Pediatric ankle (AP view)

Last revised by Andrew Murphy on 23 Mar 2023

The anteroposterior ankle view for pediatrics is one of three views in order to examine the distal tibia, distal fibula, proximal talus and proximal fifth metatarsal.

This projection demonstrates the ankle joint in its natural anatomical position. It is useful in diagnosing fractures, joint space abnormalities and localizing foreign bodies in pediatric patients.

  • the patient is supine with their affected foot in dorsiflexion

  • anteroposterior projection

  • centering point

    • the midpoint of the lateral and medial malleoli

  • collimation

    • laterally to the skin margins

    • superior to examine the distal third of the tibia and fibula

    • inferior to the proximal aspect of the metatarsals

  • orientation

    • portrait

  • detector size

    • 18 x 24 cm

  • exposure 1

    • 50-55 kVp

    • 1-2 mAs

  • SID

    • 100 cm

  • grid

    • no

No rotation of the ankle which is demonstrated by a closed lateral mortise and open medial mortise. The distal fibula should slightly superimpose the distal tibia 2. A physical metal marker is ideal for pediatric imaging. 

Preparing the room beforehand (setting up the detector, exposure and preparing lead gowns) is important as pediatric patients may not remain still when their affected ankle is moved onto the detector. 

It is important for the radiograph to be free from motion artifact and rotation to avoid repeated x-rays.

  • it may be necessary for the parent or radiographer to hold the patient in position

  • ideally the parent should be in the child's direct line of sight

  • techniques will vary based on the department

  • distraction techniques can be utilized to avoid scattered radiation to parents and staff 3

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