TAUC X-Ray Training Compendium Sample Films: Ankle/Foot ● 105259 - toe fracture (6/07/17) ● 60892 - distal fibular fracture (6/05/17) ● 300666 - trimalleolar fracture (6/12/17) ● 297939 - second toe fracture (6/13/17) ● 119183 - subtle avulsion of navicular bone (6/12/17) ● 307079 - subtle distal fibular fracture best visualized on lateral view (7/6/17) ● 116487 - 3rd toe distal osteomyelitis (7/22/18) ● 150913 - atypical distal tibial fracture (2/3/19) Chest X-Ray ● 299559 - RLL infiltrate (7/7/17) ● 115692 - LLL infiltrate (compare to resolved CXR) (5/16/17) ● 122346 - RML, LLL infiltrate (6/24/17) ● 305880 - Azygous lobe variant (RUL) - compare to CT (7/1/17) ● 55422 - CXR, dextrocardia ● 383795 - CXR, empyema - compare to CT (2/27/18) ● 392006 - CXR, LLL pulmonary contusion with rib fracture - compare to CT (3/25/18) ● 264095 - Subcutaneous emphysema of mediastinum - compare with soft tissue neck (7/3/18) ● 422974 - inhalation vs. exhalation for bronchial foreign body (7/8/18) ● 258914 - pneumothorax, compare to CT (8/22/18/0 ● 452734 - pleural effusion, multilobar infiltrate - compare to CT (metastatic disease) (10/9/18) ● 465769 - spontaneous pneumothorax (11/19/18/0 ● 468466 - spontaneous pneumothorax (unusual location of collapse) (11/26/18) ● 491822 - hiatal hernia (compare to CT) (2/2/19) ● 283384 - multiple displaced rib fractures with left upper pneumothorax (compare to CT) (5/8/19) ● 303268- pneumomediastinum with upper soft tissue free air (compare to CT) (5/10/19) ● 894109 - inhaled foreign body with empyema (3/6/21) ● 582335 - COVID-19 pneumonia (3/15/21) ● 953884 - pneumomediastinum, subcutaneous emphysema (6/28/2021) ● 955718 - lymphoma CT scans ● 504906 - Abdominal/Pelvis CT scan, abdominal aortic aneurysm (3/8/19) ● 955718 - CTA, lymphoma (7/8/21) ○ Prominent mediastinal and bilateral hilar soft tissue mass is likely due to lymphadenopathy although other etiologies cannot be excluded. Findings are suspicious for lymphoma. Elbow ● 296750 - radial head fracture with fat pad/sail sign (5/27/17) ● 164420 - radial head fracture (6/24/17) ● 330728 - radial neck fracture (note step off/right angle) missed by provider (9/28/17) ● 463480 - subtle radial head fracture (11/11/18) Facial Bones/Skull (Scout films from a CT) ● 439611 - Scout film and CT head open skull fracture (8/30/18) Foot ● 907382 - sclerotic, lytic lesion with fracture 3/30/21 ● 902265 - osteomyelitis 3/21/21 ● 124709 - fracture base of 1st MT and Lisfranc injury 4/5/2021 Hip/Pelvis ● 16485 - pelvic fracture (3/18/17) ● 163524 - normal pelvis (6/14/17) ● 206472 - left hip prosthesis dislocation (206472) ● 69701 - osteophyte right superior acetabulum (correlate with CT) (6/23/17) ● 297395 - right slipped capital femoral epiphysis (5/13/2021) Knee ● 299928 - OA (6/9/17) ● 299969 - normal knee (6/9/17) ● 56237 - tibial spine avulsion fracture and joint effusion (6/12/17) ● 301436 - right tibial plateau fracture (correlate with CT) (6/15/17) ● 304104 - avulsion/cortical irregularity distal medial femur (6/25/17) ● 305194 - patellar fracture (6/29/17) ● 383827 - lateral tibial plateau fracture (correlate with CT) (2/27/18) ● 550972 - lateral tibial plateau fracture (correlate with CT) (7/11/19) ● 604036 - lateral distal femur avulsion with lateral joint space widening (11/27/19) Shoulder ● 299707 - clavicle fracture (6/8/17) ● 151179 - impacted humeral head fracture (6/14/17) ● 266000 - humeral neck fracture (7/2/17) ● 889296 - anterior shoulder dislocation with post reduction view (2/24/21) ● 309680 - scapular fracture (7/15/17) ● 454801 - left clavicular fracture (superimposed on left rib border) - missed by provider (10/15/18) ● 460730 - subtle non-displaced humeral fracture (11/3/18) ● 897575 - scapular fracture (3/12/21) Soft Tissue Neck ● 788461 - “thumb sign,” epiglottitis (10/6/20) Spine ● 251295 - cervical C2 fracture (12/1/16) ● 270004 - normal c-spine anatomy (6/8/17) ● 299704 - scoliosis, retrolisthesis of L2 on L3 with pars defect (6/8/17) ● 308154 - transverse process fracture, correlate to CT (7/9/17) ● 289836 - C1 fracture - compare to CT, unremarkable plain film although odontoid is not well visualized (4/27/17) ● 308722 - limbus vertebra L4 (7/12/17) ● 311857 - lytic bone lesion of C2 (compare to CT) (7/23/17) ● 449755 - C1 fracture (1/19/19) ● 792760 - C2 fracture (limited on x-ray; compare to CT) (10/11/20) Wrist/Hand ● 209011 - fracture at base of metacarpal (6/7/17) ● 169093 - scaphoid fracture (6/8/17) ● 170789 - tuft fracture (6/14/17) ● 278625 - left hand paint FB inside hand from power sprayer (high risk injury) (3/12/17) ● 304123 - distal radius fracture (subtle pediatric) (6/25/17) ● Pediatric wrist/hand with open growth plates ○ 303279 - torus fracture distal radius (6/21/17) ○ 299047 - torus fracture radius and ulna (6/21/17) ○ 43485 - subtle distal radius fracture (6/15/17) ○ 302456 - distal radius and ulna fracture (6/19/17) ○ 897426 - SH V distal radius fracture (rammed together - crush injury) (3/12/21) Basics of X-Ray Film Reading: ABCs of Joint/Bone Films ● A - Adequacy of film, Alignment ● B - Bones ● C - Cartilage, Cortex ● S - Soft tissue ABC’s of Chest films ● A - Adequacy of film, Airway ● B - Bones and soft tissue ● C - Cardiac silhouette ● D - Diaphragm ● E - Effusions ● F - Fields (lung fields), Fissures ● G - Great vessels ● H - Hila and mediastinum ABCs of Spine films ● A - Adequacy, Alignment ○ ensure full view of each vertebrae of corresponding spine, full view of odontoid ○ Alignment - connect corners of vertebrae for alignment ● B - Bone ● C - Cortex ● D - Disc space ● E - Edges (lung apex - check for pneumothorax, upper ribs, lower skull) ● S - Soft tissue Special considerations: ● Tenderness over a growth plate should be diagnosed as a Salter Harris I fracture ● Clinical fractures should always be diagnosed and treated as a fracture (NO “possible”) ● Anterior/Posterior fat pads in elbows indicate an occult fracture ● Anatomical snuff box tenderness is a clinical scaphoid fracture regardless of x-ray read ● Consider bilateral elbow films in pediatrics to compare growth plates ● Consider bilateral AP shoulder views to compare AC joints for AC separation ● Concerning chest films should be CT scanned for confirmatory diagnosis ● Rib films and KUBs are not definitive and should be CT scanned ● Facial bones/sinus films are difficult to read and not definitive and should be CT scanned.