XRay Interpretation

Aka: XRay Interpretation, Radiographic Imaging, Radiography, XRay, Mach Band, Musculoskeletal XRay ABCs

advertisement

II. Background

  1. Five Radiographic Densities (in order of increasing brightness)
    1. Air (e.g. lung, dark)
    2. Fat
    3. Fluid and soft tissue (e.g. heart)
    4. Bone or calcifications
    5. Metal or Contrast Material (very bright)
  2. Differences in radiographic density allows for differentiation of structures on XRay
    1. Adjacent objects with similar densities will have indistinct abbutting margins
    2. Blurred structural margin suggests an adjacent structure (Silhouette Sign)
  3. Image Geometry
    1. Orthogonal views (90 degrees) reduces distortion
    2. Objects further from the xray film are distorted
      1. Objects close to XRay film or cassette have sharp edges without significant magnification
      2. Objects further from XRay film or cassette have blurred edges and greater magnification
  4. Penetration
    1. Over-penetration: Dark films
    2. Under-penetration: White films
  5. Artifacts
    1. Mach Bands
      1. Optical Illusion that appears similar to a Fracture line at the interface between radiopaque objects
      2. Two superimposed structures (e.g. bone on bone) have slightly different shades of gray

III. Precautions: Radiology

  1. Read the full imaging report (not just the impression)
  2. Read your own imaging studies early
    1. Follow the established review pattern for each imaging study (e.g. ABCD for Chest XRay Interpretation)
    2. Do not wait for radiology over-read (delays care, missed findings)
    3. Act on serious findings, and alert radiology if needing faster over-read for related findings
  3. Discharging before radiology over-read risks missed patient notification
    1. Have a system for abnormal late-result review (e.g. nurse triage pool)
    2. Alert the patient to which results are pending and how they can view final results (e.g. Epic MyChart)
    3. Facilitate patient follow-up

IV. Precautions: Radiation Exposure Risk

  1. Unlike fluoroscopy or CT, single modern xray exposure risk is negligible (0.04 mSv)
    1. Single Xray exposure is equivalent to 10 days of environmental background Radiation Exposure
  2. Radiation Exposure is reduced even further with distance from XRay source (by inverse of square of distance)
    1. Distance 2 feet from XRay Source drops Radiation Exposure to 25% (compared with 1 foot distance)
    2. Distance 3 feet from XRay Source drops Radiation Exposure to 11% (compared with 1 foot distance)
    3. Distance 4 feet from XRay Source drops Radiation Exposure to 6.3% (compared with 1 foot distance)
    4. Distance 5 feet from XRay Source drops Radiation Exposure to 4% (compared with 1 foot distance)

V. Approach: General

  1. Check Metadata
    1. Patient Name and Identifiers
    2. Exam Date and Time
    3. Technician Notations (e.g. Expiration film)
  2. Patient Position
    1. Supine
    2. Semiupright
    3. Erect
  3. Patient Alignment
    1. Rotation
    2. Lordosis or kyphosis
  4. Systematic Review in General
    1. Prowl the film in systematic fashion (see xray findings below for specific approaches)
    2. View images adjusting brightness/contrast presets (e.g. bone window) and different magnification
  5. Systematic Review: Musculoskeletal XRay ABCs
    1. Adequacy and Alignment
    2. Bones
    3. Cartilage and Joints
    4. Soft tissue and spacing

VI. Findings

  1. Head
    1. See Sinus XRay
    2. See Skull XRay
  2. Chest
    1. See Chest XRay
    2. See Chest XRay Interpretation
    3. See Chest XRay Changes Suggestive of Tb
    4. See Chest XRay in Asthma
    5. See Chest XRay in Congenital Heart Disease
    6. See Chest XRay in Congestive Heart Failure
    7. See Chest XRay in Pneumothorax
  3. Upper Extremity
    1. See Shoulder XRay
    2. See Elbow XRay
    3. See Wrist XRay
    4. See Hand XRay
  4. Lower Extremity
    1. See Pelvis XRay
    2. See Hip XRay
    3. See Knee XRay
    4. See Ankle XRay
    5. See Foot XRay
  5. Spine
    1. See Cervical Spine XRay
    2. See Thoracic Spine XRay
    3. See Lumbar Spine XRay
    4. See Scoliosis XRay
  6. Specific Conditions
    1. See XRay Changes in Rheumatic Conditions
    2. See Osteoarthritis XRay
    3. See Osteomyelitis XRay
    4. See Stress Fracture XRay

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "XRay Interpretation." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Studies

Related Topics in X-Ray

advertisement