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Harris Growth Arrest Lines

M.J.Fuller — Tue, 31 Jan 2012 19:10:03 CST

Introduction

Metaphyseal Harris growth arrest lines (or lines of Park) result from a temporary interruption to normal longitudinal bone growth. These lines are usually incidental findings of no clinical significance, but may cause confusion. Radiographers should be aware of these lines and their significance.

Case 1

5 year old boy with a history of osteogenesis imperfecta.

There are multiple growth arrest lines with the following features

the growth arrest lines are transversely orientated and match the contour of the epiphysis

the lines are parallel

The lines closest to the epiphysis are thickest and more widely spaced

The further the lines are away from the epiphysis, the more the lines become broken, irregular, and indistinct

The tibial, fibular and femoral lines show different spacings reflecting different rates of bone growth.
It has been argued that these lines seen in OGI patients are a separate entity from what might be called normal growth arrest lines. Al Muderis et al (2007) has termed these 'Zebra lines' associated with Pamidronate therapy- this is used in children for the treatment of low bone mineral density.

	5 year old boy with a history of osteogenesis imperfecta. There are multiple growth arrest lines with the following features the growth arrest lines are transversely orientated and match the contour of the epiphysis the lines are parallel The lines closest to the epiphysis are thickest and more widely spaced The further the lines are away from the epiphysis, the more the lines become broken, irregular, and indistinct The tibial, fibular and femoral lines show different spacings reflecting different rates of bone growth. It has been argued that these lines seen in OGI patients are a separate entity from what might be called normal growth arrest lines. Al Muderis et al (2007) has termed these 'Zebra lines' associated with Pamidronate therapy- this is used in children for the treatment of low bone mineral density.

Radiography

M.J.Fuller — Tue, 24 Jan 2012 07:17:24 CST

Welcome to wikiRadiography the best radiography resource on the web! To contribute to the pages inside or join discussions, you must first sign in or sign up.

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To contribute to the pages inside or join discussions, you must first sign in or sign up.

These articles will compliment your skills and add an extra dimension to your work! Written by M.J.Fuller they cover such topics as - image evaluation, technique, positioning aids, normal variants and case studies.
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Case of the Month Quiz 2

M.J.Fuller — Mon, 23 Jan 2012 19:32:17 CST

This 60 year old male was transported to the Emergency Department by ambulance following an RTA/MVA. The radiographer was called to the resus room to perform a routine trauma plain film series (Chest, C spine, Pelvis). The AP pelvis image is shown below.

Question 1
Is there any pathology demonstrated?
Question 2
Is any further imaging of the pelvis warranted?

Neonatal Chest Pathology

M.J.Fuller — Fri, 20 Jan 2012 07:21:42 CST

Recognizing the 5 Most Common

Hyaline Membrane Disease
Bronchopulmonary Dysplasia
Transient Tachypnea of the Newborn
Meconium Aspiration Syndrome
Neonatal Pneumonia

Hyaline Membrane Disease (Respiratory Distress Syndrome, RDS)

• Originates from insufficient surfactant production
• Inadequate surfactant production leads to high air-water (blood) surface
tensions which favour alveolar collapse and gas exchange failure in the lung

•Instability of terminal airspaces due to elevated surface forces at liquid-gas interfaces

•Stable alveolar volume depends on a balance between:
1)surface tension at the liquid-gas interface, and
2) recoil of tissue elasticity

• Collapsed alveoli contain fluid with a high protein content, hyaline
membranes, and lamellar bodies derived from the surfactant layer of lung
http://microanatomy.net/digestive/Lecture_33_Dev_GI_Resp_Kielian_4_slides_per_page.pdf

Typically, diffuse “ground-glass” or finely granular appearance
Bilateral and symmetrical distribution
Air bronchograms are common
Especially extending peripherally
Hypoaeration in non-ventilated lungs
Hyperinflation excludes HMD
“Granularity” is the interplay of
Air-distended bronchioles & ducts
Background of atelectasis of alveoli
May change from film-to-film if there is
Expiration (air disappears)
Better aeration (small bubble formation)
http://www.learningradiology.com/archives2008/COW%20292-TTN/ttnccorrect.htm

•Surfactant consists of phospholipids and protein. It begins to be produced at about 24-28 weeks of pregnancy. Surfactant is found in amniotic fluid between 28 and 32 weeks. By about 35 weeks gestation, most babies have adequate amounts of surfactant.

•Surfactant is normally released into the lung tissues where it helps lower surface tension in the airways. This helps keep the lung alveoli open. When there is not enough surfactant, the alveoli collapse. As the alveoli collapse, damaged cells collect in the airways, creating a “hyaline membrane.”

chest x-rays of lungs - often show a unique "ground glass" appearance called a reticulogranular pattern.

Moderately severe HMD/RDS Typical appearance of HMD/RDS


Moderately severe HMD/RDS	Typical appearance of HMD/RDS

Bronchopulmonary Dysplasia

May be impossible to distinguish early stages of BPD from later stages of HMD
Coarse, irregular, rope-like, linear densities
Represents atelectasis or fibrosis
Lucent, cyst-like foci
Hyperexpanded areas of air-trapping
Hyperaeration of the lungs
Conglomerate disease in BPD
Shifting atelectasis
Episodes of aspiration or pulmonary edema
Superimposed pneumonia
Changes of BPD will revert to normal on the chest radiograph in most patients after the age of two
http://www.learningradiology.com/archives2008/COW%20292-TTN/ttnccorrect.html

Pulmonary Interstitial Emphysema (PIE)

Source: Roderick MacPherson M.D. Professor Emeritus Radiology, Medical University of South Carolina

Source: Roderick MacPherson M.D. Professor Emeritus Radiology, Medical University of South Carolina

Transient Tachypnea of the Newborn (Also known as RDS type 2 or wet lung syndrome)

Mild and self-limited

Delayed resorption of fetal lung fluid

Hyperinflation of the lungs
Fluid in the fissures
Laminar effusions
Fuzzy vessels
http://www.learningradiology.com/archives2008/COW%20292-TTN/ttnccorrect.html

•It is thought that slow absorption of the fluid in the fetal lungs causes TTN. This fluid makes taking in oxygen harder and the baby breathes faster to compensate.

•rapid breathing rate (over 60 breaths/minute)

•grunting sounds with breathing

•flaring of the nostrils

•retractions (pulling in at the ribs with breathing)

http://www.learningradiology.com/archives2008/COW%20292-TTN/caseoftheweek292page.html

Meconium Aspiration Syndrome

Diffuse “ropey” densities (similar to BPD)
irregular infiltrates

–Fluffy non-homogeneous infiltrates

Patchy areas of atelectasis and emphysema from air-trapping
Hyperinflation of lungs
Spontaneous pneumothorax and pneumomediastinum
Occurs in 25%; usually requiring no therapy
Small pleural effusions (20%)
No air bronchograms
Clearing usually quick if mostly water; days-weeks if mostly meconium
http://www.learningradiology.com/archives2008/COW%20292-TTN/ttnccorrect.html

Bilateral patchy coarse infiltrates with hyperinflation
Radiologically the typical progression is from global atelectasis in early X-rays to a widespread patchy opacification accompanied by areas of hyperinflation and/or atelectasis.

lCauses plugging of the airways with consequent atelectasis

lMeconium is irritating to the airways causing a chemical pneumonitis and secondary bacterial infection

http://www.learningradiology.com/archives2008/COW%20292-TTN/ttnccorrect.html

	Diffuse “ropey” densities (similar to BPD) irregular infiltrates –Fluffy non-homogeneous infiltrates Patchy areas of atelectasis and emphysema from air-trapping Hyperinflation of lungs Spontaneous pneumothorax and pneumomediastinum Occurs in 25%; usually requiring no therapy Small pleural effusions (20%) No air bronchograms Clearing usually quick if mostly water; days-weeks if mostly meconium http://www.learningradiology.com/archives2008/COW%20292-TTN/ttnccorrect.html
	Bilateral patchy coarse infiltrates with hyperinflation Radiologically the typical progression is from global atelectasis in early X-rays to a widespread patchy opacification accompanied by areas of hyperinflation and/or atelectasis. lCauses plugging of the airways with consequent atelectasis lMeconium is irritating to the airways causing a chemical pneumonitis and secondary bacterial infection

Neonatal Pneumonia

Perihilar streaky pattern may resemble TTN
Patchy airspace disease
Diffuse, relatively homogeneous infiltrates resembling ground-glass pattern of HMD
Occasionally pleural effusion may occur
Lobar consolidation from infection is unusual in a newborn
Group B Strep looks most like HMD
Term infant with findings of “HMD” should be considered to have pneumonia until proven otherwise

http://www.learningradiology.com/archives2008/COW%20292-TTN/ttnccorrect.html

Spontaneous Pneumothorax

Spontaneous right pneumothorax (? tension) in newborn.

visible lung edge (top arrow)
deep sulcus sign
silhouette sign right hemidiaphragm
mediastinal shift

	Spontaneous right pneumothorax (? tension) in newborn. visible lung edge (top arrow) deep sulcus sign silhouette sign right hemidiaphragm mediastinal shift

Pneumomediastinum and Pneumoperitoneum

Subcutaneous emphysema (top arrow)
Pneumomediastinum (middle arrow)
Pneumoperitoneum
Continuous diaphragm sign
Rigler's sign (bottom arrow)
drain in pericardial space
? thickened bowel wall

thermometer in right axilla

	Subcutaneous emphysema (top arrow) Pneumomediastinum (middle arrow) Pneumoperitoneum Continuous diaphragm sign Rigler's sign (bottom arrow) drain in pericardial space ? thickened bowel wall thermometer in right axilla

Pneumomediastinum

This baby has pneumomediastinum. The dotted line in the upper right lung is the thyroid which is displaced by the pneumomediastinum. The other dotted lines outline the airfilled mediastinum


This baby has pneumomediastinum.	The dotted line in the upper right lung is the thyroid which is displaced by the pneumomediastinum. The other dotted lines outline the airfilled mediastinum

Right Upper Lobe Consolidation

This baby has a right upper lobe consolidation with some associated collapse

	This baby has a right upper lobe consolidation with some associated collapse

Rib anomalies

This baby has multiple bifid/conjoined ribs.
? thoracic vertebral anomalies

	This baby has multiple bifid/conjoined ribs. ? thoracic vertebral anomalies

Diaphragmatic Hernia

Baby with bowel and stomach in herniated into left hemithorax.

Pneumomediastinum and right pneumothorax

•developmental abnormality of the diaphragm resulting in a defect that permits abdominal viscera to enter the chest

•1 in 3,000 live births

•Males > females

•Mortality approaches 50%

	Baby with bowel and stomach in herniated into left hemithorax. Pneumomediastinum and right pneumothorax •developmental abnormality of the diaphragm resulting in a defect that permits abdominal viscera to enter the chest •1 in 3,000 live births •Males > females •Mortality approaches 50%

Pneumatocoele

This premature baby has a pneumatocoele in the right lung (arrowed). A pneumatocoele is a thinwalled, air-filled, circumscribed collection of abnormal gas. In a neonate the mechanism is likely to be a check-valve type localised increase in airway pressure causing airtrapping.

Pneumatocoeles can increase rapidly in size (doubling in size in 24 hours) or may resolve spontaneously.

	This premature baby has a pneumatocoele in the right lung (arrowed). A pneumatocoele is a thinwalled, air-filled, circumscribed collection of abnormal gas. In a neonate the mechanism is likely to be a check-valve type localised increase in airway pressure causing airtrapping. Pneumatocoeles can increase rapidly in size (doubling in size in 24 hours) or may resolve spontaneously.

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Medical Abbreviations

Cubby_1 — Tue, 17 Jan 2012 04:44:08 CST

This page contains medical abbreviations that radiographers should be familiar with to enable interpretation of request forms.

Medical Abbreviations

Symbols

0	Not Present OR No abnormality	Also in superscript e.g. ……..o
+/-	Uncertain/equivocal
+	Present or Noted
++	Present Significantly
+++	Present in Excess	eg BMI +++
=	Equivalent to
Numbers
3	OK or satisfactory
A
A	Ankle Jerk/Reflex	Hitting the ankle with a patella hammer to test reflexes
AAA	Abdominal Aortic Aneurysm	Dilatation of abdominal aorta
AAL	Anterior Axillary Line	Imaginary line drawn from the front arm pit down the chest wall
Ab	Abortion
ABG	Arterial Blood Gas "Sats"	Blood test to see how much oxygen there is in the blood (percentage ‘saturation’ with oxygen)
ACD	Acid Citrate Dextrose	Anticoagulant solution
ACE	Angiotensin Converting Enzyme
ACJ	Acromio Clavicular Joint
ACL	Anterior Clavicular Line or Anterior Cruciate Ligament	An imaginary line down the front of the body from the inner end of the collarbone OR a ligament in the knee
ACTH	Adrenocorticotropic Hormone
A.d	As Directed
A&E	Accident and Emergency
AE	After Evacuation
A/E	Air Entry to Lungs OR Accident & Emergency
AF	Atrial Fibrillation	Irregular heart beat
AFM	After Fatty meal
AFP	Alpha Feto Protein
AIDS	Acquired Immune Deficiency Syndrome
AIIS	Anterior Inferior Iliac Spine
AI/R	Aortic Incompetence/regurgitation	Leaking heart valve.
ALL	Acute Lymphatic Leukaemia
ALP	Alkaline-Phosphatase
AM	After Micturation
AML	Acute Myeloid Leukaemia
AMNIO	Amniocentesis
ANC	Ante-Natal Clinic
ANT	Anterior
AODM	Adult Onset of Diabetes Mellitus
AP	Anterior Posterior
APH	Ante Partum Haemorrhage
AoR	Aortic Valve Replacement	AVR
ARDS	Adult Respiratory Distress Syndrome
ARF	Acute Renal Failure
AS	Abdominal System OR Aortic Stenosis	Aortic Stenosis is a narrowed heart valve
ASAP	As Soon As Possible
ASD	Atrial Septal Defect
ASIS	Anterior Superior Iliac Spine
ATB	Antibiotic
ATN	Acute Tubular Necrosis
AV	Avascular Necrosis
AVF	Arterial Venous Fistula
AVM	Arterial Venous Malformation
AVR	Atrial Valve Replacement
AXR	Abdominal X-Ray
B
Ba	Barium
BaE (BE)	Barium Enema
BA	Bowel Action
bd/bid	Twice a Day
B	Biceps Jerk/Reflex	Hitting the arm with a patella hammer to test reflexes
BB	Battered Baby
BBB	Blood Brain Barrier
BCC	Basal Cell Carcinoma	Skin Cancer – Very Low Malignancy
BCDH	Bilateral Congenital Dislocated Hips
BE (BaE)	BariumEnema
BFR	Bone Formation Rate
BIBA	Brought in by Ambulance
BMI	Body Mass Index	A measure of body size relating to height and weight
B-mode	Brightness Modulation (ultrasound)
BMT	Bone Marrow Transplant
BNO	Bowels Not Opened
BOR	Bowels Open Regularly
BOP	Base of Penis
BP	Blood Pressure
BPd	Diastolic Blood Pressure	The lower blood pressure (heart relaxed)
BPD	Bi-Parietal Diameter
BPH	Benign Prostatic Hypertrophy
BPs	Systolic Blood Pressure	The higher blood pressure (heart contracted)
BS	Bowel Sounds
BSO	Bilateral Salpingo Oopherectomy
BTD	Biliary Tract Disease
Bx	Biopsy
C
C	Celsius
CA or Ca	Carcinoma	Cancer
CABG/S or CAG/S	Coronary Artery (Bypass) Graft/Surgery	Heart surgery to bypass blocked blood supply
Cal	Calorie
Cas	Casualty
CAT	Computed Axial Tomography
CBD	Common Bile Duct
CBE	Complete Blood Examination
CBP	Complete Blood Picture
CCF	Congestive Cardiac Failure
CCK	Cholecystokinin
CCU	Coronary Care Unit
CDH	Congenital Dislocated Hip
CFS	Chronic Fatigue Syndrome	Also called ME
CHD	Congenital Heart Disease
CHI	Closed Head Injury
CLL	Colapsed Lower Lobe Chronic Lymphatic Leukaemia
Cm	Centimetre
CN	Charge Nurse
CNC	Clinical Nurse Consultant
CNS	Central Nervous System
cnts	Countss
c/o or C.o	Complains of
CO	Cardiac Output
COAD	Chronic Obstructive Airways Disease	Chronic lung disease
COPD	Chronic Obstructive Pulmonary Disease	Chronic lung disease
CPR	Cardiopulmonary Resuscitation
Cr	Creatinine
CRF	Chronic Renal Failure
CRL	Crown Rump Length
CRT	Cathode Ray Tube
CS	Caesarean Section
CSF	Cerebro Spinal Fluid
CT or CAT	Computerised Axial Tomography	Body Scan
CVA	Cerebrovascular Accident	Stroke
CVD	Cerebrovascular Disease
CVP	Central Venous Pressure
CVS	Cardiovascular System	The heart and blood vessels
CX or Cx	Cervix OR Cervical Spine	Cervix is the neck of the womb For example, Cx smear = Cervical smear
CXR	Chest X-ray
D
D	Dates
dB	Decibel
D&C	Dilatation and Cutettage
D/C	Discharge
DCG	Dacrocystogram
D/D	Differential Diagnosis
D=E	Dates=Exam
D>E	Large For Dates
D<E	Small for Dates
D+V	Diarrhoea and Vomiting
D/H	Drug History
DIP, PIP	Distal/proximal interphalangeal joints	Finger joints
DLE	Discoid Lupus Erythematosus	A connective tissue disorder
DNA	Did Not Attend
DOA	Dead on Arrival
DOB	Date of Birth
DS	Disseminated (Multiple) Sclerosis
DU	Duodenal Ulcer
DUB	Dysfunctional Uterine Bleeding
DUI	Driving under the Influence
DVT	Deep Vein Thrombosis	Blood clot
Dx	Diagnosis
DXT	Deep X-ray Treatment	Radiotherapy
E
e	Electron
EAM	External Auditory Meatus	Ear canal opening
ECG	Electrocardiograph	Electrical heart trace
ECT	Electroconvulsive Therapy
ED	Emergency Department
EF	Ejection Fraction
EFW	Estimated Fetal Weight
EMLA	Local anaesthetic cream used before injections
EMU	Early Morning Specimen of Urine
ENG	Head engaged (Baby)	Head of baby low in pelvis (in Womb)
ENT	Ear, Nose & Throat
ERCP	Endoscopic Retrograde Cholangio Pancreatogrophy
ES	End Systole
E/S	Emergency Service
ESR	Erythrocyte Sedimentation Rate	A blood test for inflammation
ETOH	Ethanol Alcohol
EUA	Evaluate under Anaesthetic
EWS	Early Warning Score
F
F	Fhrenheight
FA	Fetal Abnormality
FAC	Family Advisory Clinic
FB	Foreign Body
FBC	Full Blood Count
FBE	Full Blood Examination
FBG/S	Fasting Blood Glucose/Sugar
FBL	Faecal Blood Loss
FBP	Full Blood Picture
FD	Forceps Delivery
Fe	Iron
FFD	Focal Film Distance
F/H or FH	Family History Fetal heart
FHH/R	Foetal Heart Heard/Regular	Baby’s heartbeat in the womb
FI	For Investigation
FOOSH	Fall On Outstretched Hand
FOV	Field of View
FROM	Full Range of Movement
FSD	Focal Source Distance
FSH	Folilicle Stimulating Hormone
FT	Follow Through
FTD	Formal Thought Disorder	Psychiatric disorder
FTND	Full Term Normal Delivery
FTT	Failure to Thrive
FUO	Fever of Unknown origin
G
G	Gravida
GA	General Anaesthetic
GB	Gallbladder
GCS	Glasgow Coma Scale	Consciousness state; score out of 15
GE	Gastric Emptying
GFR	Glomerular Filtration Rate
GI or GIT	Gastro Intestinal / Tract	To do with the intestines
GOR	Gastro-Oesophageal Reflux
GORD	Gastro-Oesophageal Reflux Disease	Back flow of stomach acid into the gullet
GSW	Gun Shot Wound
GTT	Glucose Tolerance Test
GU or GUT or GUS	Genito Urinary / Tract / System	Relating to kidneys, bladder & genitals
GU	Gastric Ulcer
GUM	Genito-Urinary Medicine	For sexually transmitted diseases/infections
Gyn	Gynaecology
H
H2O	Water
H/A	Head Ache
Hb	Haemoglobin	A measure of blood count (eg in Anaemia)
HBP	High Blood Pressure
HC	Head Circumference
Hct	Haematocrit
HD	Hepatic Duct Hodgkins Disease
HDU	High Dependency Unit
HF	High Frequency
HH	Hiatus Hernia	Part of stomach displaced above diaphragm
HI	Head Injury
HIV	Human Immune Deficiency Virus
HMD	Hyaline Membrane Disease
HNPU	Has Not Passed Urine
HO or H/O	History Of
HOP	Head of Pancrease
HR	Heart Rate
HRT	Hormone Replacement Therapy History of Radiotherapy
HS	Heart Sounds
HSA	Human Serum Albumin
HT	Height Hypertensive
Hx	History (of complaint)
Hz	Hertz
I
I	Iodine
IAM	Internal Auditory Meatus
IBS	Irritable Bowel Syndrome
IC	Iliac Crest
ICP	Intra Cranial Pressure
ICU	Intensive Care Unit
IDDM	Insulin Dependent Diabetes Mellitus
IDK	Internal Derangement of the Knee
IF	Intrinsic Factors
IGT or IGTN	In Growing Toenail
IH	Infectious Hepatitis
IHD	Ischaemic Heart Disease
II	Image Intensifier
IM	Intra Muscular
IMB	Intermenstrual Bleeding	Vaginal bleeding between periods
Inf	Infection
IOFB	Intra Occular Foreign Body
ISQ	"In Status Quo" - Nothing has Changed
IUCD	Intra Uterine Contraceptive Device
IUGR	Intrauterine Growth Restriction
IUFD	Intrauterine Fetal Demise
IUP	Intrauterine Pregnancy
IV	Intra Venous
IVC	Inferior Vena Cava Intra Venous Catheter
IVP	Intravenous Pyelogram	X-ray of kidneys using an injected dye
IVU	Intravenous Urogram
Ix	Investigations
J
JODM	Juvenile Onset diabetes mellitus
JVP	Jugular Venous Pressure	Neck Vein – back pressure from the heart
K
K	Knee Jerk / Reflex Potassium
Kg	Kilogram
K nail	Kintscher Nail
Km	Kilometre
KUB	Kidneys, Ureters, Bladder	X-ray or ultrasound of renal track (IVP)
KV	Kilo Volts
KVp	Kilovolts Peak
K wire	Kirschner wire
L
L	Left
LA	Local Anaesthetic
LAO	Left Anterior Oblique
LAT	Lateral
LB	Large Bowel
LBD	Light Beam Diaphragm
LBP	Lower back Pain
LE	Lower Extremeties
LFT	Liver Function Test	Blood tests for liver function
LH	Luteinizing Hormone
LIF	Left Iliac Fossa	Left groin
LIH	Left Inguinal Hernia	Hernia of left groin
LK	Left Kidney
LKKS	Liver, kidney, kidney, spleen	Result of examination
LL	Lower Limb
LLL	Left Lower Lobe
LLQ	Left Lower Quadrant
LLZ	Left Lower Zone
LML	Left Middle Lobe
LOC	Loss of Consciousness
LMP	Last Menstrual Period
LMZ	Left Middle Zone
LN	Lymph Node
LOC	Loss of Consciousness
LP	Lumbar puncture	Needle inserted into the spine for diagnostic purposes
LPO	Left Posterior Oblique
L/R/ IH	Left or Right Inguinal Hernia	Hernia of groins
LRTI	Lower Respiratory Tract Infection
LS	Lymph System
LSCS or LUSCS	Lower (Uterine) Segment Caesarean section
LSJ	Lumbo-Sacral Joint
LSU	Left Side Up
Lt	Left
LUL	Left Upper Lobe
LUQ	Left Upper Quadrant	Left upper part of abdomen
LUZ	Left Upper Zone
LV	Left Ventricle
LVEF	Left Ventricular Ejection Fraction
LVSD	Left Ventricular Septal Defect
LVF	Left Ventricular Failure
M
m	Metre
mA	Milli Amps
MA	Mental Age
mAs	Milli Ampere Seconds
Mane	In the Morning
MBA	Motor Bike Accident
MBC	Maximum Breathing Capacity
M&C (S)	Microscopy & Culture Sensitivity of Bacteria	Of a sample e.g. urine
MC	Metacarpals
MCA	Motor Cycle Accident Multiple Congenital Abnormalities Middle Cerebral Artery
MCL	Mid Clavicular Line	An imaginary line down the body from the middle of the collarbone to the described area
MCP	Metacarpophalangeal Joint
MCU	Micturating Cysto Urethrogram
MCV	Mean Corpuscular Volume	A measure of the size of red blood cells
MD	Mentally Deficient
ME	Myalgic Encephalomyelitis	Also called Chronic Fatigue Syndrome
MET/S	Metastases	Cancer spread
Mhz	Megahertz
MI	Myocardial Infarction Mitral Incompetence	Heart attack OR leaking heart valve (sometimes MR)
mitte or mite	Dispense this number of tablets
ML	Midline
mm	millimetre
MMG	Mammogram
MRI	Magnetic Resonance Imaging	Body/Brain Scan
MS	Multiple Sclerosis Mitral Stenosis	Mitral Stenosis is a narrowed heart valve
MSS	Musculo-Skeletal System
MSE	Mental State Examination
MSU or MSSU	Mid-Stream Urine Sample
MTP	Metatarso-phalangeal Joint
MU	Motor Unit
MVA	Motor Vehicle Accident
MVR	Mitral Valve Replacement
N
N	Notch (Sternal)
Na	Sodium
NAD	Nothing Abnormality Detected
NAI	Non accidental Injury (Silvermans Disease)
NaI	Sodium Iodide
NBI	No Bone Injury
NEC	Necrotising Enterocolitis
NGT	Nasogastric Tube
NHL	Non Hodgkins Lymphoma
Nocte	At Night
NOF	Neck of Femur
NFR	Not For Resuscitation
NNU	Neonatal Unit
NPO	Nil by Mouth
NSS	Normal Shape and Size
NSVD	Normal Spontaneous Vaginal Delivery
N&V	Nausea & Vomiting
O
O2	Oxygen
OA	Osteoarthritis	‘Wear & Tear’ Arthritis
Ob	Obstetrics
OBL	Oblique
OC/COC	(Combined) Oral Contraceptive
OCP	Oral Contraceptive Pill
OCT	Orthotopic Cardiac Transplant	Heart Transplant
o.d.	Once a Day
O/E or o.e	On Examination
OFD	Object Film Distance
O&G	Obstetrics and Gynaecology
OGD	Oesophago-gastro-duodenoscopy	endoscopic examination of stomach and duodenum
on	At Night
om	In the Morning
OM (R/L)	Otitis Media Occipital Mental	Ear infection
OP	Out Patient
OPG	Orthopantomogram
OR	Operating Room
ORIF	Open Reduction and Internal Fixation (of fracture)
otc	Over the counter (bought medication)
P
P	Pulse Para Phosphorus Posterior
PA	Postero-Anterior Popliteal Artery Popliteal Aneurysm
PC	Post Cibum	After a meal
PCB	Post Coital Bleeding	Vaginal bleeding after intercourse
PCC	Post Coital Contraception	"Morning after" pill
PCV	Pack Cell Volume
PD	Pancreatic Duct Peritoneal Dialysis
PDA	Patent Ductus Arteriosis
PE	Pulmonary Embolism Post Evacuation Pleural Effusion	Blood clot on the lung
PEG	Percutaneous Endoscopic Gastrostomy
PERLA	Pupils equal and reacting to light and accommodation	On examination of nervous system/eyes
PET	Positron Emission Tomography
PFA	Plain Film Abdomen	Abdominal X-ray
PF(R)	Peak Flow (Rate)	Breathing test – speed of expiration
PH	Past History
PHx	Previous Medical History
PID	Pelvic Inflammatory Disease Prolapsed Intervertebral Disc	Gynaecological infection Slipped vertebral Disc
PIIS	Posterior Inferior Iliac Spine
PIP	Proximal Interphalangeal (Joint)
PKD	Polycystic Kidney Disease
PM	Post Mortem Examination Post Micturation Post Meridian
PMH also PHx	Previous Medical History
PND	Paroxysmal Nocturnal Dyspnoea	Short of breath at night
PNS	Paranasal Sinuses
PO	Per Orim	By Mouth
POP	Progesterone Only Pill Plaster of Paris Private Outpatient	Minipill Cast
PORT	Portable X-Ray
PP	Private Patient Placenta Praevia Postpartum
PPH	Postpartum Haemorrhage
PPs	Peripheral pulses	Pulses felt for example in the feet, ankles etc…
PR	Per Rectum	Rectal examination
PPROM	Preterm Premature Rupture of Membranes
PROM	Premature Rupture of Membrane
PSI	Post Saline Injection
PSIS	Posterior Superior Iliac Spine
PT	Pregnancy Test
PTA	Prior to Admission
PTB	Pulmonary Tuberculosis
PTCA	Percutaneous transluminal coronary angioplasty	Opening up the main arteries of the heart using a balloon inserted usually near the groin
PTH	Parathyroid Hormone
PTSD	Post Traumatic Stress Disorder
PTT	Prothrombin Time
PU	Peptic Ulcer Passed urine Per urethra	Peptic Ulcer – Stomach or Duodenal Ulcer
PUD	Peptic Ulcer Disease
PUJ	Pelviureteric Junction
PUO	Pyrexia of Unknown Origin
PV	Per Vagina Portal Vein	Vaginal examination
PVD	Peripheral Vascular Disease	Arterial disease of the limbs
PYP	Pyrophosphate
Q
QA	Quality Assurance
QC	Quality Control
qds (or) qid	Four times a day
R
R	Right
R (R)	Respiration (Rate)	Rate of breathing in breaths per minute
RA	Rheumatoid Arthritis
RAI	Radioimmunoassay
RAO	Right Anterior Oblique
RAS	Renal Artery Stenosis
RBC	Red Blood Cell
RCM	Right Costal Margin
RDS	Respiratory Distress Syndrome	Difficulty in breathing – usually in premature babies
RF	Renal Failure
RFT	Renal (Kidney) Function tests OR Respiratory Function tests
RHD	Rheumatic Heart Disease
RIF	Right Iliac Fossa	Right lower abdomen
RIH	Right Inguinal Hernia	Hernia in right groin
RK	Right Kidney
R/L	Right/Left
RLL	Right Lower Lobe
RLQ	Right Lower Quadrant
RLZ	Right Lower Zone
R/L HC	Right/Left Hypochordrium	Right/Left upper abdomen
R/LIF	Right/Left Iliacfossa	Right/Left groin
R/LOL or RLOP	Right/Left occipito lateral / posterior	Position of baby’s head in womb
RN	Registered Nurse
R/O	Rule Out
ROI	Region of Interest
ROM	Range of Movement Rupture of Membranes
RPO	Right Posterior Oblique
RS	Respiratory System
RSI	Repetitive Strain Injury	Usually of wrist
RT	Real Time Radiation Therapy
RTA	Road Traffic Accident	Car smash
RUL	Right Upper Lobe
RUQ	Right Upper Quadrant	Right upper abdomen
RUZ	Right Upper Zone
RV	Right Ventricle
RVF	Right Ventricular Failure
Rx	Prescription or Treatment	Usually prescription
S
S	Supinator (jerk /reflex)	Hitting the am with a patella hammer to test reflexes
S	Size
SAH	Subarachnoid Haemorrhage
SB	Spina Bifida Small Bowel
SBA	Subacute Bacterial Endocarditis
SBG	Serum Blood Glucose	Blood Sugar Level
SBO	Small Bowel Obstruction
SCJ	Sterno Clavicular Joint
SDH	Subdural Haematoma
sec	seconds
SEP	Separation
SI	Supero Inferior
SIJ	Sacro Iliac Joint
Silvermans Disease	Non Accidental Injury (NAI)
SLR	Straight Leg Raise
SM	Systolic Mumur
SMA	Superior Mesenteric Artery
SMR	Submucosal Resection	Nasal operation
SMV	Superior Mesenteric Vein Submento Vertical
SOA	Swelling of Ankle
SOB	Short of Breath
SOL	Space Occupying Lesion	Tumour, usually of head
SOF	Shaft of Femur
SOM	Secretary Otitis Media	Middle ear infection/glue ear
SOS	In an Emergency
SSD	Source Skin Distance
SR	Sinus rhythm	Normal heart beat
ST	Soft Tissue
Stat	Immediately
STD	Sexually Transmitted Disease
STI	Sexually Transmitted Infection
SV	Stroke Volume
SVC	Superior Vena Cava
SVD	Spontaneous Vaginal Delivery	Normal delivery
SVT	Supra-Ventricular Tachycardia
Sx	Symptoms
SXR	Skull X-ray
T
T	Triceps Jerk/Reflex Temperature Term	Hitting the arm with a patella hammer to test reflexes
T (usually with a circle with a dot in the centre)	Trachea Central	Breathing tube not displaced. If displaced, direction of displacement usually indicated by an arrow
TAB	Therapeutic Abortion
TAH	Total Abdominal Hysterectomy
TATT	Tired all the Time
TB	Tuberculosis
TCI	To come in-date or fact that a person is due to be admitted to hospital
TD	Tumour Dose
tds (or) tid	Three Times a Day
TFTs	Thyroid Function Test
TGC	Time Gain Compensation
THR	Total Hip Replacement
TIA	Transient Ischaemic Attack	Small, short lived stroke – often recurrent
TKR	Total Knee Replacement
TLC	Tender Loving Care	Treat only with symptom relief and nursing care, usually meaning that this is all that is needed.
TM or Tm	Tympanic Membrane	Ear drum
TMJ	Tempero Mandibular Joint
TOA	Tubo-Ovarian Abscess
TOC	Tightness of Chest
TOP	Termination of Pregnancy
TPN	Total Parental Nutrtion
Trauma Series	Cervcal Spine, Chest and Pelvis Xray	Frquently requested after major trauma
Ts & As	Tonsilectomy and Adenoidectomy
TSH	Thyroid Stimulating Hormone
TShR	Total Shoulder Replacement
TTO/A	To take home/away (medication)
TU(R)P	Transurethral (resection) of Prostate	Operation on the prostate gland carried out through the penis
TVH	Total Vaginal Hysterectomy
U
U	Umbilicus
UA	Upper Abdomen
UBI	Unknown Basal Insufficiency
UC	Ulcerative Colitis
UE	Upper Extremity
U&Es	Urea and Electrolytes	Blood test for kidney function
UL	Upper Limb
UO	Under Observation
UPJ	Ureteropelvic Junction
UR (No)	Unit Record (Number)
URTI	Upper Respiratory Tract Infection
US or U/S	Ultrasound
UT	Urinary Tract
UTI	Urinary Tract Infection
UVJ	Ureterovesical Junction
UWSD	Under Water Seal Drainage
UTWB	Unable to Weight Bear
V
VA	Vehicular Accident
VDH	Valvular Disease of the Heart
VF	Ventricular Fibrillation	Rapid uncoordinated heart beat usually leading to collapse, and need for defibrillation
VP	Ventriculo-Peritoneal (shunt)
VQ	Ventilation / Pefusion (Lung Scan)
VSD	Ventricular Septal Defect
V/S/TOP	Vaginal suction termination of pregnancy
VT	Ventricular Tachycardia	Fast heart beat
VUJ	Vesicoureteric Junction
VUR	Vesicoureteric Reflux
W
WBBS	Whole Body Bone Scan
WBC	White Blood Cell
WCC	White Cell Count
WOB	Work of Breath
Wt	Weight
X
X	Xiphoid
Xe	Xenon
XR	X-Ray
XS	Excess
Y
Y	Yttrium

◄ Go back to General Radiograhy Page
◄ Go back to wikiRadiography Home Page

These abbreviations are based on a list from the The Royal College of General Practitioners the professional membership body for family doctors in the UK and abroad.

Related Links

Radiographic Anatomy

AndyC — Wed, 11 Jan 2012 01:36:50 CST

Radiographic Anatomy

Adult

Head

Thorax

Vertebral Column

Abdomen

Abdomen
Abdomen - IVU (IVP)
Abdomen - Barium Enema
Abdomen - Barium SBS
Abdomen - Barium Meal

Shoulder

Upper Extremities

Pelvis

Lower Extremities

Pediatric

Head

Thorax

Vertebral Column

Abdomen

Shoulder

Upper Extremeties

Humerus
Elbow
Forearm
Wrist
Hand
Fingers

Pelvis

Pelvis
Hip

Lower Extremities

Male Bone Age Atlas

Left Hand

◄ .....Go back to the General Radiography homepage

Links

Awards

AndyC — Wed, 11 Jan 2012 01:31:48 CST

Awards 2011

Awards 2009

◄....Go back to wikiRadiography homepage

General Radiography

AndyC — Wed, 11 Jan 2012 01:29:53 CST

Basic Skills

Applied Radiography - by M.J.Fuller

MJ Fuller has written extensive image interpretation articles. These are an excellent resource for both student and professional

Applied Radiography Homepage

Rules

wikiRadiography Rules

Continuing Education

Conferences and Seminars

Paediatrics

General Information

Anatomy

Radiation Safety

Surface Anatomy

General Interest

Digital tomosynthesis

Technique

Lines

Podiatry

Podiatry

Physics

Pregnancy

Pathology

Image Evaluation

Ottawa Rules

Ottawa Rules

Word Find Puzzles

◄....Go to the main wikiRadiography homepage

Conferences / CPD / Seminars

eliseleblanc — Thu, 22 Dec 2011 07:35:19 CST

Online CPD

Medscape

Radiography Conferences

Ultrasound Conferences 2010

Check the Associations & Unions page for links to professional societies homepages

...Go back to wikiRadiography main Page

Associated Links

Associations & Unions

Orbit - Superior Orbital Fissures (PA 25°)

gmack — Tue, 06 Dec 2011 22:06:16 CST

Radiographic Positioning

Adult

Other related pages of interest

Name of projection	Orbit - Superior Orbital Fissures (PA 25°)
Area Covered
Pathology shown
Radiographic Anatomy	Facial Bone Radiographic Anatomy
IR Size & Orientation
Film / Screen Combination	DR / CR
Bucky / Grid	Moving or Stationary Grid
Filter	No
Exposure	75 kVp 20 mAs
FFD / SID	115 cm
Central Ray
Collimation	face
Markers	Inferior and Lateral Marker orientation PA
Shielding	N/A
Respiration	Suspended
Positioning
Critique PACEMAN	Positioning Area Covered Collimation Exposure
Special Notes

Nasal - Axial

gmack — Tue, 06 Dec 2011 22:04:21 CST

Radiographic Positioning

Adult

Other related pages of interest

Name of projection	Nasal Bone - Axial (Superoinferior)
Area Covered	Mid nasal and distal nasal bones, nasal soft tisssues
Pathology shown	Fractures of nasal bones
Radiographic Anatomy	Nasal Bone Radiographic Anatomy
IR Size & Orientation	18 x 24cm Landscape
Film / Screen Combination	DR or CR
Bucky / Grid	No
Filter	No
Exposure	52 kVp 2.5 mAs
FFD / SID	105cm
Central Ray	Centre CR to nasion and angle as needed to ensure it is parrallel to GAL (glabelloalveolar line)
Collimation	Four sides of collimation Collimate closely to nasal bones
Markers	Lateral Marker orientation PA
Shielding	N/A
Respiration	Suspend
Positioning	Patient seated erect in a chair at the end of the table Extend and rest chin on IR Place 45° sponge under IR, to put IR perpendicular to glabelloalveolar line (GAL) Centre CR to nasion and angle as needed to ensure it is parrallel to GAL (glabelloalveolar line)
Critique PACEMAN	Positioning Area Covered Collimation Exposure
Special Notes

Case of the Month Quiz 1

M.J.Fuller — Sat, 03 Dec 2011 18:32:25 CST

This 79 year old lady presented to the Emergency Department following a fall. She was examined and found to have a painful right lower leg with an anterior skin tear/laceration and bruising. She reported having extreme difficulty weight-bearing on her right leg following the fall. She was referred for right lower leg radiography.

Her left leg was also injured in the fall but was thought to be a soft tissue injury only.

Her lower legs and initial plainfilm imaging is shown below.

Question 1
Is there evidence of bony injury or joint dislocation demonstrated on the plain films?

Question 2
Does the clinical history/patient presentation provide any indications of possible bone/joint injury?

Question 3
What additional imaging (if any) is warranted?

wikiradiography members can provide a response using the thread at the bottom of the page

Answer

The radiographer considered the patient's age, sex , mechanism of injury and clinical signs to indicate possible bony injury. Females over the age of 60 years are at high risk of osteoporosis predisposing them to bony injury.

The radiographer noted a difference in alignment between the patient's knees (Q-angle). Whilst this could be due to knee joint degenerative disease, a tibial plateau fracture would also account for the appearance.

Note that at this stage, the radiographer has only asked the patient her about her injury and clinical signs. Despite the fact that no imaging has been undertaken, the radiographer is already compiling a list of differential diagnoses. Whilst this might appear unimportant, a targeted search will be undertaken by the radiographer to ensure that subtle signs of tibial plateau fracture are not overlooked on the initial imaging.
The AP tib/fib image demonstrated two important findings

there is a cortical irregularity of the lateral aspect of the proximal tibial metaphysis
there is abnormal alignment of the knee joint articular surfaces laterally
At this point the radiographer considered that the patient has sustained a lateral tibial condyle fracture during her fall. The objective at this point is to confirm the existence of the fracture unequivocally and to demonstrate the nature and extent of the fracture.
The lateral tib/fib projection provides little by way of new information. There is a subtle cortical breach of the proximal tibial articular surface (arrowed)
The horizontal ray lateral knee projection image demonstrates a large knee effusion with a superior fat density indicating lipohaemarthrosis.
Oblique projections of the knee can be very useful in demonstrating tibial plateau fractures. The radiographer performed both oblique projections of the patient's right knee.

Some cortical irregularity of the proximal tibial metaphysis and articular surface is demonstrated, but it is subtle and unconvincing of an acute fracture.

The external oblique position demonstrates the fracture clearly.

Discussion
The radiographer has demonstrated the patient's tibial fracture by employing a clinical approach to radiography. The radiographer's aim is not simply to produce images of the patient's lower leg, but to take on shared responsibility for establishing the correct diagnosis (MDT thinking). It could be argued that if it was known that the patient had sustained a tibial fracture, and a knee CT scan would be definitely be performed, supplementary plain film imaging was not warranted.

	The radiographer considered the patient's age, sex , mechanism of injury and clinical signs to indicate possible bony injury. Females over the age of 60 years are at high risk of osteoporosis predisposing them to bony injury. The radiographer noted a difference in alignment between the patient's knees (Q-angle). Whilst this could be due to knee joint degenerative disease, a tibial plateau fracture would also account for the appearance. Note that at this stage, the radiographer has only asked the patient her about her injury and clinical signs. Despite the fact that no imaging has been undertaken, the radiographer is already compiling a list of differential diagnoses. Whilst this might appear unimportant, a targeted search will be undertaken by the radiographer to ensure that subtle signs of tibial plateau fracture are not overlooked on the initial imaging.
	The AP tib/fib image demonstrated two important findings there is a cortical irregularity of the lateral aspect of the proximal tibial metaphysis there is abnormal alignment of the knee joint articular surfaces laterally At this point the radiographer considered that the patient has sustained a lateral tibial condyle fracture during her fall. The objective at this point is to confirm the existence of the fracture unequivocally and to demonstrate the nature and extent of the fracture.
	The lateral tib/fib projection provides little by way of new information. There is a subtle cortical breach of the proximal tibial articular surface (arrowed)
	The horizontal ray lateral knee projection image demonstrates a large knee effusion with a superior fat density indicating lipohaemarthrosis.
	Oblique projections of the knee can be very useful in demonstrating tibial plateau fractures. The radiographer performed both oblique projections of the patient's right knee. Some cortical irregularity of the proximal tibial metaphysis and articular surface is demonstrated, but it is subtle and unconvincing of an acute fracture.
	The external oblique position demonstrates the fracture clearly.

ivu

saeda — Wed, 30 Nov 2011 14:00:01 CST

Radiographic Positioning

Adult

Other related pages of interest

Name of projection
Area Covered
Pathology shown
Radiographic Anatomy
IR Size & Orientation
Film / Screen Combination	(CR and DR as recommended by manufacturer)
Bucky / Grid
Filter
Exposure
FFD / SID
Central Ray
Collimation
Markers
Shielding	(check your department's policy guidelines)
Respiration
Positioning
Critique PACEMAN	Positioning Area Covered Collimation Exposure
Special Notes

Urethrography

M.J.Fuller — Mon, 21 Nov 2011 19:35:54 CST

Introduction

This page considers all aspects of urethrography in both acute and non-acute settings.

Case 1

This 50 year old male presented to the ED by ambulance following a motor vehicle accident.

A radiographic trauma series was undertaken in the resus room. The trauma series revealed several fractures including pelvic fractures.

The patient underwent urethrography to asses the urethra for potential traumatic injury.

A Carestream 35 x 43cm DRX cassette was placed in landscape orientation under the patient's pelvis. Contrast injection into the urethra was performed via a foley catheter.

The AP projection does not demonstrate the urethra well.

The DRX cassette was not moved. The beam was angled across the patient to achieve an LPO projection. The urethra is demonstrated well.

The opposite oblique was again achieved without moving the patient or imaging cassette. The urethra appears to be undamaged. The urinary bladder has an abnormal elongated shape associated with pressure from traumatic pelvic haematoma.

... back to wikiradiography home page
... back to applied radiography

signs of increased intracranial pressure on a skull plain x-ray

mayanjajulius — Mon, 21 Nov 2011 02:55:23 CST

Increased vascular markings
Widening of the sella turcica
Erosion of the sella turcica
Gyri make prominent markings on the skull
The pineal gland is displaced from the midline.

Applied Radiography - by M.J.Fuller

M.J.Fuller — Sun, 20 Nov 2011 21:19:17 CST

"understanding what you are seeing is its own reward - image interpretation skills add an extra dimension to your work and afford additional meaning to your role."

These articles written by M.J.Fuller involve case studies, techniques and image evaluation for both the student and seasoned radiographer.

Radiographic Technique

General

The Fundamental Tenets of Radiographic Technique
Radiographic Terminology

Conventions, Customs, Cultures, Common Practices and Quirks in Radiography

Aluminium Filter Techniques in Radiography
Radiography in the Round
Top 20 Tips for Radiography in the Operating Theatre
Artifacts and Artefacts
Using the Lead Snake to reduce Scatter Radiation
Imaging Nail Gun Injuries
Passe Radiography
Geometric Concepts in Radiography
Foreign Body Radiography

Radiography for Ingested/Aspirated Foreign Bodies
Sesamoid Bone Radiography
Breathing Exposure Techniques in Radiography
VP Shunt Radiography
Orthopaedic Clinic Radiography
Mach Bands
Combination Shadows
CR vs DR image quality
Harris Growth Arrest Lines

High Contrast is not always Good !
Upper Extremities

Imaging Severe Hand Trauma
What Constitutes a True Lateral Wrist Position?

Functional Views of the Wrist
Scaphoid Radiography
Imaging Radial Head Fractures
Imaging Supracondylar Fractures of the Elbow
Elbow Supracondylar fractures- Cases

The Lateral Elbow
Orthopaedic Clinic Wrist Radiography
Is the Screw in the Joint?
Carpal Tunnel Radiography
Finger Radiography
Lower Extremities

Supine Intercondylar Knee Radiography
The Skyline Patella Projection
Lateral Toe Radiography
Lateral Ankle Radiography

The Lateral Ankle Trap
Imaging Talar Fractures
Tarsal Bone Fractures
Imaging Tibial Plateau Fractures
Lateral Knee Radiography
Imaging Calcaneal Fractures
Abdomen

Neonatal Abdominal Radiography
Neonatal Tubes, Lines and Catheters
Nasogastric tube position confirmation
The Lateral Decubitus Abdominal Plain Film
Abdominal Calcifications
Abdominal Aortic Aneurysm

Abdominal Plain Film Anatomy
Abdominal Artifacts and Devices
Abdominal Radiography of the Morbidly Obese Patient

Pelvis

Modified Trauma Lateral Hip Radiography
Pubic Rami Fractures
Judets Views
Radiography of Hip Dislocations
Periprosthetic Hip Fractures
Spine

Lumbar

Lumbar Spine Radiography
Lateral Lumbar Spine Radiography

Lumbar Spine AP Breathing Technique
Lateral Lumbar Spine Breathing Technique
Lumbar Spine Obliques
Imaging Wedge Fractures

Thoracic

AP Thoracic Spine Breathing Technique
The Swimmers View
Modified Lateral Thoracic Spine Technique
Imaging Wedge Fractures

Cervical

Oblique Cervical Spine Technique
Trauma Obliques of the Cervical Spine
Trauma Lateral cervical Spine
The Odontoid Peg Projection

Odontoid-Lateral Mass Asymmetry
The Swimmers Technique

Transthoracic Lateral Shoulder
Lateral Soft Tissue Neck for Foreign Body
Flexion and Extension Cervical Spine Radiography

Shoulder

Clavicle Radiography
Lateral Scapula Radiography
Shoulder- SI vs Lateral Scapula
Radiography of the Bicipital Groove
Imaging Shoulder Dislocations
Acromioclavicular Joint Radiography
Imaging Scapular Fractures
Oblique Shoulder for Scapular Fractures
Imaging Coracoid Process Fractures
Neck of Humerus Fractures
The SI Projection of the Trauma Shoulder
Breathing Technique for Demonstration of the Scapula
Chest

Lateral Sternum from Lateral Chest - Digital Double Dipping
Sternum Radiography

Lateral Chest Paravertebral Gutter Positioning Technique

Notes on Chest Radiography
Notes on Paediatric Chest Radiography

Lateral Chest X-ray Digital Double-Dipping
Lordotic Chest Technique
Nasogastric tube position confirmation
Nasogastric tube psoition confirmation II

Digital Double Dipping in Chest Trauma Radiography
Rib Radiography
Chest Radiography for Inhaled Foreign Body
Paediatric Chest Radiography Positioning Aids
Lateral Soft Tissue Neck for Foreign Body

Skull and Face

The "Leaning Tower" view of the Paranasal Sinuses
Lateral Facial Bones Technique
Slit Basal and Teacup Views of the Zygoma
Imaging mandibular fractures
Radiography of Intracranial devices
Radiography of VP Shunts
Radiography of Orbital Foreign Bodies
Facial Bone Radiography

Radiography in the Neonatal Unit

Neonatal Abdominal Radiography Technique
Neonatal Abdominal Pathology

Neonatal Tubes, Lines and Catheters
Neonatal Chest Radiography
Neonatal Chest Pathology
Hyaline Membrane Disease (syn RDS) and BPD

Positioning Aids and Radiographic Accessories

Using the Lead Snake to Reduce Radiation Scatter
The Fronsko dripstand Base
The Smart Cone
Leddra Skyline Patella View Cassette Holder
Supine Intercondylar Knee Radiography
Bucky Markers
The Stent Board
Head Clamps for Skull Radiography
The Binocular Cone
Using Baker Cones in the Neonatal Intensive Care Unit
Aluminium Filter Techniques in Radiography
Radiography in the Round

Using the Lead Snake to reduce Scatter Radiation

Named Radiographic Techniques

Fuch's View of the Odontoid Process

Paediatrics

Chest Radiography for Inhaled Foreign Body
Normal Paediatric Anatomy

Elbow
Shoulder
Hip
Femur

Fluoroscopic Procedures

Arthrography

-Wrist
-Shoulder
-Elbow

Myelography

- lumbar
- thoracic
- Cervical

Discography

-Lumbar
-Cervical

Facet Joint Injection

-Lumbar
-Cervical

Trigeminal Nerve block

Hysterosalpingogram
Dacrocystography
Micturating Cystourethogram
Urethrography
Cystogram
T-tube cholangiogram
ERCP

Venogram
Gastrostomy Tube check

Anatomy

ankle
Chest

Radiography in the Operating Theatre

Top 20 Tips for Radiography in the Operating Theatre

Wrist

Volar Plate

Elbow

Olecranon FractureTension Banding

Abdomen

Laparoscopic Cholangiography
ERCP

Quality Control

Simple Quality Control Testing
Artifacts and Artefacts

Other

Preparing Images for the Web in Photoshop
Mach Bands and other Optical Illusions
X-ray Room Design

Image Evaluation, Pathology, Normal Variants

General

osteochondroses
Salter-Harris Fractures
Patterns of Misdiagnosis in Plain Film Radiography

The Peripheral Pathology

Fracture Types and Mechanisms of Injury
Soft Tissue Calcification
Soft Tissue Signs in Orthopaedics

Soft Tissue Signs-The Elbow
Soft Tissue Signs- Knee Trauma
Soft Tissue Signs- knee nontrauma
Soft Tissue Signs-The Ankle
Soft Tissue Signs- Wrist
Soft Tissue Signs- Shoulder

Soft Tissue Signs- Thoracic Spine
Soft Tissue Signs- Skull and Facial Bones
Soft Tissue Signs- Cervical Spine
Lipohaemarthrosis

Satisfaction Syndrome
Orthopaedic Internal Fixation Failure
Orthopaedic Scews, Plates and Prosthesis

Mechanisms of Injury

fall onto an outstretched hand

Bone Tumours and Tumour-like Lesions
Osteopaenia and Osteoporosis
sesamoid bone radiography
Systemic Disease

Renal osteodystrophy
Rickets
Pagets Disease
Arthritidies

Osteoarthritis
Rheumatoid Arthritis
Charcot's Joints
Gout

Upper Extremities

The forearm

Monteggia and Galeazzi fracture-dislocations of the forearm

The Elbow

The Paediatric Elbow
Imaging Radial Head Fractures
The Axial Elbow View
Medial Epicondyle Fractures
Elbow Dislocations
Lateral Condylar Elbow Fractures
Imaging Olecranon Fractures
Radial Head Dislocations
Imaging Supracondylar Fractures of the Elbow
Coronoid Process Fractures

The Wrist

Paediatric Wrist Trauma
Radiography of subtle wrist fractures
Subluxation of the Distal Radio-ulnar Joint
Wrist Measurements
Colles' Fracture
Dislocations and Subluxations of the Carpus

Lunate and Perilunate dislocations

DISI and VISI Deformities

Functional Views of the Wrist
Imaging Carpal Bone Fractures

Imaging Scaphoid Fractures

Triquetral Fractures
Hamate Fractures
Pisiform Fractures
Lunate Fractures

The Hand

Imaging Severe Hand Trauma
Thumb Fractures

Metacarpal Fractures

Lower Extremities

Knee

Pellegrini-Stieda Disease
Calcaneal Fractures

Dislocations and subluxations of the knee

Proximal Tibiofibular Joint Dislocation

Osgood Schlatter Disease
Segond Fracture
Snow Globe Effect
Patellar Fractures and Dislocations
The Patella- Normal Anatomical Variants
Quadriceps Tendon Rupture

Ankle

The Lateral Ankle Trap
Talus Fractures
Posterior Malleolus Fractures of the Ankle
Maisonneuve Fracture

Foot

Talus Fractures
Fifth Metatarsal Fractures
Tarsal Bone Fractures
Calcaneal Fractures
Lisfranc's Fracture

Abdomen

Normal Plain Film Abdominal Anatomy
Abdominal Calcifications
- Gallstones

Common abdominal pathologies an Normal Anatomical Variants

The Abdominal Plain Film in Clinical Context

Abdominal Plain Film Terminology
The Erect Abdominal Plain Film
The Abdominal Plain Film- Differentiating Large and Small Bowel
The Abdominal Plain Film- Ileus
The Abdominal Plain Film- Gasless vs Featureless
Pneumoperitoneum
Pneumoperitoneum- Radiographic Techniques
Pneumoperitoneum Cases

Nasogastric Tube Position Confirmation
Small Bowel Obstruction
Large Bowel Obstruction

The Abdominal Plain Film- Appendicitis

The Abdominal Plain Film- Intramural Gas
The Abdominal Plain Film- Emphysematous Cystitis

Normal Bowel Patterns in Sedentary Patients

Imaging Abdominal Hernias
Imaging Incisional Hernias

Neonatal Tubes, Lines and Catheters
Neonatal Abdominal Pathology
Toxic megacolon

Pelvis

Pelvis Anatomy, Artifacts Normal Variants

Pelvic Calcifications
Pelvis Trauma Radiography

Neck of Femur Fractures
Neck of Femur Fractures- Cases
Pubic Rami Fractures
Paediatric Hip Pathology

Spine

Common Cervical Spine fractures
Terminology- the "spondyls"
Lateral Soft Tissue Neck for Foreign Body

Shoulder

Clavicle Radiography

Vacuum Phenomenon of the Shoulder
Imaging Shoulder Dislocations
Imaging Scapular Fractures
Bankart and Hill-Sachs Lesions

Chest

Interstitial vs Alveolar Patterns
Pneumothorax

Pneumothoraces
Pneumothorax Cases
Pneumothorax Self-test
The Supine Pneumothorax

Pneumomediastinum
Cardiac Calcifications

Pleural Effusions
Chest Anatomy

Lymphangitis carcinomatosis

Imaging Subpulmonic Effusions
Dextracardia in the Resus Room
Neonatal Chest Pathology
What is the Value of the Lateral Chest Projection?
Nasogastric tube position confirmation
Chest Normal Anatomical Variants

Juxtaphrenic Peaks
Coarctation of the Aorta
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Urthrography

M.J.Fuller — Sun, 20 Nov 2011 20:55:31 CST

There is no abstract available for this page revision.

Radiography of Subtle Wrist Fractures

M.J.Fuller — Sun, 20 Nov 2011 20:49:19 CST

Introduction

Wrist fractures are occasionally very difficult to demonstrate radiographically, indeed, they are sometimes evident on MRI scanning or bone scan only. This page looks at some cases of tricky wrist fractures and the techniques for demonstrating them with plain film radiography. As is often the case, a clinical approach to radiography will yield better results than a photographic approach.

Case 1a

This lady presented to the Emergency Department after a fall and was referred for wrist radiography. The image left shows her wrist after the bandage was removed. She was in considerable pain and the focal swelling over the dorsum of her wrist suggested that she had sustained a fractured radius.

Routine wrist views were performed

This series demonstrated no obvious fracture. Moreover, the scaphoid fat pad (white arrow) and the pronator fat pad (black arrow) were normal.

The radiographer was convinced clinically that the patient had sustained a fracture and considered whether the soft tissue signs were misleading (as there are known to be on occasions). Supplementary views were performed as shown below.

The views performed are (from left to right)
a reverse oblique wrist
modified lateral wrist to profile articular surface of radius
modified pa wrist to profile the articular surface of radius
The reverse oblique image demonstrates a fractured distal radius (white arrow). The fracture and step in the articular surface of the radius is also demonstrated on the modified PA image (black arrow).

Case 1b

The 40 year old lady presented to the Emergency Department after falling over her dog. She was examined and was found to have a very painful right wrist. In addition, there was localised swelling over the dorsum of her wrist. She was referred for right wrist radiography.

There is an impression of a vertical lucent line through the distal radial metaphysis. There is an impression of a vertical lucent line through the distal radial metaphysis (arrowed).

There appears to be a step in the articular surface of the distal radius. There appears to be a step in the articular surface of the distal radius (arrowed)

There is evidence of localised swelling over the dorsal aspect of the wrist There is evidence of localised swelling over the dorsal aspect of the wrist (arrowed)

Intermission
The radiographer thought that the patient had sustained a wrist fracture based on clinical evidence (pain, swelling, limitations of movement). The radiographic evidence of wrist fracture on the routine projection images was inconclusive- on balance, supplementary projections were warranted

This is an AP oblique wrist projection. There is evidence of cortical irregularity of the distal radial metaphysis This is an AP oblique wrist projection. There is evidence of cortical irregularity of the distal radial metaphysis (arrowed)

This is a PA reverse oblique position. There is an osteochondral fracture of the radial styloid with minimal displacement. There is an osteochondral fracture of the radial styloid with minimal displacement (arrowed)

Comment
This is a good example of trauma radiography. The radiographers clinical assessment was the key factor that led to demonstration of the fracture. The radiographer was not satisfied that the routine projections had demonstrated a fracture conclusively in a patient who had convincing clinical signs of fracture.

Case 2

This 14 year old boy presented to the Emergency Department after a fall from his skateboard and was referred for wrist radiography. On examination, he had a painful wrist.

The PA wrist shows no evidence of displaced fracture There is a suggestion of a subtle cortical buckle on the oblique image There is no clear evidence of a displaced fracture on the view lateral image. The pronator quadratus fat pad is not clearly abnormal There is a subtle cortical buckle demonstrated on the reverse oblique image. Compare with the smooth even contours of the other metaphyseal cortices (radius and ulna)
Comment
This is a very subtle fracture of the distal radius. There is a suggestion of dorsal palmar tilt on the lateral view although this is not convincing (zero degrees of palmar tilt can be a normal finding). Irregularity of the distal metaphysis immediately adjacent to the physis is normal. However, this does not appear to be typical of this commonly seen normal feature. As is often the case, the non-routine view (reverse oblique) demonstrates the cortical buckle most convincingly.

Case 3

This 87 year old lady presented to the Emergency Department after a fall onto an outstretched hand. On examination she had a painful swollen wrist.

Unlabelled PA wrist The PA wrist image demonstrates a cortical irregularity on the medial aspect of the radial metaphysis (black arrow). There is an additional cortical contour deformity on the lateral aspect of the distal radius (white arrow). There is associated soft tissue swelling (grey arrow). Unlabelled lateral wrist There is evidence of trabecular disruption (white arrow). There is soft tissue swelling on the dorsal aspect of the wrist (grey arrow) and the pronator quadratus fat pad is displaced away from the radial cortex (black arrow).
Comment

Case 4

This14 year old boy presented to the Emergency Department after a fall onto an outstretched hand. On examination he had a painful swollen wrist.

Unlabelled PA wrist The PA wrist image demonstrates a cortical irregularity along the medial border of the radius (white arrow). Unlabelled lateral wrist There is evidence of buckle fracture of the distal radius (black arrow). The pronator quadratus fat pad is normal.
Comment

Case 5

This14 year old girl presented to the Emergency Department after a fall onto an outstretched hand while playing netball. On examination she had a painful wrist.

Unlabelled PA wrist There is a cortical irregularity on the medial aspect of the radial metaphysis immediately proximal to the physis. There is also an associated irregularity of the trabecular pattern. There is a spur seen at the base of the 5th metacarpal of uncertain aetiology. Unlabelled lateral wrist There is a cortical defect of the radial metaphysis (arrowed).
Comment

Case 6

This16 year old boy presented to the Emergency Department after a fall onto an outstretched hand. On examination he had a painful wrist.

There is no evidence of displaced fracture in this view. Unlabelled lateral wrist There is a buckling of the dorsal aspect of the radial metaphysis with a possible associated lucency extending into the distal radius. This is an elongated reverse oblique view. There is a defect in the postero-anterior radial cortex (arrowed) with an associated trabecular defect obliquely traversing the radial metaphysis.
Comment

Case 7

This14 year old boy presented to the Emergency Department after a fall from his pushbike. On examination he had a painful swollen wrist.

There is no evidence of displaced fracture in this view. The cortical irregularity immediately adjacent to the growth plate is normal. This appearance is associated with the rapid bone growth that is occurring at the physis. Unlabelled lateral wrist The cortical irregularity on the dorsal aspect of the radius (white arrows) appears to be too florid to be dismissed as normal irregularity associated with the physis. In addition, there is soft tissue swelling over the dorsum of the wrist and there is a large pronator quadratus fatpad sign (black arrow) This is an over-rotated lateral position. Note that the pisiform is projected clear of the other carpal bones. There is a cortical buckling of the dorso-radial aspect of radial metaphysis (arrowed)

Comment

Case 8

This13 year old boy presented to the Emergency Department after a fall onto an outstretched hand.

There is no evidence of displaced fracture in this view. There is a subtle cortical irregularity along the ulnar aspect of the radial metaphysis. There is an equally subtle associated trabecular oblique defect line
There is a buckle of the dorsal aspect of the radial metaphysis (arrowed)

Comment

Case 9

This 17 year old boy presented to the Emergency Department after a fall onto an outstretched hand.

There is a cortical irregularity on the ulnar aspect of the radial metaphysis (arrowed)
The cortical buckle is seen again on the oblique image (arrowed) There is a buckle of the dorsal aspect of the radial metaphysis (arrowed).

Comment

Case 10

This 45 year old man presented to the Emergency Department after a fall onto an outstretched hand.

There is a fracture of the distal radius which extends into the wrist joint.(arrowed) The cortical buckle is seen on the dorsal aspect of the wrist. (arrowed) There is obliteration of the pronator quadratus fat pad There is cortical irregularity of the radio-dorsal aspect of the wrist (white arrow).

There is a fracture of the ulna (black arrow)

Case 11

This 31 year old man presented to the Emergency Department after a fall onto an outstretched hand.

No convincing evidence of a fracture There is some loss of smooth contour of the radial aspect of the radial styloid. This is not convincing of a fracture There is a loss of continuity of the dorsal aspect of the radial metaphysis. There also appears to be a pronator quadratus soft tissue sign. The radiographic findings were considered to be equivocal. The patient's symptoms persisted. The referring doctor considered that the patient may have sustained a fractured scaphoid. The patient was referred for MRI scanning which revealed a radial metaphysis transverse fracture.

Case 12

This 13 year old boy presented to the Emergency Department after a fall onto an outstretched hand while running backwards.

There is a very subtle buckle in the radial aspect of the radial metaphysis. There is an even more subtle defect in the radial metaphysis demonstrated on the lateral wrist image.

The findings are consistent with a subtle buckle fracture of the wrist T1 weighted MRI image with transverse irregular low T1 band consistent with the fracture seen on the plain film images.

Case 13

This 10 year old boy presented to the Emergency Department after a fall from his pushbike and was referred for wrist radiography. On examination, he had a painful wrist.

The PA wrist shows no evidence of displaced fracture There oblique wrist projection image shows no evidence of displaced fracture The lateral wrist projection image is not clearly abnormal.

Comment
The radiographer noted the dorsal angular displacement of the distal radius and considered the possibility of a subtle distal radius fracture. A repeat off-lateral wrist projection was considered justified.

The off-lateral wrist projection image demonstrates a buckle fracture of the dorsal aspect of the radial metaphysis. Buckle fracture arrowed.

Comment
The radiographer should have a high level of willingness to undertake what would normally be considered poor quality radiography in order to demonstrate a suspected pathology. The off-lateral projection is a case-in-point.... doctrinaire thinking can be at the detriment of the diagnosis.

Discussion

The radial and ulnar cortical contours should appear as smoothly curved lines on plain film images of the wrist. . Any appearance other than a smooth curve should be considered as a possible fracture. The radial metaphysis in children and adolescents is fertile territory for subtle buckle fractures. Supplementary views such as reverse oblique and off-lateral can be useful in confirming the presence of a fracture. A clinical approach by the radiographer is particularly important- the radiographer should consider the patient's mechanism of injury, the clinical presentation and the soft tissue signs (clinical and radiographic).

Is the diagnosis of these fractures important? The simple answer is yes. A patient who has sustained a subtle buckle fracture will be treated with an immobilising plaster which will protect the fractured bone from further injury and reduce pain. Importantly, the patient's pain will be accounted for and appropriate pain relief prescribed. The patient will be assured that their symptoms have been explained and the patient be unlikely to represent for further diagnosis/treatment. The fracture can be followed up at a subsequent orthopaedic clinic appointment to ensure that it was not more serious than originally thought and remains minimally displaced. Appropriate limitations of activity can be explained to the patient to reduce the possibility of re-injury while the bone is healing. I also believe that there is an innate benefit in getting the diagnosis correct- satisfying for the patient, satisfying for the radiographer, and reassuring for the referring clinician. A more subtle benefit to the radiographer will be in the form of admiration and trust from the referring doctor- the radiographers can be left to their own devices if their radiography and judgements can be relied upon.

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Lumbar Spine Radiographic Anatomy

spinerep1970 — Sat, 12 Nov 2011 07:05:00 CST

This page contains radiographic anatomy of the adult lumbar spine

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Lateral
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Adult Lumbar Spine - AP View

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Adult Lumbar Spine - Lumbosacral L5S1 View

Adult Lumbar Spine - Oblique View

....Go Back to Radiographic Anatomy Index

Lumbar Spine Links

Lumbar Spine Positioning

Lumbar Radiographic Anatomy

Lumbar Spine - Paediatric

Lumbar Spine Miscellaneous

Normal Paediatric Shoulder- 15 year old male

M.J.Fuller — Fri, 11 Nov 2011 04:48:22 CST

	"Two or or three ossification centres, and sometimes more, appear at the lateral end of the acromion in the 15th to 18th years of life" Borderlands of Normal and Early Pathological Findings in Skeletal Radiography. 5th Ed., Juergen Freyschmidt et al, Thieme, 2003, p264

	The SI projection image demonstrates the normal synchondrosis at the base of the coracoid and the normal apophyseal ossification centre

	Mild and self-limited Delayed resorption of fetal lung fluid Hyperinflation of the lungs Fluid in the fissures Laminar effusions Fuzzy vessels http://www.learningradiology.com/archives2008/COW%20292-TTN/ttnccorrect.html •It is thought that slow absorption of the fluid in the fetal lungs causes TTN. This fluid makes taking in oxygen harder and the baby breathes faster to compensate. •rapid breathing rate (over 60 breaths/minute) •grunting sounds with breathing •flaring of the nostrils •retractions (pulling in at the ribs with breathing)
http://www.learningradiology.com/archives2008/COW%20292-TTN/caseoftheweek292page.html

	This 50 year old male presented to the ED by ambulance following a motor vehicle accident. A radiographic trauma series was undertaken in the resus room. The trauma series revealed several fractures including pelvic fractures. The patient underwent urethrography to asses the urethra for potential traumatic injury. A Carestream 35 x 43cm DRX cassette was placed in landscape orientation under the patient's pelvis. Contrast injection into the urethra was performed via a foley catheter. The AP projection does not demonstrate the urethra well.
	The DRX cassette was not moved. The beam was angled across the patient to achieve an LPO projection. The urethra is demonstrated well.
	The opposite oblique was again achieved without moving the patient or imaging cassette. The urethra appears to be undamaged. The urinary bladder has an abnormal elongated shape associated with pressure from traumatic pelvic haematoma.


There is an impression of a vertical lucent line through the distal radial metaphysis.	There is an impression of a vertical lucent line through the distal radial metaphysis (arrowed).


There appears to be a step in the articular surface of the distal radius.	There appears to be a step in the articular surface of the distal radius (arrowed)


There is evidence of localised swelling over the dorsal aspect of the wrist	There is evidence of localised swelling over the dorsal aspect of the wrist (arrowed)


This is an AP oblique wrist projection. There is evidence of cortical irregularity of the distal radial metaphysis	This is an AP oblique wrist projection. There is evidence of cortical irregularity of the distal radial metaphysis (arrowed)


This is a PA reverse oblique position. There is an osteochondral fracture of the radial styloid with minimal displacement.	There is an osteochondral fracture of the radial styloid with minimal displacement (arrowed)


The PA wrist shows no evidence of displaced fracture	There is a suggestion of a subtle cortical buckle on the oblique image	There is no clear evidence of a displaced fracture on the view lateral image. The pronator quadratus fat pad is not clearly abnormal	There is a subtle cortical buckle demonstrated on the reverse oblique image. Compare with the smooth even contours of the other metaphyseal cortices (radius and ulna)


Unlabelled PA wrist	The PA wrist image demonstrates a cortical irregularity on the medial aspect of the radial metaphysis (black arrow). There is an additional cortical contour deformity on the lateral aspect of the distal radius (white arrow). There is associated soft tissue swelling (grey arrow).	Unlabelled lateral wrist	There is evidence of trabecular disruption (white arrow). There is soft tissue swelling on the dorsal aspect of the wrist (grey arrow) and the pronator quadratus fat pad is displaced away from the radial cortex (black arrow).


Unlabelled PA wrist	There is a cortical irregularity on the medial aspect of the radial metaphysis immediately proximal to the physis. There is also an associated irregularity of the trabecular pattern. There is a spur seen at the base of the 5th metacarpal of uncertain aetiology.	Unlabelled lateral wrist	There is a cortical defect of the radial metaphysis (arrowed).


There is no evidence of displaced fracture in this view.	Unlabelled lateral wrist	There is a buckling of the dorsal aspect of the radial metaphysis with a possible associated lucency extending into the distal radius.	This is an elongated reverse oblique view. There is a defect in the postero-anterior radial cortex (arrowed) with an associated trabecular defect obliquely traversing the radial metaphysis.


There is no evidence of displaced fracture in this view. The cortical irregularity immediately adjacent to the growth plate is normal. This appearance is associated with the rapid bone growth that is occurring at the physis.	Unlabelled lateral wrist	The cortical irregularity on the dorsal aspect of the radius (white arrows) appears to be too florid to be dismissed as normal irregularity associated with the physis. In addition, there is soft tissue swelling over the dorsum of the wrist and there is a large pronator quadratus fatpad sign (black arrow)	This is an over-rotated lateral position. Note that the pisiform is projected clear of the other carpal bones. There is a cortical buckling of the dorso-radial aspect of radial metaphysis (arrowed)


There is no evidence of displaced fracture in this view.	There is a subtle cortical irregularity along the ulnar aspect of the radial metaphysis. There is an equally subtle associated trabecular oblique defect line		There is a buckle of the dorsal aspect of the radial metaphysis (arrowed)


There is a cortical irregularity on the ulnar aspect of the radial metaphysis (arrowed)		The cortical buckle is seen again on the oblique image (arrowed)	There is a buckle of the dorsal aspect of the radial metaphysis (arrowed).


	There is a fracture of the distal radius which extends into the wrist joint.(arrowed)	The cortical buckle is seen on the dorsal aspect of the wrist. (arrowed) There is obliteration of the pronator quadratus fat pad	There is cortical irregularity of the radio-dorsal aspect of the wrist (white arrow). There is a fracture of the ulna (black arrow)


No convincing evidence of a fracture	There is some loss of smooth contour of the radial aspect of the radial styloid. This is not convincing of a fracture	There is a loss of continuity of the dorsal aspect of the radial metaphysis. There also appears to be a pronator quadratus soft tissue sign.	The radiographic findings were considered to be equivocal. The patient's symptoms persisted. The referring doctor considered that the patient may have sustained a fractured scaphoid. The patient was referred for MRI scanning which revealed a radial metaphysis transverse fracture.


There is a very subtle buckle in the radial aspect of the radial metaphysis.	There is an even more subtle defect in the radial metaphysis demonstrated on the lateral wrist image. The findings are consistent with a subtle buckle fracture of the wrist	T1 weighted MRI image with transverse irregular low T1 band consistent with the fracture seen on the plain film images.


The PA wrist shows no evidence of displaced fracture	There oblique wrist projection image shows no evidence of displaced fracture	The lateral wrist projection image is not clearly abnormal.


The off-lateral wrist projection image demonstrates a buckle fracture of the dorsal aspect of the radial metaphysis.	Buckle fracture arrowed.

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Normal Paediatric Shoulder- 15 year old male