How to read X-ray

How to read an X-ray

Ahmed H ABDELAZEEMDipl. SICOT, M.D.

Lecturer of Orthopaedics and TraumatologyCairo University

Objectives

■What is an x-ray

■How can you write an x-ray request

■How to read x-rays systematically

■How to describe fracture patterns

What is an X-ray…?

● X-radiation; discovered by Wilhelm Röntgen who coined the name (x-ray as he didn’t know its nature)

● It is a form of electromagnetic radiation● X-radiation = Röntgen radiation

What is X-rays…?

● X-ray film = Photosenstive film or its electronic equivalent

No x-rays Lots of x-raysSome x-rays

X-radiation and X-rays film

different shades of grey with

different tissues

Tissue volume penetrated

X-radiation and X-rays film

Tissue volume penetratedType of tissue/material

Fluids Bone MetalAir Soft tissues

Bonecancellous

cortical

Metal object

Air

Soft tissues

Tissue penetration and projection

Bone cement

X-ray Request

● Correct spelling of X-ray(s) in the English language includes x-ray(s) and/or X ray(s)

● Rule of ‘TWO’1. Two views: At 90 degrees, usually anterior-

posterior and lateral2. Two joints: The joints above and below.3. Two occasions: Some fractures are not easily

visible immediately after trauma4. Two limbs: If required for comparison

Two views

Two occasions

Two joints

Two limbs

Systematic reading

PROPER PLACEMENT OF THE X-RAY

Aided by■Name of patient■Side of injury■Date of x-ray

Ahmed 20.1.2012

What view…???

● AP● Lateral

Lateral AP View Medial

Ant LAT View post

Identify part of boneEpiphysisMetaphysisDiaphysis

Identify bone or anatomical region (if multiple bones

eg. Hand or foot)

Identify type of fractureSimple (TWO parts)

Transverse (<30 degrees)

Oblique (> 30 degrees)

Spiral

Wedge (usually three parts)

Complex (comminuted)

Bones Quality

Normal Osteopenia Osteopetrosis

Bone age

Skeletally mature Skeletally immature

EXAMPLE

This is;

1. Plain X-ray2. AP view 3. Of the left humerus bone4. Showing a spiral fracture 5. at its diaphysis6. with a normal bone density7. in a skeletally mature case….

Describe the deformity

1. Displacement (translation)2. Angulation3. Malrotation4. Shortening

Always describe the movement of the distal fragment relative to

the proximal one

1. Displacement (translation)

2. Angulation

3. Rotation 4. Shortening

1. Displacement (translation)

2. Angulation

3. Rotation 4. Shortening

1. Displacement (translation)

2. Angulation

3. Rotation 4. Shortening

Displacement (translation)

AP view

Lateral view

Medial and lateral

Anterior and Posterior

Angulation

AP view

Lateral view

Medial and lateral

Anterior and Posterior

Describing angulation(confusing….!!!)

According to the tip of

the angle

Fracture is angulated

laterally

According to distal fragment

Distal fragment is angulated

Medially

Easier

Angulation knee

Varus “O”Towards the midline

Valgus “X”Always from the midline

Thank you