Musculoskeletal X-Rays for Medical Students and Trainees

Andrew Brown, David G. King

• Publisher: Wiley-Blackwell
• Year: 2016
• ISBN:
  9781118458723
• Edition: 1
• Topic: Medicine
• Subtopic: Radiology, Radiotherapy & Nuclear Medicine

Musculoskeletal X-rays for Medical Students provides the key principles and skills needed for the assessment of normal and abnormal musculoskeletal radiographs. With a focus on concise information and clear visual presentation, it uses a unique colour overlay system to clearly present abnormalities. Musculoskeletal X-rays for Medical Students:
•Presents each radiograph twice, side by side – once as would be seen in a clinical setting and again with clearly highlighted anatomy or pathology
•Focuses on radiographic appearances and abnormalities seen in common clinical presentations, highlighting key learning points relevant to each condition
•Covers introductory principles, normal anatomy and common pathologies, in addition to disease-specific sections covering adult and paediatric practice
•Includes self-assessment to test knowledge and presentation techniques Musculoskeletal X-rays for Medical Students is designed for medical students, junior doctors, nurses and radiographers, and is ideal for both study and clinical reference.

PART 1
Introduction

1
Musculoskeletal X‐rays

Introduction

Despite the availability of a wide range of imaging techniques to visualise musculoskeletal structures, plain radiographs or X‐rays remain an important and widely used first‐line investigation. It is probably the most readily available and least expensive imaging modality and is easily accessible to patients and healthcare professionals. As such, all medical professionals require at least a basic level of knowledge and training in the fundamental principles of requesting, interpreting and reporting plain radiographs of bones and joints.

Basic principles of requesting plain radiographs of bones and joints

Which structures?

Before requesting an X‐ray, the clinician should already have a good idea of the likely nature of the clinical problem and which musculoskeletal structures may be affected and what may or may not be visualised on an X‐ray. For example, radiographs are best at detecting pathological changes in bones, joints and cartilage, such as joint space narrowing, fracture, subluxation and dislocation. However, many soft tissue structures such as ligaments, tendons and synovium are not well visualised, and alternative imaging may be more appropriate to provide additional useful information to aid diagnosis and treatment.

Clinical assessment including the patient’s symptoms and a physical examination will usually determine the site or region that is to be evaluated by X‐ray. Exceptions may include a patient with rheumatoid arthritis where X‐rays of both hands and feet may be used to evaluate the extent of disease or structural damage which may be repeated serially to compare any disease progression over time.

Which views?

It is important to consider which views are chosen to visualise a particular region of interest. This is because the X‐ray beam creates a two dimensional shadow of a structure so selecting the correct view will maximise sensitivity. A basic principle is that two views should be requested, ideally 90° apart, which are usually obtained in antero‐posterior (AP) and lateral or oblique views. This is particularly important in a trauma context where fracture or dislocation may be missed if only a single view is acquired but may be less important for the assessment of arthritis. There are a number of established techniques and protocols for optimal image acquisition using standardised views of most musculoskeletal sites. Specialist views may also be considered in particular clinical situations, such as a ‘skyline view’ for the patello‐femoral joint or ‘through‐mouth view’ for the cervical spine. As well as the particular plane used to acquire the radiographic image, the position of the patient should also be considered. For example, weight‐bearing views with...

Table of contents

• Cover
• Title Page
• Table of Contents
• Preface
• Acknowledgements
• PART 1: Introduction
• PART 2: Pathology
• PART 3
• Self-assessment questions
• Self-assessment questions
• Index
• End User License Agreement