Pediatric tibia fibula (AP view)

Last revised by Amanda Er on 27 Mar 2023

Citation, DOI, disclosures and article data

Citation:

Tan W, Er A, Fahrenhorst-Jones T, Pediatric tibia fibula (AP view). Reference article, Radiopaedia.org (Accessed on 19 Apr 2024) https://doi.org/10.53347/rID-164337

DOI:

https://doi.org/10.53347/rID-164337

Permalink:

https://radiopaedia.org/articles/164337

rID:

164337

Article created:

12 Mar 2023, Weiling Tan ◉

Disclosures:

At the time the article was created Weiling Tan had no financial relationships to ineligible companies to disclose.

View Weiling Tan's current disclosures

Last revised:

27 Mar 2023, Amanda Er ◉

Disclosures:

At the time the article was last revised Amanda Er had the following disclosures:

Radiopaedia Events Pty Ltd, Speaker fees (past)

These were assessed during peer review and were determined to not be relevant to the changes that were made.

View Amanda Er's current disclosures

Revisions:

3 times, by 3 contributors - see full revision history and disclosures

Systems:

Paediatrics

Sections:

Radiography

The pediatric tibia fibula anteroposterior view is part of a two-view series of the entire tibia, fibula, and both the knee and ankle joint.

The tibia fibula AP view is performed for evaluation of the lower leg in pediatric patients. It allows for assessment of fractures in trauma or suspicion of a foreign body or bone lesions, including osteomyelitis. If one is concerned about the ankle joint, the ankle series is more appropriate, if the knee is the point of focus, a knee series.

Patient position

the patient may be supine or sitting upright with their leg extended on the table
the foot is in dorsiflexion with the toes pointing directly toward the ceiling

Technical factors

anteroposterior projection
centering point
- midpoint of the tibia
collimation
- laterally to the skin margins
- superior to the knee joint
- inferior to the ankle joint
orientation
- portrait or diagonal depending on limb length
detector size
- 35 cm x 43 cm or 43 cm x 35 cm
exposure
- 55-60 kVp
- 1-3 mAs¹
SID
- 100 cm
grid
- no

Image technical evaluation

tibia superimposes about one fourth of the fibular head, and about half of the distal fibula
mid shaft of the fibular is free of superimposition with the tibia
tibia and fibula are demonstrated in the AP position in their entirety from the knee joint to the ankle
lateral and medial malleoli of the distal fibula and tibia are in profile
tibiotalar joint space and the knee joint space are open²

Practical points

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 leg is moved onto the detector.

In some cases where the patient's limb does not fit in one image, it is better to take two images at both points than perform a sub-par projection in the center. If both the ankle and the knee joints are not present it is not a complete series.

Immobilization techniques

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

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