COMMON ERRORS IN XRAY INTERPRETATION

DR SAM DEPARTMENT OF RADIOLOGY

Misinterpretation
Forgivable Regrettable
Leave town

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 ?

 you cant see what you dont know .

CXR - REVIEW AREAS

APICES HILA BEHIND THE HEART CP ANGLES BREASTS BONES PARASPINAL

CXR - MASSES THAT ARENT

COSTOCHONDRAL JUNCTION STERNUM NIPPLES HAIR BRAIDS / ACCESSORIES BUTTONS SKIN LESIONS LOCULATED FLUID

LEFT UPPER LOBE COLLAPSE

LEFT LOWER LOBE COLLAPSE

Pseudotumor loculated pleural fluid

NB THE RIGHT HEART BORDER

CXR CHILDREN
AP FILM CTR 60% THYMUS HYPERINFLATION SUBTLE OPACIFICATION NODES

The Thymus

ASPIRATION OF FB

PNEUMOMEDIASTINUM

Pleural effusion -

The widened mediastinum

Abdominal XRay

BOWEL PERFORATION

DANGEROUS ABDOMENS

AIR!

AIR IN THE WRONG PLACE

ABDOMINAL CALCIFICATION

BONES
NB 2 VIEWS - ALWAYS COMPARE WITH OPPOSITE SIDE REPEAT XRAY IN 2 WEEKS ( PANNUS ) CONSULT FRIENDLY TEXT ( KEATS )

THE VEXATIOUS CERVICAL SPINE

12MM 12MM

10mm

CERVICAL SPINE
Base of skull to T1! Longitudinal lines Prevertebral soft tissue ADI ( adults 3mm, kids 5mm ) Normal variants

TECHNIQUE,TECHNIQUE, TECHNIQUE

THE OPEN MOUTH VIEW

MISCHIEVOUS FRACTURES

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

The normal adult wrist

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

Salter Harris Physeal Injuries

Scaphoid fractures

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

THE ELEVATED FAT PAD

POST OLECRANON

ANT CORONOID

Normal alignment elbow Anterior humeral line

RADIOCAPITELLAR LINE

Ossification centres elbow

C R I T O L E

CAPITELLUM RADIAL HEAD INT EPICONDYLE TROCHLEA OLECRANON LATERAL EPICONDYLE

THANK YOU!