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Approach to reporting
radiographs
Dr G Abraham
X-Ray
• Form of electromagnetic
radiation.
• First discovered in 1895 by
Wilhelm Röntgen who
recognized its medical
properties.
• A radiograph is obtained by
passing X ray beams
through the patient who is
in front of a detector.
Bones and other structures
cast a shadow allowing
their visualisation
Quick guide
• Patient identity
• Inspiration – 5- 7 anterior ribs for chest x ray
• Rotation –thoracic spinous processes/clavicles
• Projection
• Penetrance
• Field of view
• Overall quality
• The obvious abnormality?
• Systematic check of anatomical structures
• Consider the clinical question
Anatomical structures on the chest X-
ray
• Trachea and bronchi
• Hilar structures
• Heart and mediastinum
• Lung fields
• Pleura
• Lung lobes and fissures
• Costophrenic angles
• Diaphragm
• Soft tissues
• Bones
Normal anatomy
• Dark – gas
• White –
bone/calcification
• Grey – soft tissues
• Dark grey - fat
68 year old
gentleman with
shortness of
breath.
85 year old lady with a
fever and recurrent falls
68 year old
smoker with
hemoptysis
75 year old with
reduced GCS in
ED resus.
20 year old intoxicated
in ED with multiple
injuries.
30 year old with severe abdominal pain.
49 year old man with chest pain
and low blood pressure
80 year old gentleman admitted with a
fall.
67 year old with extensive
smoking history
40 year old woman pleuritic chest pain.
Summary
• A systematic approach
is vital
• Start with technical
aspects and then
anatomy
• Remember bone, soft
tissue and artefacts
• Consider clinical
context
• Investigations are an
adjunct to clinical
assessment.

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Approach to reporting radiographs

  • 2. X-Ray • Form of electromagnetic radiation. • First discovered in 1895 by Wilhelm Röntgen who recognized its medical properties. • A radiograph is obtained by passing X ray beams through the patient who is in front of a detector. Bones and other structures cast a shadow allowing their visualisation
  • 3. Quick guide • Patient identity • Inspiration – 5- 7 anterior ribs for chest x ray • Rotation –thoracic spinous processes/clavicles • Projection • Penetrance • Field of view • Overall quality • The obvious abnormality? • Systematic check of anatomical structures • Consider the clinical question
  • 4. Anatomical structures on the chest X- ray • Trachea and bronchi • Hilar structures • Heart and mediastinum • Lung fields • Pleura • Lung lobes and fissures • Costophrenic angles • Diaphragm • Soft tissues • Bones
  • 5. Normal anatomy • Dark – gas • White – bone/calcification • Grey – soft tissues • Dark grey - fat
  • 6. 68 year old gentleman with shortness of breath.
  • 7. 85 year old lady with a fever and recurrent falls
  • 8. 68 year old smoker with hemoptysis
  • 9. 75 year old with reduced GCS in ED resus.
  • 10. 20 year old intoxicated in ED with multiple injuries.
  • 11. 30 year old with severe abdominal pain.
  • 12. 49 year old man with chest pain and low blood pressure
  • 13. 80 year old gentleman admitted with a fall.
  • 14. 67 year old with extensive smoking history
  • 15. 40 year old woman pleuritic chest pain.
  • 16. Summary • A systematic approach is vital • Start with technical aspects and then anatomy • Remember bone, soft tissue and artefacts • Consider clinical context • Investigations are an adjunct to clinical assessment.