How do you look at your X-rays?

How to read an X-ray

(written by Kat Evans BSc (Hons) Radiography)

During a busy day within a practice we often forget to take the time to consider how to properly look at the images we create while undertaking radiography or other imaging modalities. It is important to accurately read the images that we produce in order to get the full amount of information from them.


Sadly while we often carefully consider the location of a digital X-ray processor to ensure that it’s in a good location for processing X-ray, that placement is rarely good for reading the resulting images. Normally in a human hospital, or veterinary referral hospital, X-rays are read in their own viewing area because to read an x-ray accurately takes time, and this is best done in a location where you can concentrate. We have all got used to the idea that to do a good ultrasound scan you need a quiet, dark location where you can sit and dedicate full concentration to the task at hand and this is the same for reading a radiographic study.


The ideal location should be where you can sit down, turn off the lights, and work quietly for 5-10 minutes while carefully checking each image. You don’t want light from a window reflecting on the monitor, or to be interrupted while checking each image. It can be worth having a checklist of the things you want to go through.As you gain experience you won’t need to use the list as much, but it can be good to have to refer too.
A basic checklist would include:


  • Patient ID 
  • Image data
  • date, time and markers
  • Image quality
  • Check for obvious abnormalities 
  • Systematically check for anatomy 
  • Confirm all areas covered
  • Consider the clinical question


A few years ago a study was done where human radiologists were asked to report on 5 images from a thoracic CT scan, and 83% of them failed to notice the dancing gorilla!  The main reason for this is that the radiologists were looking for nodules within the lung, they were not looking for gorillas, so while it was known that they had looked directly at the gorilla while reading the image their brains ignored the gorilla. So it’s important to always approach every radiograph with an open mind as to what you may see.

 Image courtesy of Trafton Drew and Jeremay Wolfe/Brigham and Women's hospital
(Image courtesy of Trafton Drew and Jeremay Wolfe/Brigham and Women's hospital)

One way in which you can view images in a good location is through the use of a PACS system, which then enables you to have a high quality monitor in an office or other good location, where you can sit down and read the images well. This can be even more important with equine images, as trying to fully interpret a full set of images when on a yard, with the owner asking questions can be very stressful.


If you want more help and advice about the best way to view your images, or you want to know more about PACS please contact your local BCF account manager.

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