An initial Evaluation of a Radiographic film

• Discovery and History of x-rays• Image Perception• Radiographic densities• How to read a Radiograph (AABCS)• Describe a fracture and terminology• Mechanism of Injury• Lines and measurements

Image perception• Searching for familiar identifiable patterns or a

combinations of patterns.• The success or failure of this process depends

on a number of factors:– Knowledge, Understanding and Experience.

• Anatomy and physiology• Abnormal and normal appearances .• Spatial awareness• Attenuating properties of structures• Image artefacts• Optical illusions

Mach Band Effect

The Machband describes an effect where the human mind subconsciously increases the contrast between two surfaces with different densities.

Radiographic Densities

Pb BaSO4 Bone Muscle Fat Air

Different density material will attenuate different amounts of x-ray beam.

X-ray film

82 56 20 8

How to read a Radiograph ?

Film Viewing Box / Monitor

Ambient lighting

No distractions

Biscuits and coffee

Good Film ViewingConcentration on the part of the observer is crucial.

Physical discomfort due to poor ventilation

Excessive temp, Humidity

Anxieties, domestic and personal distractions

Poor health, workload can all effect diagnostic accuracy.

High priority is given to optimise image quality

How ever little thought is given to optimal image viewing conditions

Why is it important to have TWO views.

Why do we need to examine all the views ?

Some Useful Terms

• Abnormality• Asymmetry• Bilateral• Defect• Deformity• Degeneration• Demineralisation• Depressed• Deviated

•Diastasis•Discontinuity•Displacement•Disruption•Erosion•Extends through•Impaction•Irregularity•Intact•Malalignment

•Mild, Moderate Gross•Opacity•Radiolucent•Rotation•Unilateral

Degree of Severity

• Minor• Mild• Low grade• Marginal• Partial• Extremely• Considerable• Pronounced• Marked• Severe• Gross• Excessive

Progression/time related

• Acute• Chronic• Recent• Healed• Longstanding• Active• Aggressive• Developing• Deterioration• Improvement

Direction of the Fracture Line

Types of Fractures

• Buckle/Green Stick

• Comminuted

• Avulsion

• Pathological

• Stress

• Impacted

Initial Evaluation of a Radiographic Film----------

• Name, Date, Anatomical markers, projections

• Overall size and shape of the bones– Consistent with age ,

sex, uniformity

• Thickness of cortex– thick at mid-shaft, Is it

visible all the way round.

• Density of the bone– Increased or decreased

Bones• Step or break in the Cortex• Distortion of Trabecular pattern• Distortion of bone shape

Cartilage and Joint space:

• Intra-articular involvement

• Look for Joint Space narrowing or widening

Soft Tissue Swelling

Film has edges

There are certain normal anatomical relationships that can be measured or assessed for alignment. These can be of great benefit when trying to spot fractures.

Measurements and Lines

the ankle…..

20 - 40°

Boehler’s AngleBoehler’s Angle

A

B

C

Summary

• Start with an overall observation of your radiograph, pt. details, correct hand ?

• Think of the MOI, adult, child• Pitfalls- accessory ossicles• Consider soft tissue- occult fractures• Once you spot a fracture, carry on to

examine rest of the radiograph• Describe what you see• Use measurements and line to help you