radio cases

Case 1 — Marfan’s, tall patient, restricted neck rotation: views and considerations

Cervical AP, AP open-mouth (APOM), lateral. Adjust receptor/bucky height; seat if needed, support posture and include C7–T1. Flexion/extension only if instability assessment is indicated and cleared. Thoracic curve does not determine cervical curve.

Case 2 — Acute whiplash: views and considerations

Cervical AP, APOM and lateral. Assess trauma safety first; support comfortably and do not force neck movement or shoulder depression. Consider a swimmer’s view if C7–T1 is obscured and safe. No acute flexion/extension.

Case 3 — Fall, thoracic pain, kyphosis and unsteadiness: views and considerations

Thoracic AP and lateral. Use stable seated or recumbent positioning, accommodate kyphosis, support transfers, avoid painful arm elevation and collimate to required anatomy.

Case 4 — Right posterolateral rib trauma: views and considerations

PA chest if tolerated plus right AP-oblique rib projection targeting the painful level. Use taught right posterior-oblique positioning. Ribs above diaphragm: inspiration; below diaphragm: expiration. Adapt breathing/positioning to tolerance.

Case 5 — Lumbopelvic pain with L4–L5 step defect: views and considerations

Lumbopelvic AP and lateral. Assess alignment/slip and preserve L4–L5 detail. Add a targeted view only if relevant anatomy is inadequately shown. Optimise receptor size/orientation, centring and coverage before considering longer SID.

Case 6 — Adolescent gymnast with extension-related back pain: views and considerations

Lumbopelvic AP and lateral. Guardian consent as taught; explain the exam and gain cooperation. Accommodate hyperlordosis and use size-based paediatric factors. Flexion/extension only if justified, safe and cleared; never force painful extension.

Case 7 — Previous prostate cancer with progressive sacral/buttock pain: views and considerations

Lumbopelvic AP and lateral; consider a targeted sacral view if needed. Urgent medical assessment for possible metastasis. Normal radiographs do not exclude malignancy. Support painful transfers.

Case 8 — Older adult after a fall, suspected hip fracture: views and considerations

AP hip/pelvis and trauma-appropriate lateral, commonly cross-table. Support the leg in its presenting position. No forced internal rotation, weight-bearing or frog-leg positioning. If suspicion persists despite negative films, arrange further imaging.

Case 9 — Twisting knee injury, knee fixed at 20° flexion: views and considerations

Knee AP and lateral, modified for the flexed position. Support the knee; do not force extension or rotation. Adapt beam/receptor geometry. A horizontal-beam lateral may help when indicated; do not automatically use a Rosenberg or sunrise view.

Case 10 — Child struck on tibia/fibula: views and considerations

Non-weight-bearing AP and lateral tibia/fibula. Include the full tibia/fibula and both knee and ankle joints on each view. Support around the injury; guardian consent and paediatric size-based exposure.

Case 11 — Heel pain with limited dorsiflexion: views and considerations

Calcaneal axial and lateral. Non-weight-bearing if appropriate. Support the foot; do not force dorsiflexion. Adjust axial beam angulation to the position achieved.

Case 12 — Bilateral midfoot pain and forefoot swelling: views and considerations

Bilateral foot AP, medial oblique and lateral. Use weight-bearing if alignment assessment requires it and it is tolerated; otherwise non-weight-bearing. Ball-of-foot swelling is the forefoot/metatarsal-head region, not the heel.

Case 13 — Acute shoulder trauma, arm immobile: views and considerations

AP in the presenting arm position and modified scapular Y. Support the arm and rotate the torso for the Y rather than forcing arm movement. Avoid forced abduction/external rotation. Seek a trauma imaging alternative if views remain inadequate.

Case 14 — Shoulder pain, rolled shoulders and scapular winging: views and considerations

Shoulder AP and scapular Y. Consider Grashey or axial view only for a specific unanswered clinical question. Y: scapular plane perpendicular to receptor; Grashey: scapular plane parallel. Adapt torso rotation to landmarks.

Case 15 — Adolescent FOOSH, elbow cannot fully extend: views and considerations

Elbow AP and lateral; use partial-flexion AP modification if needed. Two AP images: humerus parallel to receptor, then forearm parallel to receptor, with the beam perpendicular to each part. Guardian consent as taught; support the limb and do not force extension or forearm rotation.

Case 16 — Hand crush injury with forearm cast: views and considerations

Hand PA, lateral oblique and lateral. Leave cast intact. Support hand/forearm and adapt receptor/beam to available positioning. Compensate for cast attenuation only if it overlies the anatomy in the beam.

Case 17 — Bilateral swollen MCPs, suspected inflammatory arthritis and artefacts: views and considerations

Bilateral hand PA, lateral oblique and lateral; consider bilateral Norgaard/ball-catcher’s view for arthritis. Remove jewellery only if safe; do not force tight rings or acrylic nails off. Assess buddy strapping before removal. Clarify whether wrist imaging is also required.

Case 18 — Pregnancy with persistent snuffbox pain after FOOSH: views and considerations

Standard wrist PA, lateral oblique and lateral, plus ONE indicated scaphoid view as taught (e.g. PA with ulnar deviation). Follow pregnancy-consent process and explain very low fetal exposure. Tight collimation; do not force painful deviation. If suspicion persists despite negative films, protect the wrist and arrange follow-up/further imaging.