1. How To Read X-Rays in the Clinical Setting Earl R. Chase, D.O. Director of Emergency Services Hereford Regional Medical Center

3. Topics Why get an x-ray Dangers of radiography Most common films in the clinical setting Approach to reading x-ray films Let's all read Conclusion Questions

4. Why Get An X-Ray Acute injury Follow-up from an acute injury Acute illness Follow-up on chronic illness Pre-Op study

5. Dangers of Radiography Exposure to radiation Cancer Pregnancy

6. Most Common Films in the Clinical Setting Chest Back Joints Limbs

7. Approach to Reading X-Rays Systematic Approach Outside in Inside out ABC's

8. Approach to Reading X-Rays Basic Principles Plain films demonstrate four shade of grey (not 50!) Air is black Fat is dark grey Heavy metal is white Everything else is light grey, termed "soft tissue"

9. Approach to Reading X-Rays Systematic Approach Outside in Inside out ABC's

10. Approach to Reading X-Rays Outside- In Soft Tissues Thoracic Wall Lungs Mediastinum Heart Compare with previous X-Rays

11. Approach to Reading X-Rays Inside- Out Heart Mediastinum Lungs Thoracic Wall Soft Tissues Compare with previous X-Rays

12. Approach to Reading X-Rays ABC's

13. Approach to Reading X-Rays A-airway B-bones C-cardiac silhouette D-diaphragm E-effusion F-equal (lung) fields G-gastric bubble H-hilum (and mediastinum) I-invasive devices and lines

14. Approach to Reading X-Rays A-air (black) B-bones and calcifications (white) C-'S'oft tissues (gray) Abdome n

15. Approach to Reading X-Rays Evaluate Soft tissues Bones Joints Musculoskelet al

16. Approach to Reading X-Rays Musculoskeleta l Soft Tissues Fat Pad Sign Suggest an occult fracture my be present.

17. Approach to Reading X-Rays Musculoskeleta l Bone Inspect the periosteumInspect for focal lesions

18. Approach to Reading X-Rays Back Lumbar AP View Lateral View Oblique View

19. Approach to Reading X-Rays Back Lumbar AP View Alignment Bone density

20. Approach to Reading X-Rays Back Lumbar Lateral View Count the vertebrae Examine vertebral bodies Examine disc space

21. Approach to Reading X-Rays Back Lumbar Oblique View Limited value Useful for looking for Pars Defects Look for the Scottie Dog

22. Let's Read Together

23. Case #1 Mr. Smith CC: Here for a check-up HPI: Pt is a 57 y/o WM with occasional non-productive no complaints today. PMHx: occasional Bronchitis PSx: None SHx: works as a Mechanic Smokes 1ppd x30 yrs PE: VS BP 132/77 P 82 O2 94% HEENT: Normal CV:RRR Lungs: CTAB ABD: ND/NT Ext: No edema Neuro: Non Focal

24. Case #1

25. Case #2 Mrs. Garcia CC: Sore left wrist HPI: Pt is a 75 y/o HF c/o pain to left wrist after falling walking to chruch PMHx: OA, HTN PSx: Hyst SHx: Retired PE: VS BP 128/82 P 82 O2 94% HEENT: Normal CV:RRR Lungs: CTAB ABD: ND/NT Ext: Wrist tender to palpation Pain with ROM

26. Case #2

27. Case #3 Jonny Dep CC: Cough and fever HPI: Pt is a 4 y/o WM non- productive and subjective fever for 2 days. PMHx: occasional OM PSx: None SHx: Lives with Mom & Dad Pt in Daycare PE: VS Temp 100.6 F P 96 O2 92% HEENT: Normal CV:RRR Lungs: Rales in RUL ABD: ND/NT Ext: No edema Neuro: Non Focal

28. Case #3

29. Case #4 Mr. Hackysack CC: Right shoulder pain HPI: Pt is a 68 y/o WM c/o right shoulder pain after falling while gardening today. PMHx: HTN, DMII, CAD PSx: Chole, Stents x 3V SHx: Retired PE: VS BP 140/92 P 98 O2 94% HEENT: Normal CV:RRR Lungs: CTAB ABD: ND/NT Ext: Right shoulder tender with decreased ROM Neuro: Non Focal

30. Case #4

31. Case #5 Tatum Gossling CC: Low back pain HPI: Pt is a 25 y/o WM c/o acute onset of LBP at lifting a 50 lb sack at work yesterday. PMHx: None PSx: Appendectomy SHx: Works in a Lumbar Yard PE: VS BP 115/68 P 85 O2 96% HEENT: Normal CV:RRR Lungs: CTAB ABD: ND/NT Ext: Lumbar muscle are tender to palpation with decreased ROM Neuro: LE MS 5/5, Neg SLR

32. Case #5

33. Case #6 Jackie Lee CC: Pain to right hand HPI: Pt is a 17 y/o AM c/o pain to right after punching a wall demonstrating is Kung Fu skills. PMHx: None PSx: None SHx: High School student PE: VS BP 126/68 P 85 O2 96% HEENT: Normal CV:RRR Lungs: CTAB ABD: ND/NT Ext: Tender to palpation to dorsum of right hand. Neuro: Neurovascular intact

34. Case #6

35. Case #7 Abcde Herring CC: Severe abdominal pain HPI: Pt is a 7 y/o WF c/o severe abdominal pain for 2 days. No N/V/D, no F/C/NS PMHx: None PSx: None SHx: student PE: VS BP 116/68 P 85 O2 96% HEENT: Normal CV:RRR Lungs: CTAB ABD: Non distended with tenderness to RUQ and RLQ Ext: Non-tender. Neuro: Non-Focal

36. Case #7

37. Case #8 Abcde Herring CC: Right sided pain HPI: Pt is a 38 y/o WM c/o right sided pain after falling off his sons skateboard. PMHx: HTN PSx: T&A SHx: Account, Smokes 1/2 ppd PE: VS BP 137/90 P 110 O2 90% HEENT: NC/AT A&O x 3 CV:RRR Lungs: CTAB but diminished on the right ABD: ND/NT Ext: Right shoulder tender with decreased ROM due to pain Neuro: Non-Focal

38. Case #8

39. Case #9 Sarah Gomez CC: Pain to right ankle HPI: Pt is a 5 y/o HM c/o right ankle pain after tripping while chasing her dog. PMHx: None PSx: None SHx: Live with parents attends school PE: VS BP 99/65 P 95 O2 98% HEENT: NC/AT A&O CV:RRR Lungs: CTAB ABD: ND/NT Ext: Right ankle tender with decreased ROM due to pain Neuro: Non-Focal

40. Case #9

41. Case #10 Tiffany Jones CC: Pain to right ankle HPI: Pt is a 8 y/o BM c/o left elbow pain after tripping during PE at school today. PMHx: None PSx: None SHx: Live with parents attends school PE: VS BP 102/72 P 96 O2 97% HEENT: NC/AT A&O CV:RRR Lungs: CTAB ABD: ND/NT Ext: Left elbow with edema and tender. Decreased ROM due to pain Neuro: Non-Focal

42. Case #10

43. Summary Importance of radiographic exams Read x-rays in a systematic approach Have fun and don't fear the reaper.

44. Questions?