Interpreting X rays

Question 1

When interpreting radiographic imagining, what is meant by the ABCS approach?

Answer 1

Adequacy/alignment

Bones

Cartilage and joint space

Soft tissue

Question 2

What 2 standard views are used in radiographic imaging of hip joint?

Answer 2

Anteroposterior (AP)

Lateral

Question 3

Before interpreting an X-ray, what do you need to confirm?

Answer 3

Confirm that this is the x ray of the correct patient

Question 4

What 3 pieces of info do you need to confirm out loud in order to make sure that this X-ray is of the correct patient?

Answer 4

Patient personal details such as name, DOB, hospital number

Date and time at which radiograph was taken

What anatomical site was imaged and in what view eg. AP view of pelvis

Question 5

If the pelvis is perfectly aligned in a X-ray, what 2 structures should be in the midline?

Answer 5

Pubis symphysis

Coccyx

Question 6

What structures can you outline to identify bony fragments or fractures?

Answer 6

Cortical outlines of bone surfaces, if outline doesn’t run smoothly then it is often due to a fracture breaking the cortical outline or a fragment projecting outwards

Question 7

What 2 features of an x-ray provide good adequacy?

Answer 7

Image shows above and below the area of concern

Beam penetration is neither under or over exposed

Question 8

What are the 4 types of femoral fractures in the hip joint, and explain the location of each fracture?

Answer 8

Subcapital: immediately under femoral head, on femoral neck

Transcervical: middle of femoral neck

Intertrochanteric: across intertrcohanteric line between greater and lesser trochanter

Subtrochanteric: under femoral neck and lesser trochanter

Question 9

Describe this x-ray?

Answer 9

Subcapital fracture of left neck of femur

Question 10

Describe this x-ray?

Answer 10

Transcervical fracture of right neck of femur

It is Transcervical as the fracture is on the neck but still above intertrochanteric line, so is not intertrochanteric fracture

Question 11

Describe this x-ray and what each of the arrows point to?

Answer 11

Blue arrow shows comminuted intertrochanteric fracture of right femur

White arrow shows fragments of greater trochanter

Red arrow shows fragments of lesser trochanter

Question 12

Describe this x-ray?

Answer 12

Subcapital simple fracture of left femur

Question 13

Describe this x-ray, and what 4 conditions could be the cause of this finding?

Answer 13

Lytic/lucent lesions in right femoral head and left femoral shaft

Osteomyelitis
Bone cyst
Metastasis of myeloma
Osteoblastoma

Question 14

Describe this x-ray?

Answer 14

Sclerotic lines on posterior surface of calcaneus suggests stress fracture

Question 15

What do sclerotic lines on an x-ray suggest?

Answer 15

Stress fracture or new bone growth due to fracture

Question 16

Describe this x-ray?

Answer 16

Transverse stress fracture of right distal fibula due to sclerotic line

Question 17

Describe 3 findings on this x-ray and what conditions these suggest?

Answer 17

Sclerotic borders of phalanges as proximal interphalangeal joints, suggests new bone growth

Narrowed joint space

Osteophytes at proximal interphalangeal joints

These affect all signs of OA

Question 18

Describe this x-ray?

Answer 18

Narrowed joint space between distal femur and proximal tibia in medial compartment of left knee and lateral compartment of right knee

Sclerotic borders of proximal tibia suggests compression of bone

Osteophytes of right femur and tibia

Suggests knee OA