Image Evaluation

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Image Evaluation
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What is Image Evaluation?

• May also be called Image Interpretation
  Different to Image Critique which discusses
  evaluation of images from a technical point of
  view. Patient position, exposure, inclusion of
  correct anatomy etc.
• Image Evaluation discusses radiographic pathology
  or abnormal radiographic appearances.
• It will begin to equip you with the terminology
  required to describe abnormal radiographic
  appearances.
• Note! Before you can identify what is abnormal,
  you must first learn to recognise what is normal!

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• It takes time to learn what is normalDONT
  PANIC!

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Image Evaluation has two parts.

• Describing what you seeusing appropriate and
  professional terminology
• Providing a diagnosis.

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Example
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Thats a grotty
looking chest!
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Triangular shaped density in the mid
zone of the right hemi-thorax probably
representing airspace opacification.Horizontal
line represents an air/fluid interface at the
junction of the upper and middle
lobes.Diagnosis Rt upper lobe pneumonia
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Interesting Images
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Interesting Images

• Trauma e.g MVA (Motor Vehicle Accident)
• Transverse fracture of the mid-shaft of the left
  humerus.
• 45degree varus angulation of the distal fragment.
• External rotation of the distal fragment around
  the fracture site.

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• As is typical of the field of imaging Image
  Evaluation provides a pathway of learning that is
  almost never ending. Remember lifelong learning!
• Image Evaluation will teach you mainly about the
  most commonly encountered pathologies.

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Musculoskeletal Colloquialisms
(Colloquial informal speech
or conversation)

• Some radiographic pathologies can be described in
  very plain and un-scientific language, but convey
  a complete and accurate picture

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Chauffeur Fracture
Lee, 2004
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Chauffeur Fracture

• In the days when cars had to be hand-cranked to
  start.
• The crank would kick back or backfire against
  the hand putting pressure on the wrist joint.

Lee, 2004
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Boxers Fracture
Lee, 2004
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Boxers Fracture.

• Also called a Saturday night fracture, or
  bar-room fracture.
• Be sure to aim well when you throw a punch!

Lee, 2004
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Clay-shovelers Fracture
Lee, 2004
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Clay-shovelers Fracture

• Fracture of the spinous process usually C6 or
  C7.
• Was noted as an injury in men employed to dig
  drainage ditches in clay soil in western
  Australia.
• The clay was tossed out on long handled shovels.
• Sometimes the clay stuck to the shovel causing
  strain on the neck and back muscles causing a
  tearing of the spinous process.

Lee, 2004
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Greenstick Fracture
Lee, 2004
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Greenstick Fracture

• Typically occurs in young children where the
  bones are growing.
• Fracture on one side of the bone, and bone cortex
  (edge) remains intact on the other.
• Compare this to snapping a young green sapling
  twig, it does not snap completely hence the
  name.

Lee, 2004
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Nightstick Fracture.
Lee, 2004
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Nightstick Fracture

• Caused typically when arm is raised in defence,
  to protect against a blow from a policemans
  baton, or nightstick.
• Fracture typically occurs in the middle third of
  the ulna the bone to be contacted.

Lee, 2004
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Wagon Wheel Fracture.!
Lee, 2004
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Wagon Wheel Fracture.!

• In the days of horse and cart, or wagon.
• Children used to hitch a ride.
• Leg caught in spokes of wagon wheel which then
  causes twisting and forced extension of the leg.
• Fracture through the epiphysis or growth plate of
  the distal femur

Lee, 2004
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A normal horizontal ray lateral knee radiograph
Normal epiphysis
Lee, 2004
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Metaphysis Flared end of long bone
Diaphysis shaft of long bone
Epiphysis secondary ossification centre
Physis or growth plate where lengthways growth
of bone is layed down
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How about?

• A Casanova's fracture?
• A Lovers Fracture?
• A Hangmans Fracture?
• A March Fracture?
• Gamekeepers thumb?

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Nasal Polyp
Ghorayeb, B. 2006
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This ones infected!
Ghorayeb, B. 2006
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Plain film imaging can also be used to evaluate
soft tissues particularly of the abdomen
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Gas in the stomach, called a gastric bubble
Gas in the intestine
Faeces contents of the bowel
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Chicken bone
Trachea
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Clavicle
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Osteolytic metastasis (secondary tumor deposits)
of proximal left humerus with complete bony
destruction
Osteolytic destruction bone destroying Osteoblas
tic bone forming
Eisenberg Johnson, 2003
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Test

• Pyrexia?
• Tachycardia?
• Epistaxis?
• Thenar Eminence?

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References

• Eisenberg, R.L. Johnson, N.M. Comprehensive
  Radiographic Pathology. Mosby. 2003.
• Ghorayeb, B. 2006. Anatomy of the sinuses,
  Otolaryngology Houston. Viewed 11 June 2006.
  http//www.ghorayeb.com/AnatomySinuses.html
• Lee P, Hunter T, and Taljanovic M, 2004.
  Musculoskeletal Colloquialisms How Did We Come
  Up with These Names? Radiographics. Viewed 15
  July 2006. lthttp//radiographics.rsnajnls.orggt