From the Guidelines
To describe a bone X-ray, first identify the specific bone or anatomical region being examined and note the projection (anteroposterior, lateral, oblique), then assess the bone density, margins, joint spaces, and surrounding soft tissues for any abnormalities, using a systematic approach to ensure comprehensive evaluation of bone structure, alignment, density, and surrounding tissues, as recommended by the most recent guidelines 1. When evaluating a bone X-ray, it is essential to consider the following key aspects:
- Identify the specific bone or anatomical region being examined
- Note the projection (anteroposterior, lateral, oblique)
- Assess the bone density, looking for areas of increased opacity (sclerosis) or decreased opacity (lucency)
- Examine the bone margins for irregularities, cortical breaks, or periosteal reactions that might indicate fractures or other pathologies
- Evaluate joint spaces for proper width and alignment, checking for any narrowing, widening, or subluxation
- Inspect the surrounding soft tissues for swelling, calcifications, or foreign bodies
- Note any hardware or prosthetic devices if present
- Pay attention to growth plates in pediatric patients
- Compare with the contralateral side when available for reference This structured approach ensures comprehensive evaluation of bone structure, alignment, density, and surrounding tissues, allowing for accurate diagnosis of fractures, degenerative changes, tumors, infections, or congenital abnormalities, as supported by recent studies 1. In cases where plain X-rays are normal but clinical suspicion of active Charcot neuro-osteoarthropathy (CNO) remains, it is recommended to perform MRI to diagnose or exclude the disease, due to its high sensitivity and specificity in detecting bone and joint abnormalities, as well as signs of inflammation and/or remission 1. It is also important to note that while radiography may detect fragility fractures, its use as a primary screening tool is limited due to its low sensitivity to bone loss, and patients with radiographs interpreted as demonstrating radiographic osteopenia and/or fragility fractures should be referred to DXA for further characterization 1.
From the Research
Description of Radiographic Examination of Bone
A radiographic (X-ray) examination of bone is a diagnostic tool used to visualize the internal structure of bones. The following are key aspects of a radiographic examination of bone:
- It provides a low-cost diagnostic tool for diagnosis and visualization of bone cancer 2
- The plain radiograph remains the most important radiological method for diagnosis in bone, despite advances in other imaging techniques 3
- X-ray images can be used to analyze bone texture and detect variations in the affected region, which can be indicative of bone cancer 2
- Radiographic examination can be used to assess the stage and grade of bone cancer, as well as identify the underlying bone-destruction pattern 2
- Bone X-ray radiography manuals can be created using human bone specimens to educate students and junior radiological technologists on the procedure of bone X-ray radiography 4
Key Findings
- X-ray images can be used to detect lytic cortical lesions, which can be indicative of underlying conditions such as Rosai-Dorfman disease 5
- CT and MRI can provide better anatomic delineation of the extent of infection in cases of musculoskeletal infection, but plain film and nuclear medicine bone scan are still traditional imaging modalities used in evaluation 6
- Digital geometry and support vector machine (SVM) can be used to extract features from bone X-ray images and discriminate healthy and cancerous bones 2