PRACTICAL POINTS-

Radiograph Posting
For Beginner RAD Residents

Dr. Mahnoor Hafeez

MBBS, FCPS, EDiR
Senior Instructor & Consultant Radiologist
Dow Institute of Radiology, DUHS,
TECHNICAL FACTORS
Poor Inspiratory Effort
Check Marker- Otherwise there Is Situs Inversus
Normal Cardiothoracic Ratio
Cardiac silhouette cannot be commented
upon AP supine projection.
Increased Cardiothoracic Ratio Suggests
Cardiomegaly. Correlation With Echocardiography Is
Recommended.
Mach Effect refers to an optical illusion mimicking
odontoid fracture
ABNORMAL
LUNG
PATTERNS
1) Consolidation: Homogenous air space opacification in
lung obscuring Broncho vascular markings
2) Ground glass opacity: air space opacification in lung
not obscuring Broncho vascular markings
3) Interstitial pattern- reticular net like shadows
4) Bronchiectasis: dilated thick walled non tapering
bronchi
CONSOLIDATION
GROUND GLASS OPACITY -
Alveolar Pulmmonary Edema
BRONCHIECTASIS
BRONCHIECTASIS
BRONCHIECTASIS
BRONCHIECTASIS
INTERSTITIAL PATTERN-
 SILHOUETTE SIGN
• An intra thoracic opacity when in contact with
heart or aorta will obliterate that border
SILHOUETTE SIGN
MASS- A mass is seen at right hilum with irregular outline along
with mediastinal lymphadenopathy and right pleural effusion
suggests bronchial carcinoma, contrast CT chest is recommended
Bilateral Hilar Congestion
MENISCUS SIGN- PLEURAL EFFUSION

• Homogenous opacification seen in right lower zone extending

upto right lateral chest wall obscuring right hemi diaphragm and
right lower heart border causing obliteration of right costophrenic
angle representing right pleural effusion.
obliteration of costo phrenic angle could be due to
pleural effusion or thickening, US chest is
recommended
Apical Pleural Thickening
Bilateral hyperinflated lung fields are seen with paucity of
brochvascular markings and flattened diaphragm suggests
COPD.
Status Post Sternotomy and Coronary Artery Bypass Graft
(CABG)
sternotomy and bypass graft sutures are seen
PEDIATRIC CHEST X RAY
- Peri bronchial Cuffing / Bronchial Wall Thickening
Possibility Of Pulmonary Infection. Clinical Correlation Is Advised.
PEDIATRIC CHEST X RAY
 KNEE OSTEOARTHRITIS (OA):
tricompartmental degenerative change
Mild Knee Osteoarthritis: tibial spiking with marginal
osteophytes.
Moderate Knee OA- Marginal Osteophytes, Subchondral
Sclerosis, Joint Space Reduction
severe knee OA- marginal osteophytes, subchondral
sclerosis, severe joint space reduction, varus deformity.
 SPINE

• Curvature

• Normal
• Straight
• Lordosis: exaggerated normal lumbar curvature
• Kyphosis: increased dorsal curvature
• Scoliosis : increased lateral curvature
 SPINE

• Spondylosis: (osteoarthritis (OA) of the spine), [Spon- Spine].

Degenerative changes seen in the spine

• Spondylolysis: refers to a stress fracture defect in the pars

interarticularis of the vertebrae (commonly found in the L4/L5 region).

• Spondylolisthesis: Anterior displacement of L5 vertebra over the S1

vertebral body below it (commonly known as a “step off” or “slip” at
the / level)
Straightening of the lumbar spine
is likely due to muscle spasm with
mild degenerative changes
Severe Degenerative Changes Seen In the lumbar Spine with
scoliosis, Marginal Osteophytes, Disc Space Reduction, Facet
Joint Arthropathy.
Pars interarticularis fractures at L5 level without
anterolisthesis
Grade I anterolisthesis of L5 over S1 vertebral body secondary to
bilateral pars interarticularis fracture of L5 vertebra.
Lumbosacral transitional vertebra:
sacralisation of L5: fusion of L5 vertebra transverse process to
the sacrum
Lumbosacral transitional vertebra:
sacralisation of L5: fusion of L5 vertebra transverse process to
the sacrum
compression fractures of the
vertebral bodies is seen with
severe compression of the
L1 superior end plate
causing significant reduction
in height. no focal spinal
canal stenosis is seen at this
level.
could be post traumatic or
osteoporotic compression
fracture.

reduced bone density:

generalized reduced bone
density with prominence of
trabecular pattern- requires
dexa scan
DISH: changes of diffuse idiopathic skeletal hyperostosis (DISH) ,
flowing ossification along the anterior longitudinal ligament seen
in cervical/ dorsal spine
HOW TO REPORT FRACTURE
• Hairline/ comminuted
• POP cast
• Callus
• Angulation
• Fracture
• Part anatomy
• Alignment
• Intra articular extension
• Prosthesis: hip nail
fracture of left para symphyseal region of body of mandible
reaching upto alveolar process and right mandibular ramus.
displaced fracture of distal metaphysis of radius with
volar angulation deformity. no intra articular extension.
FRACTURE FIXATION
• Cast
• Orthopedic devices
1. External fixator; Ilizarov apparatus
2. Open reduction and internal fixation (ORIF) is a
type of surgery used to stabilize and heal a
broken bone.
Plaster Of Paris (POP)
CAST
U Slab
ORIF
cortical plate and
screws seen in place,
no fracture or
loosening of
prosthesis seen
ORIF with complication
Prosthesis Bone Interface
• The lucent gap between Prosthesis and adjacent Bone should
be < 2mm
• If > 2mm- loosening of prosthesis
HIP
ARTHROPLASTY
 DYNAMIC HIP SCREWS (DHS) to treat femoral
neck fractures.
Intra Medullary Nail and screws
ILIZAROV APPARATUS
OBSERVATIONAL FILM
OBSERVATIONAL FILM- absent patella
OBSERVATIONAL FILM
OBSERVATIONAL FILM- left mastectomy
OBSERVATIONAL FILM- edge of film case
OBSERVATIONAL FILM- humeral fracture
Fracture malunion occurs
when a fracture heals in a
non-anatomical position,
which result in
misalignment
Fracture non-union describes the
failure of normal fracture healing
processes. a fracture with a
minimum of at least nine
months with non-united edges.
FOR RADIOLOGICAL BONE AGE ASSESSMENT:

• Use Digital Charts- NOT paper charts (obsolete)

• Always correlate with Gaskin Digital chart (for Hand)

before Lowel Digital chart (for elbow or pelvis)
REFERENCES:

• Radiology Masterclass CHEST X Ray

• Trauma Radiology Masterclass- Musculoskeletal X-ray tutorials
 Introduction to trauma X-ray
 Trauma X-ray - Upper limb
 Trauma X-ray - Lower limb
 Trauma X-ray - Axial skeleton
CHEST X RAY – FELSON
FLUOROSCOPY
CHAPMAN -Guide To Radiological Procedures