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a) How To Present A Radiograph

1. Identify the patient and type of radiograph. E.g. This is a plain CHEST/ABDOMINAL radiograph of PATIENT'S NAME taken on DATE at TIME, it is a PA/AP/SUPINE/MOBILE image, and I note the side marker is correct...' Most chest radiographs are PA because when taken AP, the heart becomes slightly magnified. PROTIP: If you dont know if it is an AP or PA image, just describe is as frontal (that is, you are looking at the patient straight on). 2. Comment briefly on the quality of the image. In an OSCE, we wont get an inadequate image, but it would be good to state that the image is of a good quality (unless it obviously isnt). When a CXR is done, the patient is asked to take a deep break to make the lungs and CPAs more visible, but it is important to check if the lungs are hyperexpanded anyway. The best way to check this is to see if the hemidiaphragms are flattened. If you are not sure, count the ribs. 3. Describe the most obvious abnormality first. Some radiologists dont like the phrase obvious abnormality, so if you feel uncomfortable saying this, say something like the first abnormality that I notice is If you cannot see any obvious abnormalities, then say I cannot see any abnormality at first glance and then proceed to examine the image systematically (tell the examiner that you are now going to examine the image systematically to check for abnormalities). 4. Describe the image systemically 5. Summarise
In summary, this X-ray demonstrates evidence of.However,is 1. Trachea/bronchi 2. Hilar structures 3. Lung zones 4. Pleura 5. Lung lobes/fissures 6. Costophrenic angles 7. Diaphragm 8. Heart 9. Mediastinum 10. Soft tissues 11. Bones 1. Assess bowel gas pattern (check for obstructions etc.) 2. Soft tissues 3. Bones N.B. Many abdominal structures are not clearly defined on a radiograph and cannot be fully assessed. Abdominal radiographs provide limited information. normal. If necessary, relate the image to the clinical scenario (if there is one). It would also be good to suggest an initial management plan and/or further investigations.

Chest X-ray

Abdominal X-ray

b) Chest Radiographs

b) Chest Radiographs 1. Normal anatomy

This is a normal PA chest radiograph of a male.

This is a normal right lateral chest radiograph of a male.

c) Abnormalities on Chest Radiographs 5. Tracheal Deviation (mediastinal thyroid enlargement)

6. Bilateral Hilar Enlargement (sarcoidosis)

7. Consolidation (pneumonia causing consolidation and pus)

8. Right Upper Lobe Collapse (lung cancer obstructing right upper lobe bronchus)

9. Right Costophrenic Angle Blunting (lung cancer occluding central airways)

10. Lung Hyperexpansion (COPD)

11. Pneumothorax (due to rib fracture)

c. Abnormalities on an Abdominal Radiograph 1. Free Air/Gas Under the Diaphragm (perforation of duodenum by a large ulcer- medical emergency)

2. Small Bowel Obstruction (red circle is an anastomosis causing adhesions: >3cm dilation is abnormal)

3. Post-Operative Ileus (common. It is aperistaltic bowel not caused by mechanical obstruction)

4. Large Bowel Obstruction (obstruction colon carcinoma. >5cm is abnormal.)

5. Sigmoid Volvulus (happens because sigmoid has its own mesentery. Dilation/perforation ++++) - Note coffee bean shape. This is a classic sign for a sigmoid volvulus.

6. Caecal volvulus (identify SB by valvulae conniventes, which are identified by arrows)

7. Ascites

8. Pleural Effusion and Dilated Colon (pseudo obstruction secondary to left basal consolidation and pleural effusion caused by pneumonia)

d. Abnormalities of the Musculoskeletal System There are 4 anatomical classes of bone: I. II. III. IV. Long Short Flat Irregular

Description of a bone fracture depends on: I. II. The class of bone The direction of the facture line

Long bone fractures are described with reference to the direction of the fracture line in relation to the shaft of the bone. For example, a fracture passing perpendicular across the bone is described as transverse. Other fractures passing across a long bone include, oblique and spiral fractures. If a fracture passes along the shaft of a long bone then it can be described with reference to the plane in which is passes, for example coronal or sagittal. Irregular bone fractures are a fracture of a short, flat or irregular bone and require a description determined by its direction through the bone. Useful terms include - horizontal, vertical, coronal, sagittal and axial. Often a fracture can be seen to pass in more than one direction, in which case a more detailed description may be needed.

1. Transverse fracture of a Tibia

2. Oblique fracture of a Metatarsal

3. Spiral fracture of a Tibia

4. Sagittal plane fracture of a Tibia

5. Irregular (bone) fracture passing through the body of a Calcaneus in both coronal and axial planes

6. Comminuted fracture of a Humerus

f. Pathology 1. Osteoporotic fracture

2. Fragment avulsed from distal phalanx due to hyperflexion at DIPJ

3. Dislocation of finger (when a fracture and dislocation is present, the pathology is called a fracture-dislocation)

4. Displacement and Shortening

5. Angulation and Rotation

6. Distraction and Impaction

7. Combination fracture