Interpretation of Radiographs PDF

INTERPRETATION OF RADIOGRAPHS JARROD SMITH, DPM, FACFAS LEARNING OBJECTIVES Demonstrate knowledge of a structured process of reading radiographs Identify normal bony anatomy and major osseous landmarks as visualized on radiographs Demonstrate knowledge of general fracture terminology ULTIMATE GOAL E...

INTERPRETATION OF RADIOGRAPHS JARROD SMITH, DPM, FACFAS LEARNING OBJECTIVES Demonstrate knowledge of a structured process of reading radiographs Identify normal bony anatomy and major osseous landmarks as visualized on radiographs Demonstrate knowledge of general fracture terminology ULTIMATE GOAL Evaluate and describe a radiograph using a systematic approach. It is easier to do this one way all the time rather than multiple ways some of the time. The proper term for an image on X-ray film is a radiograph INTRODUCTORY STATEMENT “I am looking at (number) views of the (left/right foot/ankle) of a skeletally (mature/immature) individual in a (non-weightbearing/weightbearing) position. There is a/an (list all the image views you see). The quality of the x-rays is (adequate/inadequate) for visualizing soft tissue and bone.” There are caveats, but it is easier to pare down your verbiage as you get more comfortable reading radiographs. Early in this process it is better to have too much rather than too little. INTRODUCTORY STATEMENT “I am looking at (number) views of the (left/right foot/ankle) of a skeletally (mature/immature) individual in a (non-weightbearing/weightbearing) position. There is a/an (list all the image views you see). The quality of the x-rays is (adequate/inadequate) for visualizing soft tissue and bone.” HOW DO YOU DISTINGUISH RIGHT FROM LEFT? Anteroposterior (AP) and oblique views, you assume you are looking down on the foot with the plantar aspect on the ground (on the cassette). HOW DO YOU DISTINGUISH RIGHT FROM LEFT? Anteroposterior (AP) and oblique views, you assume you are looking down on the foot with the plantar aspect on the ground (on the cassette). INTRODUCTORY STATEMENT “I am looking at (number) views of the (left/right foot/ankle) of a skeletally (mature/immature) individual in a (non-weightbearing/weightbearing) position. There is a/an (list all the image views you see).” SKELETALLY IMMATURE VS MATURE Immature bone has at least one open growth plate Mature bone has no open growth plates SKELETALLY IMMATURE VS MATURE Immature bone has at least one open growth plate Mature bone has no open growth plates SKELETALLY IMMATURE VS MATURE Immature bone has at least one open growth plate Mature bone has no open growth plates INTRODUCTORY STATEMENT “I am looking at (number) views of the (left/right foot/ankle) of a skeletally (mature/immature) individual in a (non-weightbearing/weightbearing) position. There is a/an (list all the image views you see).” WEIGHTBEARING VS NONWEIGHTBEARING If it’s not marked on the radiograph, the lateral image will tell the story If the heel and metatarsals are on the same plane, it’s weightbearing It is appropriate to assume all images are weightbearing WEIGHTBEARING VS NONWEIGHTBEARING If it’s not marked on the radiograph, the lateral image will tell the story If the metatarsals are plantarflexed in relation to the heel it is nonweightbearing It is appropriate to assume all images are nonweightbearing WEIGHTBEARING VS NONWEIGHTBEARING Weightbearing often yields more information than nonweightbearing Usually, this only indication for nonweightbearing films is trauma INTRODUCTORY STATEMENT “I am looking at (number) views of the (left/right foot/ankle) of a skeletally (mature/immature) individual in a (non-weightbearing/weightbearing) position. There is a/an (list all the image views you see).” NORMAL ANATOMY AND LANDMARKS Anteroposterior (AP) Foot View Forefoot to rearfoot relationship First ray Metatarsal parabola MTPJs Sesamoid position Navicular body NORMAL ANATOMY AND LANDMARKS Medial Oblique (MO) Foot View Lateral column Cuboid Lateral pole of the navicular Fibular sesamoid TMTJs NORMAL ANATOMY AND LANDMARKS Lateral (LAT) Foot View Ankle joint Subtalar joint Forefoot to rearfoot relationship First ray position Medial column NORMAL ANATOMY AND LANDMARKS Lateral Oblique (LO) Foot View Medial column Navicular tuberosity Tibial sesamoid NORMAL ANATOMY AND LANDMARKS Sesamoid Axial (SA) View Sesamoid articulations Sesamoid position Frontal plane rotation of the 1st metatarsal Calcaneal Axial (CA) View Calcaneal position Subtalar joint Coalitions NORMAL ANATOMY AND LANDMARKS Anteroposterior (AP) Ankle View Medial gutter Medial malleolus Tibiofibular overlap NORMAL ANATOMY AND LANDMARKS Anteroposterior (AP) Mortise Ankle View Ankle joint Syndesmosis Lateral gutter NORMAL ANATOMY AND LANDMARKS Lateral (LAT) Ankle View Ankle joint Subtalar joint CC joint TN joint NORMAL ANATOMY AND LANDMARKS NORMAL ANATOMY AND LANDMARKS NORMAL ANATOMY AND LANDMARKS NORMAL ANATOMY AND LANDMARKS INTRODUCTORY STATEMENT “I am looking at (number) views of the (left/right foot/ankle) of a skeletally (mature/immature) individual in a (non-weightbearing/weightbearing) position. There is a/an (list all the image views you see).” 3D INTERPRETATION OF A 2D IMAGE FRACTURE TERMINOLOGY Open or Closed Location Degree “OLD ACIDDS” Articular Involvement Complete Incomplete Deformity Dislocation Special OLD ACIDDS OPEN OR CLOSED Simple or compound fracture Clinical diagnosis OLD ACIDDS LOCATION Where on the bone OLD ACIDDS DEGREE Displaced/Nondisplaced Complete/Incomplete OLD ACIDDS ARTICULAR INVOLVEMENT Intra-articular Extra-articular OLD ACIDDS COMPLETE PATTERNS Transverse Oblique Spiral Comminuted OLD ACIDDS COMPLETE PATTERNS Transverse Oblique Spiral Comminuted OLD ACIDDS COMPLETE PATTERNS Transverse Oblique Spiral Comminuted OLD ACIDDS COMPLETE PATTERNS Transverse Oblique Spiral Comminuted OLD ACIDDS INCOMPLETE PATTERNS Greenstick Buckle Bowing OLD ACIDDS INCOMPLETE PATTERNS Greenstick Buckle (Torus) Bowing OLD ACIDDS INCOMPLETE PATTERNS Greenstick Buckle Bowing OLD ACIDDS DEFORMITY OF FRACTURE Position of the distal fragment to the proximal fragment Displacement Angulation Angle created by the distal and proximal fragment Shortening Dorsal, plantar, anterior, posterior, medial and/or lateral Overlapping fracture ends Rotation Rotation along the long axis OLD ACIDDS DISLOCATION OLD ACIDDS SPECIAL FRACTURES Salter-Harris Avulsion Pathologic OLD ACIDDS SPECIAL FRACTURES Salter-Harris Avulsion Pathologic OLD ACIDDS SPECIAL FRACTURES Salter-Harris Avulsion Pathologic DESCRIBE THIS FRACTURE Open or Closed Location Degree Articular Involvement Complete Incomplete Deformity Dislocation Special DESCRIBE THIS FRACTURE Open or Closed Location Degree Articular Involvement Complete Incomplete Deformity Dislocation Special QUESTIONS COPYRIGHT NOTICE: This presentation may contain copyrighted material used for educational purposes under the guidelines of Fair Use and the TEACH Act. 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