Lateral Toe Radiographic Positioning & Image-Quality Checklist

Lateral Projection of a Digit (Toe)

Goal of the View

  • Obtain a clear lateral image of the specific toe or digit.
  • Minimize or eliminate superimposition by adjacent digits whenever possible.
    • Particularly challenging for the 3rd3^{rd}–5th5^{th} toes.
    • At a minimum, separate the distal phalanx of the target toe.
    • The proximal phalanx may remain partially superimposed but should still be visualized through surrounding structures.

Patient/Part Positioning

  • Align the long axis of the digit with the long axis of the image receptor (IR) segment being used.
  • Achieve a true lateral of the digit; diagnostic indicators include:
    • Concavity appears on the anterior surface of the distal phalanx.
    • Concavity appears on the posterior surface of the proximal phalanx.
    • The opposing (non-concave) surfaces of each phalanx should look noticeably straighter, confirming a side-on perspective.
  • Collimate tightly to the area of interest to maximize detail and minimize patient dose.

Image‐Quality & Exposure Criteria

  • No motion: sharp cortical bone margins and clear bony trabecular pattern.
  • Proper density and contrast should enable visualization of both the distal and proximal phalanges even if superimposed.
  • Reference images for comparison: Figures 6.50 & 6.51 in the text.

Special Considerations & Practical Tips

  • If toe separation is limited, pad or tape may help create minimal spacing at least at the distal end.
  • When superimposition is unavoidable, emphasize exposure factors that preserve contrast for visualizing the proximal phalanx through other anatomical shadows.
  • Always verify the patient’s comfort and immobilize the toe gently to maintain position for the duration of the exposure.