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44 - Principles of plain film

from Section 11 - Surgical radiology

Published online by Cambridge University Press:  05 July 2015

Hardi Madani
Affiliation:
Clinical Radiology, Royal Free Hospital, London Deanery, London, UK
Petrut Gogalniceanu
Affiliation:
Postgraduate School of Surgery
James Pegrum
Affiliation:
Queen Mary University
John Curtis
Affiliation:
University Hospital Aintree
Helen Marmery
Affiliation:
Royal Free Hampstead NHS Trust, London, UK
Petrut Gogalniceanu
Affiliation:
Specialist Registrar, General and Vascular Surgery, London Deanery
James Pegrum
Affiliation:
Orthopaedic Registrar, Oxford Deanery
William Lynn
Affiliation:
Specialist Registrar, General Surgery, North East Thames
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Summary

Plain film consists of a single shot image using x rays.

What are the different densities in x rays?

  1. • Black – gas

  2. • White – calcified structures

  3. • Grey – soft tissues

  4. • Darker grey – fat

  5. • Intense white – metallic objects

What are the basics that must not be missed?

Always check:

  1. • Name of patient, date of birth and date – this may give information about patient's age and gender, which could elucidate the underlying pathology.

  2. • Adequacy of imaging: does the x ray cover the entire area of interest?

  3. • Orientation of film: right vs. left – ‘R’ label on corner of film.

  4. • Position of patient. For example, a pneumothorax will look different on supine chest x ray vs. erect film; air under the diaphragm will not be seen in a chest x ray of a patient lying flat.

  5. • Cervical spine: multiple standardised views (see Chapter 49, Cervical spine x ray).

  6. • Distal limbs: minimum of two views. If only one view is shown, ask for a second view.

What are the rules of 2?

  1. • 2 sides: in paired structures (e.g. limbs) always compare the affected structure with the contralateral one, which may be normal.

  2. • 2 views: obtain two views of the same structure, e.g. anteroposterior and lateral.

  3. • 2 times: view images of the same structure at two different points in time: compare current images with previous ones.

  4. • 2 joints (in orthopaedics): view the joint above and the joint below the one of interest.

  5. • 2 readers: get a second opinion.

What is fluoroscopy?

  1. • An imaging modality that uses continuous x ray exposure to get dynamic imaging

  2. • Has the capacity to save representative images

  3. • Contrast material used to help differentiate pathology.

Type
Chapter
Information
Physical Examination for Surgeons
An Aid to the MRCS OSCE
, pp. 383 - 385
Publisher: Cambridge University Press
Print publication year: 2015

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