X-ray interpretation Cervical spine x-ray

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X-ray interpretation

Cervical spine X-ray

Adequacy –

  • Check identity of patient and date

  • Ensure base of skull, top of shoulders, the trachea and spinous processes are seen

  • Count the number of vertebra and make sure the top of T1 is seen

Alignment –

  • Assess the contours of the cervical spine and appendages – anterior, posterior, spinous processes and spinolaminar lines

Bones –

  • Check each vertebra for shape, height and fracture

  • Check the shape of the odontoid peg

  • Check the spinal canal size

Cartilage and joints

  • Check the intervertebral disc spaces

  • Check the facet joints

  • Check the interspinous distance

  • Check the C1/C2 distance

Soft tissue

  • Check the precervical and paracervical spaces – predental space <3mm in adults, <5mm in child; prevertebral space <7mm at C2, <1/2 vertebral body width at C3-4, at C6 22mm in adults <14mm in children or

  • Spinal immobilization devices or foreign bodies

Chest X-ray

Adequacy –

  • Check patient identity, side marker (dextrocardia), PA/AP view

  • Assess exposure – mid-thoracic IV discs visible through mediastinal density

  • Check lung apices and both costophrenic angles for presence on film

  • Check phase of respiration – effects on vasculature and heart size

Alignment –

  • Relationship between spinous processes of upper thoracic vertebra and medial aspects of clavicles – affects mediastinal contours and dimensions

Bones –

  • Assess ribs for deformity, fractures or flail segments

  • Check vertebrae, clavicles, scapulae and proximal humerus for abnormalities

Soft tissue –

  • Mediastinum –

    • Upper – position of trachea, check for narrowing or distortion, superior mediastinal swellings

    • Middle – hilar shadows (pulmonary vessels, hilar lymph nodes; left hila higher than right)

    • Lower – overall position, size and shape of heart, heart borders – silhouette sign, cardiothoracic ratio

  • Lungs and diaphragm –

    • Lungs – volume, density, pleural fluid, edema, cavitation, air-fluid levels, visible fissure >1mm thickness significant; pneumothorax/ hydropneumothorax

    • Diaphragm – position, shape, clarity of cardiophrenic/ costophrenic angles and diaphragm borders

  • Extrathoracic soft tissue –

    • Foreign bodies, surgical emphysema, free air under diaphragm

  • Medical equipment

    • Airway, monitoring leads, central lines

Pelvic x-ray

Adequacy –

  • Check identity and date

  • Ensure the sacrum, L5, the iliac crests and proximal parts of femur can be seen

  • Check for adequate exposure

Alignment –

  • Check for rotation by lining up the symphysis pubis with midline of sacrum

  • Check the three circles – pelvic brim and two obturator foramina

  • Complete examination of obturator foramina by tracing along Shenton’s line

Bones –

  • Check cortical surfaces of outer edges of pelvis for disruption

  • Check the internal trabecular pattern of the pelvis for disruption – iliopectineal and ilioischial lines

  • Check the femoral heads and lumbar vertebrae for disruption

Cartilage and joints –

  • Check the sacro-iliac joints

  • Check the acetabulum

Soft tissue –

  • Check for evidence of soft tissue swelling and foreign bodies in and outside pelvis

  • Elbow x-ray

    Adequacy –

    • Check identity and views available

    • Check for adequate visualization of distal humerus and proximal ends of radius and ulna

    • Check for adequate “hourglass sign” (figure of eight) at distal humerus – true lateral view

    Alignment –

    • Anterior humeral line – passes through middle third of capitellum – anterior or posterior displacement in supracondylar fractures

    • Radio-capitellar line – through middle of radius bisects capitellum on both lateral and AP x-rays – radial head dislocation

    Bones –

    • Inspect distal humerus for cortical disruption

    • Inspect ulna and olecranon for anatomical defects

    • Inspect radial head and neck for obvious fractures

    Cartilage and joints –

    • Check for ulna and capitellum articulation and evidence of anterior or posterior elbow dislocation – line disruptions may be present

    Soft tissue –

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