12 - Interpretation of X-rays Flashcards
How will you write a x-ray reading note at DMU?
The CPMS faculty along with the Radiology Department at the Tower Clinic have created a template to use when reading x-rays
“I am looking at (number) x-rays of the (left/right foot/ankle) of a skeletally (mature/immature) individual in a (non-weightbearing/weightbearing) position . There is a/an [(projection/position); list all the images you see]. The quality of the x-rays is (adequate/inadequate) for visualizing soft tissue and bone.”
How will you document an x-ray reading in EMR?
Even though the EMR uses a check-off template and dictation is no longer necessary, the same elements need to be entered
How do you determine right or left on an unmarked AP?
Always assume that you are looking down on the foot with the plantar aspect against the cassette
How do you determine right or left on an unmarked lateral x-ray?
Don’t bother
Nearly impossible
Just put “laterallity cannot be determined”
How do you determine right or left on an unmarked oblique x-ray?
Same as for an AP-x-ray
How do you determine mature vs immature?
- Immature bone has at least one open growth plate
- Mature bone has no open growth plate
Don’t need to know the age of the patient - just call it mature or immature
How do you determine weightbearing or non-weightbearing?
If not marked on the x-ray, look at the lateral image
- If the heel is on the same plane as the metatarsals, assume it is weightbearing and, therefore, all the images are weightbearing
- If the metatarsals are plantarflexed in relation to the heel, assume it is non-weightbearing, and therefore, all the images are non-weightbearing
- If you are not able to accurately assess side, weightbearing status, etc. simply say (for example) “weightbearing status cannot be determined.”
Will you ever use the term “view” in your interpretation?
NO
You will never use the term view in your interpretation (view is the opposite of projection)
Define projection
- Projection-the direction in which the beam travels through the body to arrive at the cassette
Projection of an AP foot x-ray
AP or DP of foot-from anterior (dorsal) to posterior (plantar) surface on the cassette
Projection of an AP ankle x-ray
AP of ankle-from anterior to posterior surface against the cassette
Projection of a lateral foot or ankle x-ray
Lateral of foot or ankle-from lateral to medial surface against the cassette-conventional usage does not use the term “lateromedial projection”
Most places will NOT use the term “lateromedial”
The entry point of the beam is either the first word or the only word used - “lateral” or “lateromedial”
What do we call ANY other image besides an AP or lateral?
A position
Define position
- In strict terms, position refers to the part that is closest to the cassette ***
Medial oblique foot or ankle position
Medial oblique of foot or ankle: medial surface is closest to the cassette when following the course of the x-ray beam
Lateral oblique foot or ankle position
Lateral oblique of foot or ankle: lateral surface is closest to the cassette when following the course of the x-ray beam
What does a medial oblique image look like?
If you can see the 3rd, 4th and 5th metatarsals and the 1st and 2nd mets are overlapped, that’s a medial oblique position
What does a lateral oblique image look like?
If you can see the 1st and 2nd metatarsals clearly and the 3rd, 4th, and 5th metatarsals are overlapped, it is a lateral oblique position
What does the quality of an x-ray refer to?
- Any part of the foot is “cut off”
- Appearance of the bone
- Whether or not you can see soft tissue
Describe the quality related to the appearance of bone
- If the bones look too “white”, the x-ray is “underexposed” (less x-rays have penetrated)
- If the bones look too “dark”, the x-ray is “overexposed” (too many x-rays have penetrated)
Describe the quality related to soft tissue
- Need to be able to see the soft tissue outline
- This includes skin
