X-ray interpretation (main)

Background

It is important to have a method of reading xrays and communicating these findings with colleagues or consultants

Method

Demographics

• Patient name and age
• Orientation and location of images
  • ex. AP and lateral of the right wrist
• Skeletal maturity

Assessment of bones

Follow the cortex and look for discontinuities

• Fractures
  • Location
    • Epiphysis, diaphysis, metaphysis
    • Midshaft, proximal 3rd, mid-3rd, distal 3rd
    • Joint involvement
  • Orientation
    • Transverse, oblique, sagittal
  • Comminution
    • Comminuted - small fragments
    • Segmental - small section of bone boarded by fractures distally and proximally
    • Butterfly fragment - large triangular segment
  • Displacement
    • Percentage of disruption
    • ex. 50% displacement if bones are half overlapping or 200% displacement if the bones are separated by the distance of one bone-width
    • Describe displacement of distal fragment relative to proximal
  • Angulation
    • Describe angulation as the direction the apex is pointing relative to anatomical long axis of the bone
  • Shortening
  • Rotational deformity
• Lesions
  • Lytic/blastic lesion
  • Important if assessing a pathological fracture

Assessment of Joints

• Position and alignment
• Fracture involving the joint
• Obvious degeneration or FB

Assessment of Soft Tissue

• Gas
  • Can be present in open fractures or with soft tissue infections
• Fat pads
  • ex. Sail sign
• Foreign body

Spinal Imaging

• By standard convention, spine films have slightly different terminology
• Anterolisthesis - A description of the inferior edge of a superior vertebrae in relationship to the superior edge of the inferior vertebrae
  • Anterolisthesis of C5 on C6 (C5 is more anterior than C6)
• Retrolisthesis - A description of the inferior edge of a superior vertebrae in relationship to the superior edge of the inferior vertebrae
  • Retrolisthesis of C6 on C7 (C5 is more anterior than C6)

See Also

• Chest X-ray interpretation
• Head CT interpretation

References

Authors

Neil Young, Ross Donaldson, Daniel Ostermayer