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The screening. Uh need to that. Right. Can everyone hear me? Um It uh Abby, do you mind just chucking in the chat if you can hear me and then I can go for it, I think. And if you can see the screen. Yep. Fantastic. We're away. Good. And it's two past, I'll do a slow introduction just to let other people kind of make their way here and then um we'll start into it. So, welcome back. People who have been before are following the series along and welcome to anyone who's joining for the first uh time we're doing kind of the second half of M SK uh radiology today. Um And as always, I'm doctor. Right. Well, Helen, I'm one of the teaching fellows at uh Nottingham University and I was a radiographer before I became a doctor. So I have a special interest in radiology. Enjoyed teaching with that. So, um yeah, I've got my, the chat up so I can see. So if you've got any questions at any point, please pop it into the chat and I'll kind of just keep an eye on it as we go and so I can answer any questions and stop at any point, please just uh interrupt me with those questions. Um Good. I'll wher for one more minute and then we'll get going. Uh So yes M SK. So the lower limb, so last week we covered the upper limb M SK. And as always, the plan for the session is to um kind of the aim is to kind of get you used to talking out loud, your x-rays. So verbally reporting, using radiology, um kind of vocabulary as you report. So not only are you confident if you had a an ay where you had to report an X ray or if an x-ray got thrown at you on the ward and or a consultant asked what you're looking at, but also you'll also understand the language written in the radiology report. So it's really useful for that as well. Um Great. So as always, the aim is to provide a structure. So a framework for how to report your x-ray on these ones, we're learning how to describe a fracture and using that to kind of the those words and stuff. We've got, I've got lots of different x-rays with lots of different um kind of pathologies of the lower limb which we'll make our way through and give you a chance to kind of practice that type of thing. Lovely. So, same structures we've been doing if you followed along with any of the other sessions. So um your aim is to. So the first three points are kind of are, are technical things to say. So this is a describe the imaging. So on this occasion, it's gonna be like a foot X ray or something like that. So, and that we'll go through this, don't worry of the patients. Um And it's technically good. And then the last uh that, that's a little section which um when you say it can be really slick in practice, usually only takes about 10 seconds to say those first three points and then your most obvious abnormality if you can see something, say it. Um But if you can't see anything or once you've seen that thing and described it, you now then need to go and check your review areas. There are often uh more than one pathology on an x-ray and you don't want to kind of stop looking cos you've seen the first really obvious one or you um can't see anything. So you, you, there's nothing immediately sticking out with you. So you need to have a kind of review system of how do you look over the film to make sure you've not missed anything. And then your in summary is of course, always just a single sentence. Don't repeat anything. You're just kind of showing your clinical knowledge by putting it all together. I will give examples, don't worry. So let's start from the first one. So the first phrase is this is a describe the images you were seeing. So for uh lower limb and M SK in general as a general, you need at least two films um at 90 degrees to each other. So what's normally an AP and a lateral, I've added the extra one in which is an oblique because often foot x-rays have obliques in them. The lateral foot x-ray actually is not the most useful. It doesn't give you a lot. So sometimes you end up with only an AP and oblique and that's fine. Um Two, as long as you've got two at different angles, you can kind of say, yes, I've see, I've covered most things, but an ap in a lateral is ideal. But if it's not an AP or it's not a lateral and you think, I don't really know what that looks like. It's almost certainly an oblique. The wrist is the other place, ankles, sometimes you get three as well, an ap and oblique and a lateral. So just so if anyone threw three up there, you'd know how to name it and then name the body part. Foot, not challenging, the side of it should always be written on so that it should always have a right or a left marker on. But it is useful to um be able to tell the difference without, there's no real great trick to it with the foot. Um You can just pretend your foot's going up onto the screen. So if you um don't do it with my foot. Literally put your foot up. I imagine your foot going up if my hand was a foot and does it fit with, like, which side does it fit? Would be the easiest way to tell that as a, as a way. But, uh, let me know if you struggle with, um, siding or we can chat about it more, but it's kind of in real world it will be marked every time. So yeah, so something you might say, let me just half read. This is really annoying. There we go. Ah Come back, here we go. This is an ap lateral and oblique X ray of her right foot. And that's all you need to say. That's your opening gambit. Fantastic. Just make sure you remember to describe all three. I have heard lots of people who just say this is a foot x-ray and keep moving and you'll lose marks cos you need to acknowledge that, you know what the foot, what the uh images you're looking at are called. Um So the importance of two views. So this is kind of an example of why. So you'd you'd be saying something along the lines is this is an ap projection of a left um tib fib or lower leg, whichever you'd like to say, I usually say tib fib. Um And you're all staring intently at it. Now, seeing if you can spot a problem with it if I told you there was a fracture in there. And you're thinking, hm, can I see it cos it's really subtle um uh while you're still looking, I just say this is a pediatric x-ray. Um I'm hoping you can see my mouse. Um these uh there's not really uh there's not really any patella and then you've got the um uh ossification kind of. So uh grow plates are still present. So it's a, it's a child's x-ray. So you're feeling very good if you've spotted a fracture. There we go. So the importance of a lateral, actually, incredibly obvious fracture down in the midshaft of the or the distal one third of the um tibia, but very, very difficult to see on an ap this is why you must. So uh so um have two views cool be labored that point enough patient demographics. Um I think I say this every time. So sorry, I'll say it again. It's really important you check in an ay, they're not usually trying to trick you. But so, but do please check? But in real life, it is very, very easy on the ward to bring up the wrong patient's x-ray. So please, please, please always just cast your eye over the name and make sure you've got the right patient. It's also, I think I've probably said this every time as well. It's also really important you check that it's the most recent x-ray. It's also very easy for someone to bring up the wrong x-ray and people have been sent home when they thought the x-ray was normal cos they were looking at one from three weeks ago and now there's something pathology on it. So you should always, this is the moment where you should be checking. Uh You've got the right patient and it's the correct x-ray. Um So yeah, this is an ap and lateral X ray, uh left hip for uh Missus Smith if you know the name and you can do it brilliant if you don't know the name, generic phrase of a patient of unknown demographics is fine. Uh That's kind of a get around cool. Um And this is an example of a uh AP and a lateral hip. So you can see this one looks as if you would for a normal pelvis. And with this one, they um make the patient kind of roll over. But you can see in this one now, people don't often quite, quite often don't see lateral hips, they're not super common. Um You've got the uh this is your greater tranter sitting up here, lesser tranter, but the greater trachaner is now overlying the neck of femur. So it's kind of it's twisted this way. So that's a lateral hip. You, you just don't do them very often fine technical quality uh in a in M SK ones, it's, it's really poor technical quality essentially. Can you see everything you need to see? Can you see all of the knee. Um And this is just an example. Laterals are the only ones which occasionally aren't, aren't good. This, this knee is a good lateral. So both of the condyles are overlapping and you can see a really nice joint space between, behind the patella in here. This is the one where I ignored the um dots. Sorry, I couldn't, couldn't get them off. Um Your con you can see your condyles aren't overlapping and suddenly you've lost that nice definition here. This is when they've over rotated it. Um This is just what Abi just so you have an example of what a bad uh lateral knee looks like. So this type of one you've probably been saying of poor technical quality is not a true lateral and I'd like a repeat but, you know, as long as it's vaguely in the right right area, that's fine. Um So it would be something like this. If, if we were talking about this one, we'd be saying something, we'll answer. This is a lateral. Um uh This is a uh this is a lateral x-ray for a right knee um for patients with unknown demographics and it's of good technical quality. If you were doing this one, it would be, it would have, it's a bad techni poor technical quality. I want to repeat the, do you need other projections? I always put in there because obviously we're talking about Long Bones for most things here. So you're not seeing all of the um femur or all of the tib fib in this X ray. Uh It's not always necessary to do more, but there are certain kind of specific fractures where if you fracture at one end of the long bone, the other end of the long bone might go and it might fracture as well and stuff. So, uh I always tend to say if I had a clinical concern at the hip or I think I would ask for further projections, but you don't technically have to. It's just if you kind of um.