1. 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

2. 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

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

4. Radiographic Densities

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

6. How to read a Radiograph ?

7. 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

8. Why is it important to have TWO views.
Why do we need to examine all the views ?

9. 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

10. Degree of Severity Minor Mild Low grade Marginal Partial Extremely
Considerable
Pronounced
Marked
Severe
Gross
Excessive

11. Progression/time related
Acute
Chronic
Recent
Healed
Longstanding
Active
Aggressive
Developing
Deterioration
Improvement

13. Direction of the Fracture Line

19. Types of Fractures Buckle/Green Stick Comminuted Avulsion Pathological
Stress
Impacted

20. 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

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

22. Cartilage and Joint space:
Intra-articular involvement
Look for Joint Space narrowing or widening

23. Soft Tissue Swelling

24. Black Eye Brow sign Specticles Sign
Indirect Signs

25. Film has edges

26. 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.

27. the ankle….. B ° A C
Boehler’s Angle

28. 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