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COMMON ERRORS IN XRAY INTERPRETATION

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COMMON ERRORS IN XRAY INTERPRETATION DR SALLY CANDY DEPARTMENT OF RADIOLOGY GSH Misinterpretation Forgivable Regrettable Leave town The questions CORRECT PATIENT ? – PowerPoint PPT presentation

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Title: COMMON ERRORS IN XRAY INTERPRETATION


1
COMMON ERRORS IN XRAY INTERPRETATION
  • DR SALLY CANDY
  • DEPARTMENT OF RADIOLOGY
  • GSH

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Misinterpretation
  • Forgivable
  • Regrettable
  • Leave town

7
The questions
  • CORRECT PATIENT ?
  • CORRECT HISTORY?
  • CORRECT LABELLING?
  • CORRECT POSITIONING ?
  • CORRECT EXPOSURE ?
  • 0PTIMAL VIEWING CONDITIONS?
  • 2 VIEWS?
  • PREVIOUS FILMS ?
  • REVIEW AREAS?

8
The Billion Dollar questions
  • Is it real ? Technical / artefact
  • Is it incidental ? Normal structure Variant
  • Is it significant ?

9
you cant see what you dont know .
10
CXR - REVIEW AREAS
  • APICES
  • HILA
  • BEHIND THE HEART
  • CP ANGLES
  • BREASTS
  • BONES
  • PARASPINAL

11
CXR - MASSES THAT ARENT
  • COSTOCHONDRAL JUNCTION
  • STERNUM
  • NIPPLES
  • HAIR BRAIDS / ACCESSORIES
  • BUTTONS
  • SKIN LESIONS
  • LOCULATED FLUID

12
LEFT UPPER LOBE COLLAPSE
13
LEFT LOWER LOBE COLLAPSE
14
Pseudotumor loculated pleural fluid
15
NB THE RIGHT HEART BORDER
16
CXR CHILDREN
  • AP FILM
  • CTR 60
  • THYMUS
  • HYPERINFLATION
  • SUBTLE OPACIFICATION
  • NODES

17
The Thymus
18
ASPIRATION OF FB
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PNEUMOMEDIASTINUM
20
Pleural effusion -
21
The widened mediastinum
22
Abdominal XRay
23
BOWEL PERFORATION
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DANGEROUS ABDOMENS
25
AIR!
26
AIR IN THE WRONG PLACE
27
ABDOMINAL CALCIFICATION
28
BONES
  • NB 2 VIEWS - ALWAYS
  • COMPARE WITH OPPOSITE SIDE
  • REPEAT XRAY IN 2 WEEKS ( PANNUS )
  • CONSULT FRIENDLY TEXT ( KEATS )

29
THE VEXATIOUS CERVICAL SPINE
12MM
12MM
10mm
30
CERVICAL SPINE
  • Base of skull to T1!
  • Longitudinal lines
  • Prevertebral soft tissue
  • ADI ( adults 3mm, kids 5mm )
  • Normal variants

31
TECHNIQUE,TECHNIQUE,TECHNIQUE
32
THE OPEN MOUTH VIEW
33
MISCHIEVOUS FRACTURES
34
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

37
Maisonneuve fracture
  • Pronation external rotation
  • upper third fibula
  • rupture distal tibiofibular syndesmosis and
    interosseous membrane
  • UNSTABLE
  • OUT OF ANKLE VIEW

38
The normal adult wrist
39
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

40
Perilunate dislocation
  • The lunate maintains its normal articulation with
    the radius.
  • The capitate articular surface is dislocated from
    the lunate, normally dorsally

41
Salter Harris Physeal Injuries
42
Scaphoid fractures
43
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

44
THE ELEVATED FAT PAD
POST OLECRANON
ANT CORONOID
45
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!
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