Bravo X-ray November

It's hard to read x-rays.  The darn things just shoot straight through your eyeballs!  Ha ha - stick with me, it gets better.  Since we might have to interpret some x-ray films in the next couple of days, here are some tips from me on how to Get It Right!

The very first thing to do is to figure out which side of the film is the left and which is the right.  My preferred technique is to guess while watching the consultant's eyebrows.  If the eyebrows twitch, quickly correct yourself and laugh at your slip of the tongue.  A quick excuse such as, "Ah but of course, we're in the southern hemisphere here!" will cover up your ignorance.  Other excuses that I find useful are, "Wait, you have no goatee - that means I'm back on Earth 1", "It's all been so different since Obama", and "I have a neurological condition that means I'm unaware of whether I'm saying left or left.  So if I mean left, I'll say left, but if I mean left, I'll say left instead.  How about I just point?"

Next, you should determine if the film is AP or PA.  AP stands for armour piercing.  This is a film that has been shot with pointier x-rays than normal so they can punch straight through armour.  AP is useful if your patient is wearing a flak jacket or is riding inside a Sherman tank.  The heart always appears enlarged on an AP film because the armour piercing x-rays are making it explode.  PA stands for personal assistant.  A film that is shot PA is one that was done with some extra help there, so it will probably have been done better than other x-rays.  The heart is the right size on a PA x-ray.

After that, comment on the exposure.  X-rays can see right through people's clothes, so you can almost always say that the exposure looks great!

The voice that you use is important.  Most radiologists speak slowly and ominously in sonorant voices so you should mimic them.  The more you sound like Gandalf, the better.  Try this phrase with chest x-rays: "I see a shadow in the East."  If you're looking at an abdo x-ray, you could try this one: "You shall not pass!"

A great tip is that any horizontal line on the film indicates a fluid level.  This can be helpful if you are hanging pictures, putting up shelves or building a fence and need to make sure it is straight.  Just ask the patient to hold the relevant item in place, take a quick snap with your x-ray machine, and adjust as needed.  Note: this doesn't work if you are putting up shelves made of radiolucent material such as glass, cholesterol, or air.

Another important thing to know is that it's calcium that makes bones show up so well on x-rays.  So if there's something unusually bright in a funny place on the film, it's probable that the patient ate something will lots of calcium in it.  For example: hyena faeces, milk, cheese, calcium tablets, limestone, cement, teeth, and/or eggshells.  You should be able to tell by the shape.  Limestone, for instance, will resemble the profile of a 19th century aristocrat, whereas cheese will be in large triangular wedges with holes in it.


Finally, it's very important to have a system.  For example, after a run of four or more tuberculosis cases, the odds of getting five in a row are miniscule, so at that point I would always switch and bet big on sarcoidosis.  It's easier to do this if you're back-betting someone else since your funds won't run out while you're waiting for the good run.  On the other hand, it will be very easy for the house radiologist to notice what you're doing, and most hospitals will throw you out quick smart.  Still, you might have been able to get some free drinks while you wait.

I hope these tips on interpreting x-rays will be helpful to you.  Until next time, try to cut down on the hyena faeces.