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

Different density material will attenuate different amounts of x-ray beam. Pb BaSO4 Bone Muscle Fat Air 8 82 56 20 X-ray film

How to read a Radiograph ?

Good Film Viewing Concentration 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 Film Viewing Box / Monitor Ambient lighting No distractions Biscuits and coffee

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

Black Eye Brow sign Specticles Sign Indirect Signs

Film has edges

Measurements and Lines 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.

the ankle….. B 20 - 40° A C Boehler’s Angle

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