COMMON ERRORS IN XRAY INTERPRETATION

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COMMON ERRORS IN XRAY INTERPRETATION

• DR SALLY CANDY
• DEPARTMENT OF RADIOLOGY
• GSH

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Misinterpretation

• Forgivable
• Regrettable
• Leave town

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The questions

• CORRECT PATIENT ?
• CORRECT HISTORY?
• CORRECT LABELLING?
• CORRECT POSITIONING ?
• CORRECT EXPOSURE ?
• 0PTIMAL VIEWING CONDITIONS?
• 2 VIEWS?
• PREVIOUS FILMS ?
• REVIEW AREAS?

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The Billion Dollar questions

• Is it real ? Technical / artefact
• Is it incidental ? Normal structure Variant
• Is it significant ?

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you cant see what you dont know .
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CXR - REVIEW AREAS

• APICES
• HILA
• BEHIND THE HEART
• CP ANGLES
• BREASTS
• BONES
• PARASPINAL

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CXR - MASSES THAT ARENT

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

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LEFT UPPER LOBE COLLAPSE
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LEFT LOWER LOBE COLLAPSE
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Pseudotumor loculated pleural fluid
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NB THE RIGHT HEART BORDER
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CXR CHILDREN

• AP FILM
• CTR 60
• THYMUS
• HYPERINFLATION
• SUBTLE OPACIFICATION
• NODES

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The Thymus
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ASPIRATION OF FB
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PNEUMOMEDIASTINUM
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Pleural effusion -
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The widened mediastinum
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Abdominal XRay
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BOWEL PERFORATION
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DANGEROUS ABDOMENS
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AIR!
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AIR IN THE WRONG PLACE
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ABDOMINAL CALCIFICATION
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BONES

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

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THE VEXATIOUS CERVICAL SPINE
12MM
12MM
10mm
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CERVICAL SPINE

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

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TECHNIQUE,TECHNIQUE,TECHNIQUE
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THE OPEN MOUTH VIEW
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MISCHIEVOUS FRACTURES
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LIS-FRANC

• Fracture dislocation or fracture subluxation of
  the TMT joints.
• History axial load to plantar flexed foot
• 3 views - weightbearing

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Segond fracture

• Internal rotation and varus
• Cortical avulsion of tibia at insertion of LCL
• Assoc with internal injuries (ACL and menisci)
• Reverse Segond

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Maisonneuve fracture

• Pronation external rotation
• upper third fibula
• rupture distal tibiofibular syndesmosis and
  interosseous membrane
• UNSTABLE
• OUT OF ANKLE VIEW

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The normal adult wrist
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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

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Perilunate dislocation

• The lunate maintains its normal articulation with
  the radius.
• The capitate articular surface is dislocated from
  the lunate, normally dorsally

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Salter Harris Physeal Injuries
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Scaphoid fractures
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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

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THE ELEVATED FAT PAD
POST OLECRANON
ANT CORONOID
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Normal alignment elbowAnterior humeral line
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RADIOCAPITELLAR LINE
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Ossification centres elbow

• C R I T O L E
• CAPITELLUMRADIAL HEADINT EPICONDYLE
  TROCHLEA OLECRANONLATERAL EPICONDYLE

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THANK YOU!