Ankle (horizontal beam lateral view)

Mr Andrew Murphy et al.

The ankle horizontal beam lateral view is a modified lateral view part of a three view ankle series; this projection is used to assess the distal tibia and fibulatalusnavicularcuboid, the base of the 5th metatarsal and calcaneus.

The horizontal beam lateral is a highly adaptable projection that can be used in trauma or with patients who are unable to ambulate to the desired standard lateral position. 

  • patient is in a supine position 
  • if the projection is mediolateral the non-affected leg is placed on a stand in a flexed position to avoid superposition  
  • if the projection is lateromedial both legs can lay in their natural AP position 
  • foot in dorsiflexion if possible 
  • mediolateral/lateromedial horizontal beam projection
  • centring point
    • mediolateral
      •  bony prominence of the medial malleolus of the distal tibia
    • lateromedial 
      • bony prominence of the lateral malleolus of the distal tibia
  • collimation
    • anteriorly from the hindfoot to extent of the skin margins of the most posterior portion of the calcaneus
    • superior to examine the distal third of the tibia and fibula
    • inferior to the skin margins of the plantar aspect of the foot
  • orientation  
    • portrait or landscape 
  • detector size
    • 18 cm x 24 cm
  • exposure
    • 50-60 kVp
    • 3-5 mAs
  • SID
    • 100 cm
  • grid
    • no

The distal fibula should be superimposed by the posterior portion of the distal tibia.

The talar domes should be superimposed allowing for adequate inspection of the superior articular surface of the talus.

The joint space between the distal tibia and the talus is open and uniform.

In situations where the patient cannot be moved this projection be invaluable, it requires little to no patient positioning and can be replicated in ICU wards.

If possible, placing a sponge under the ankle in question will prevent any artefacts from bed/pillows in that are native to trauma rooms. 

The projection can be done from either side depending on the makeup of the room and the patients pathology.

The patient remains supine with an image receptor placed vertically adjacent to the lateral aspect of the upright ankle; the X-ray beam is directed horizontally, centred at the bony prominence of the medial malleolus of the distal tibia. 

Superior-inferior malalignment of the superior aspect of the talus is resultant of the tibia not lying parallel to the image receptor. To adjust this, angle the tube superior-inferior to mimic the tibia laying parallel. This is not ideal but in trauma, it may be the only option. 

Anterior-posterior malalignment of the talar domes is due to over or under rotation of the foot.  To adjust this, angle the tube anterior-posterior to mimic correct positioning. This is not ideal but in trauma, it may be the only option. 


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Article Information

rID: 44934
Section: Radiography
Synonyms or Alternate Spellings:

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Cases and Figures

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    Loss of normal sh...
    Figure 1: horizontal beam lateral
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    Figure 2: talar dislocation
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    Figure 3: multiple tarsal fractures
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