X-Ray Image Interpretation Guide
ABCs systematic approach and practical report construction guide for musculoskeletal X-ray image interpretation. Designed for diagnostic radiography students preparing for Preliminary Clinical Evaluation (PCE) exams, this guide aids radiographers and radiologists in describing fractures and radiological findings. Scroll down for printable PDF version and definitions of all anatomical and reporting terms used.
X-Ray Terminology and Fracture Definitions
For more in-depth fracture definitions visit our fracture classification page.
Alignment & Adequacy
Dislocations: Occurrence when two bones at a joint separate from their normal positions.
Subluxations (partial dislocation): A partial or incomplete dislocation of a joint.
Adequacy: Refers to the quality, exposure, and projection of the radiograph ensuring it’s suitable for interpretation.
Bones – Outline & Density
Breaks: Another term for fractures, indicating a breach in the continuity of the bone.
Lucencies: Areas on the X-ray that appear darker, indicating less dense or absent tissue.
Opacities: Areas on the X-ray that appear whiter, signifying dense material like bone or metal.
Tumours: Abnormal masses of tissue that may be benign or malignant.
Periosteal reaction: Radiographic changes in the periosteum due to injury or disease.
Fracture Descriptions
Transverse/Longitudinal: Fractures that occur horizontally/vertically across the bone.
Oblique/Spiral: Fractures that occur at an angle to the bone’s axis or wind around the bone.
Buckle: A compression fracture, commonly seen in children’s bones.
Torus: A bulging of the cortex, also commonly seen in children’s bones.
Greenstick: A fracture in which one side of the bone is broken while the other is bent, common in children.
Salter-Harris: Refers to fractures involving the growth plate in children.
Avulsion: Occurs when a fragment of bone is pulled off by a tendon or ligament.
Comminuted: A fracture where the bone breaks into multiple pieces.
Pathological: Fractures due to weakening of the bone caused by conditions like osteoporosis or cancer.
Compression/Wedge: A fracture causing the vertebra to collapse, commonly seen in osteoporotic patients.
Cartilage & Soft Tissues
Swelling: Abnormal enlargement of a body part, typically due to fluid accumulation.
Fat pad sign: An indication of a joint injury, noticeable when a fat pad is pushed out of place by joint fluid.
Lipohaemarthrosis: Presence of fat and blood in a joint, typically indicating a fracture.
Fluid levels: Indicate the presence of air and fluid in a joint or body cavity.
Gas/Air: Presence of air within a joint or soft tissue, usually due to infection or injury.
Joint effusions: Excess fluid accumulation in a joint.
Too wide/narrow joint spaces: Abnormal spacing in joint areas, often indicating conditions like arthritis or injury.
Foreign bodies: Objects that don’t naturally belong in the body and appear dense on X-ray.
Position & Anatomy
Anterior (Volar/Palmar)/Posterior (Dorsal): Refers to the front/back orientation.
Lateral (Radial)/Medial (Ulnar): Refers to the sides of the body or limbs. Lateral is towards the outer side, and medial is towards the centre.
Superior/Inferior: Upwards or downwards orientation in relation to the body.
Displacement & Findings
Displacement/Angulation/Rotation: Describe the direction and angle of fractured bone pieces.
Shortening/Distraction/Impaction: Terms describing the relative position of fracture fragments.