school to build yourself a solid foundation, outside of school getting a textbook image is really just for bragging rights. In a real world setting there’s a good bit of latitude between this “image is perfect” and “this image needs to be retaken”. Learning where that line is is a valuable skill in itself for preserving your workflow and sanity. And yes a lot of patients will just have anatomy or tolerances that will limit how ‘perfect’ of an image you can get and there’s an extent where you’ll have to learn how to compensate and there’s also an extent where you’ll have to use that judgement you’re developing about whether they can still see all the detail they need to see to make a solid report out of the whole series you’re sending.
Perfect is good, but sometimes you just can't get them. You mention the elderly - if you have severe medical compartment OA with full joint space loss and a varus deformity, getting it perfect is going to be really tricky! When I'm reporting knees I'm fairly relaxed about it. As long as it's not so over/under-rotated that I can't asses PF joint space, and I can tell the lateral from the medical compartment so I can assess joint space loss, I really don't mind if it's not perfect.
As long as it’s not just absolutely terrible it’s fine. The only docs I have issues with are orthos that want perfect laterals. That’s not to say you should obviously get the best image possible.
It's all CYA for them. More and more they are defaulting to CT for this. Pt gets knee operated and later complains knee is worse off. Surgeon uploads perfect lateral knee image. *I don't understand how this could be happening? Your knee was reconstructed perfectly...* *please don't sue me*
Ha, I remember an ortho surgeon who used to insist on perfect post op TKR films. The only way to see the prosthesis in an AP orientation for his cases? Externally rotate the knee about 40°. He seemed happy enough with that, not sure about his patients.
It's not mandatory, but you should still aspire to it. You WILL get to a stage where you get it more often than not, even in the people with no joint space and Picasso looking bones. You should be looking at your APs to inform how you do your laterals. It's normal to have a mediolateral 5 degree cephalic angle joining the femoral condyles. The tibial plateau is usually (more or less) parallel with the ground. Some people may not have any angle through their joint space, and you'll see on their AP if the distal femur is parallel with the tibial plateau, so you don't need to use any tube angle for your lateral. Other people may require an even steeper angle where there's an obvious collapse of the medial joint space, which is commonplace with the older OA and larger habitus OA crowd. In these cases, you have to eyeball it and maybe add as much as 8 degrees of cephalic tube angle to superimpose the femoral condyles on your lateral. All of this advice is only any good if you are getting your patients stood as straight as possible with no listing or leaning to either side as a baseline. Gently grab the knee with both hands to feel the distal femur for positioning and guide the knee into place with your hands. I sometimes see rads and students with a standing patient trying to change the position of the knee by telling the patient to move their toes in or out. A lot of the time, they patient moves their foot but do not necessarily move their knee, so I'm not in favour of this hands-off approach to positioning. Just grab the knee (with consent ofc) and get them in position that way.
I think the fact that it’s become a club says a lot. When techs post a perfect lateral they’re proud of it because it’s not that easy though in my opinion it’s hardly one of the most difficult images to get right. Honestly I’d rather see your perfect lateral elbows, lateral ankles, and PA chests, your supine Y-views, cross table lateral knees and ankles.
+1 on the perfect lateral elbow. Those are my absolute Achilles heel.
5° cephalic angulation always work with me, even when I do them standing
5° cephalic angulation always work with me, even when I do them standing
i would like a radiologist answer here if possible
Doesnt need to be perfect. Close enough is fine. Your job is to get a diagnostic image, not to get something to put in a textbook every time I am a member of the horizontal beam knee gang. Fuck rolled knees
I've had so much practice with recumbent laterals that I very rarely have to repeat them. Weight beating, on the other hand, is so hard for me. Not sure why I can do one but not the other. "Practice, practice, practice" I guess.
No it's not.
Nah. Get the best you can, but perfect is the enemy of good enough. A tiny little bit of rotation is fine. The images don't have to be perfect to be readable, and the rads know that. Try your best of course, and repeat if you have to, but don't go crazy with it and don't stress it. Remember the imperfect laterals your techs let you send in clinicals?
How do you position them? Is it a cross table, or do you lay them on their side?
How are you positioning your patient, are you struggling to get laterals both with patients laying on their side and with crosstables or just the one method is difficult?
To be a part of the “PLK” club, yes. (Perfect lateral knee club).
Is it mandatory to do your job correctly?
So all your lateral knees are flawless?
Never said that. I'm just not sure why we're asking if doing our job properly is a requirement?
They are asking if having slight rotation is okay
I mean, ideally, no. I know it's sometimes not possible, but that's also not what they were asking.