COMMON ERRORS IN XRAY INTERPRETATION DR SALLY CANDY DEPARTMENT OF RADIOLOGY GSH
Dec 24, 2015
The questions
• CORRECT PATIENT ?• CORRECT HISTORY?• CORRECT LABELLING?• CORRECT POSITIONING ?• CORRECT EXPOSURE ? • 0PTIMAL VIEWING CONDITIONS?• 2 VIEWS?• PREVIOUS FILMS ? • REVIEW AREAS?
The Billion Dollar questions
• Is it real ? Technical / artefact
• Is it incidental ? Normal structure Variant
• Is it significant ?
CXR - MASSES THAT AREN’T
• COSTOCHONDRAL JUNCTION
• STERNUM• NIPPLES• HAIR BRAIDS /
ACCESSORIES• BUTTONS• SKIN LESIONS• LOCULATED FLUID
Pleural effusion -
BONES
• NB 2 VIEWS - ALWAYS
• COMPARE WITH OPPOSITE SIDE
• REPEAT XRAY IN 2 WEEKS ( PANNUS )
• CONSULT FRIENDLY TEXT ( KEATS )
CERVICAL SPINE
• Base of skull to T1!
• Longitudinal lines
• Prevertebral soft tissue
• ADI ( adults 3mm, kids 5mm )
• Normal variants
LIS-FRANC
• Fracture –dislocation or fracture subluxation of the TMT joints.
• History axial load to plantar flexed foot
• 3 views - weightbearing
Segond fracture
• Internal rotation and varus
• Cortical avulsion of tibia at insertion of LCL
• Assoc with internal injuries (ACL and menisci)
• Reverse Segond
Maisonneuve fracture
• Pronation external rotation
• # upper third fibula• rupture distal tibiofibular
syndesmosis and interosseous membrane
• UNSTABLE• OUT OF ANKLE VIEW
Lunate dislocation
• Lunate loses its articulation with both the capitate and the radius and is displaced volarly with up to 90 degrees rotation. The capitate remains aligned with the radius but sinks proximally
Perilunate dislocation
• The lunate maintains its normal articulation with the radius.
• The capitate articular surface is dislocated from the lunate, normally dorsally
THE PAEDIATRIC ELBOW
• Unossified epiphyses
• Fracture may be invisible
• INDIRECT signs: fat pads and lines
• POSTERIOR (OLECRANON) ***
• ANTERIOR ( CORONOID ) (SAIL SIGN)
• Not all fractures have fat pad sign
Ossification centres elbow
• C R I T O L E
• CAPITELLUMRADIAL HEADINT EPICONDYLE TROCHLEA OLECRANONLATERAL EPICONDYLE