How to read an X-ray

Ahmed H ABDELAZEEM
Dipl. SICOT, M.D.
Lecturer of Orthopaedics and Traumatology
Cairo University

Objectives
What is an x-ray
How can you write an x-ray request
How to read x-rays systematically
How to describe fracture patterns

What is an X-ray?

X-radiation; discovered by Wilhelm Rntgen

who coined the name (x-ray as he didnt know
its nature)
It is a form of electromagnetic radiation
X-radiation = Rntgen radiation

What is X-rays?

X-ray film = Photosenstive film or its

electronic equivalent
No x-rays

Some x-rays

Lots of x-rays

X-radiation and X-rays film

Tissue volume penetrated

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X-radiation and X-rays film

Tissue volume penetrated
Type of tissue/material

Air

Soft
tissues

Fluids

Bone

Metal

Tissue penetration and projection

Air

Soft
tissues
Bone
cancellous
cortical
Metal
object

Bone
cement

X-ray Request

Correct spelling of X-ray(s) in the English language

includes
x-ray(s) and/or X ray(s)

1.
2.
3.
4.

Rule of TWO
Two views: At 90 degrees, usually anteriorposterior and lateral
Two joints: The joints above and below.
Two occasions: Some fractures are not easily
visible immediately after trauma
Two limbs: If required for comparison

Two
views

Two
occasions

Two
joints

Two limbs

Systematic reading
PROPER PLACEMENT OF THE X-RAY
Ahmed
20.1.2012

Aided by
Name of patient
Side of injury
Date of x-ray

What view???

Ant LAT View post

AP
Lateral

Lateral

AP View

Medial

Identify bone
or anatomical region
(if multiple bones
eg. Hand or foot)

Identify part of bone

Epiphysis
Metaphysis
Diaphysis

Identify type of fracture

Simple
(TWO parts)

Wedge
(usually three parts)

Complex
(comminuted)

Transverse
(<30 degrees)

Oblique
(> 30 degrees)

Spiral

Bones Quality
Normal

Osteopenia

Osteopetrosis

Bone age
Skeletally mature

Skeletally immature

EXAMPLE

This is;
1. Plain X-ray
2. AP view
3. Of the left humerus bone
4. Showing a spiral fracture
5. at its diaphysis
6. with a normal bone density
7. in a skeletally mature case.

Describe the deformity

1. Displacement (translation)
2. Angulation
3. Malrotation
4. Shortening
Always describe the movement
of the distal fragment relative to
the proximal one

1. Displacement
(translation)

3. Rotation

2. Angulation

4. Shortening

1. Displacement
(translation)

3. Rotation

2. Angulation

4. Shortening

1. Displacement
(translation)

3. Rotation

2. Angulation

4. Shortening

Displacement (translation)
AP view
Medial
and lateral

Lateral view
Anterior and
Posterior

Angulation
AP view
Medial
and lateral

Lateral view
Anterior and
Posterior

Describing angulation
(confusing.!!!)
According to the tip of
the angle

According to distal
fragment

Fracture is angulated
laterally

Distal fragment is
angulated
Medially

Easier

Angulation knee
Varus O

Valgus X

Towards the midline

Always from the midline

Thank you