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Adequacy of Ankle Radiographs in the Emergency Department
Poster Title: Adequacy of Ankle Radiographs in the Emergency Department
Submitted on 28 Oct 2020
Author(s): Ziad Aldabbagh
Affiliations: Rotherham NHS Foundation Trust
This poster was presented at BIR Annual Congress 2020
Poster Views: 392
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Poster Information
Abstract: Ankle injuries are a common presentation to many emergency departments around the world. Radiographs are key in diagnosis of various ankle pathologies and rely on adequate positioning and image quality. Poor imaging results in mismanagement or incorrect diagnoses which can lead to detrimental outcomes for patients. Within the UK, AP (mortise) and lateral views are widely used throughout various emergency departments to aid in diagnoses. This audit aims to assess the adequacy of ankle radiograph views taken in one trust within South Yorkshire.

The medial and lateral malleoli should be equidistant from the cassette in a standard AP (mortise view) ankle radiograph, ensuring a clear joint space. The AP view should also include the lower third of leg, and the beam centred midway between malleoli. The lateral ankle radiograph should include the lower third of tibia and fibula, talus, base of 5th metatarsal and calcaneum. It is also essential to show general bone and joint space alignment and the X ray beam should be centred over the medial malleolus. These comply with the local guidelines as the gold standard for ankle films.

The audit tool was used within the IMPAX programme in order to compile a list of viable films, the aim was for 100 patients. Patients with previous fractures, non weight bearing films or under the age of 12 were excluded. Following the exclusions, 88 viable films were reviewed and then validated via double review. The target was for 90% of films to be adequate in both AP and lateral views.

The results showed 69% of films had adequate AP views, 91% had adequate lateral views, and overall only 63% had both AP and lateral views as adequate.

The following was advised following the results of the audit; formal education on imaging techniques, posters in the imaging areas showing proper technique and view, and guidance on re-imaging if needed, re-audit following the implementation of the above.
Summary: Poster titled "The adequacy of ankle radiographs in the emergency department" presented at the BIR Annual Congress 2020.References: Images taken from
British Orthopaedic Association, ‘The Management of Ankle Fractures’, August 2016
‘Clark’s Positioning in Radiography’, Whitley et al., 12e, p114-117
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