X Ray Interpretation Flashcards
What are key points you must state initially when interpreting an XR?
- Patient details
- Name & Age
- What you are looking at (e.g. XR of the knee)
- XR / USS / MRI (What type of scan?)
- AP / Lateral / Lumbar spine / Knee (Where in the body?)
- Date & time / Timeline of series of films
- Most obvious abnormality
How do you describe what you see?
- What views
- (e.g. AP, lateral)
- Anatomy on show (e.g. pelvis, tibia/fibula, upper limb)
- Where is the abnormality?
- Diaphyseal
- Metaphyseal
- Epiphyseal
- Articular
- Junctional/Combination
- Undisplaced / Displaced?
What is the diaphyseal region of a bone?
“Long bit” / shaft
What is the metaphyseal region of a bone?
Area where the bone becomes square, including growth plate (physis)
Where is the epiphyseal area of a bone?
End of a long bone “rounded portion”
What structures do you want to identify on an XR?
- Bones
- Soft tissues
- Joints
- Anything else
How do you identify a fracture on XR?
- Dark lines
- Where the XR shoots straight through the gap
- White line
- Where bones have pushed in together so super-imposed bone on bone
- Irregularity in the cortex
How do you identify dislocation / subluxation on XR?
- Irregularity of soft tissue shape
- Misalignment of joint
- Change in the joint space
- Wide, narrow or uneven
What bony abnormalities might you identify on XR?
- Lytic lesion
- Dark hole in bone
- Sclerotic lesion
- Whiter regions within bone due to excess bone
- Mixed
- Can get a mixed picture of both
What is acceptable on XR?
- Anatomical abnormalities don’t always mean dysfunction
- Deformity in the plane of movement is well tolerated
- Rotational deformity is not well tolerated
- Children can grow out of a deformity
Therefore take into account the age, disability , malignancies and patient preferences.
How is displacement always described?
Describe where the distal part is in relation to the proximal part
What features can be used to describe displacement of a fracture?
- Angulation
- Include direction & degrees
- Length
- Alignment in both views
- Translation / Apposition
- How much bone is on bone
- Rotation
- Intra-articular
How can you describe the pattern of a fracture?
- Transverse
- +/- butterfly fragment (potentially making it unstable)
- Oblique
- Siral
- Segmental
How many parts can you see?
- Comminution (Gravel-like fractures
How do you describe the length of a fracture (in regards to the displacement)?
- Distracted
- Length of the bone looks longer
- Impacted
- Bone looks shorter
- Normal
What does translation describe in relation to fractures?
The degree of lateral displacement between the bone fragments.
Also described as the bony apposition:
- Whole apposition (100%)
- 75% / 50% / 25% bony apposition
- No bony apposition (0%)
What articular injuries can be described on XR?
- Alignment
- Gaps
- Steps
- Subluxation
- Dislocation
What is a segmental fracture?
A fracture of a bone occuring at 2 points leading to a segment of a bone
What terminologies can be used to describe where bone abnormalities occur within the bone?
- Medullary
- Cortical
- Periosteal
- Not usually seen on XR
- Endosteal
- Along central vascular area of bone
What does the zone of transition describe?
Where it goes from one type of bony lesion to another (e.g. scleoritic to lytic)
- Is the lesion well defined / poorly defined / demarcated?
- Is there sclerosis around the margin?
What is Mirel’s score?
Scoring system that enables you to establish potential cause of a fracture using the:
- Site
- Size
- Pain
- Appearance
What 7 cancers most commonly metastasise to bone?
- Breast
- Kidney
- Lung
- Prostate
- Thyroid
- Uterus
- Melanoma
What percentage of bone tumours are metastatic?
80%
