Projection radiography of the ankle; the views used for different indications vary between medical imaging departments

Plain radiographs are used for initial evaluation of many conditions of the ankle. Many different radiographic views are described in positioning textbooks but evidence on which views to use, in which case, is scarce. The aim of this study was to map imaging procedures related to four indications for ankle projection radiography. A questionnaire was sent to all medical imaging departments in Iceland with questions about acquisition technique for ankle radiography views and which views were used for selected indications. Answer was received from 14 of the 28 departments.  All departments gave very similar descriptions of the four most common views. In the case of trauma, all but one department used four views but for control of trauma or operation, four different combinations of views were found using from two to four images. For detrition and osteomyelitis, four views were more common in the larger departments but there was not a statistically significant difference. Eight different combinations of the number of views for the four indications were found. The study indicates that there is a need for standardization in image acquisition protocols. More studies are needed to support decisions about how many views are necessary for the most common ankle radiography indications.