 Allwn. Beth yw'r pethau? Felly, rydyn ni'n gallu gwawdd. Roeddwn ni'n gallu gwawd, felly nid o'n ei ddweud o'r radiograffau fel y rhaid o'r rhannu bwysigol, ac mae'r ddweud o ddweud o'r ddweud o'r ddweud o'r rhannu. Ond yna, ddweud o'r rhannu, a'r ddweud o'r rhannu, ac rydyn ni'n gallu gwawd o'r rhannu. Ffantastic. So, real easy until it goes wrong and then it's really really difficult. Essentially. I am also someone who's had quite a lot of imaging done to me. So, not only do I know how a CT is supposed to work and how an MRI is supposed to work, I also know what they feel like and some of them feel fucking awful. But yes, diagnostic imaging comes in so many forms. The one on the right hand side is a PET CT, so that's what I do now. The one in the middle is a bog standard CT, which is what I did as a little bit as a student. And the one on the far side is a x-ray of an abdomen, which is what I used to do. Now this is my very quick and dirty idiot's guide to diagnostic imaging. Essentially, you have ionising radiation or not. MRI is the only one that uses magnets. Ultrasound is the only one that uses ultrasound. Nuclear medicine is where I am now. And with CT diagnostic imaging, by the way, or dynamic imaging, fluoroscopy, dynamic is what they do in theatres. So when you've fallen over and you've broken your arm and they send you into theatre to put a plate in, instead of splaying your arm right out so that they can see the bone themselves, they do a little slit and they slide it in and then they have a massive x-ray equipment, who it might be muggins or someone else operating, who has the picture above and it gives them moving images by repeatedly firing those x-rays. And that means that they can saw out the plate without opening you up and severing nerves and muscles and all the rest of it. Just makes it a little bit easier and quicker for you to heal afterwards. So, general, I can't tell you how to look at an x-ray and know how everything is supposed to look and how you're supposed to read them in a 30-minute talk. What I can say is for modern x-rays, if it's white, it's bone, if it's black, it's air, everything else is somewhere in between. And it's compressed. So you are not a 2D image. You are 3D, you have gubbins inside and those gubbins will overlay and sometimes you will look at a picture and go, oh my God! And then it turns out it's a roll of fat that the roll has created a darker line and it's not actually a break or anything, it is just a roll of something else. CT is a little bit more difficult. So with CT you have to imagine for an axial like this that you are stood at the foot of a person and you are looking up at their head and someone has come with agility and is slicing them. So you are looking at this person from the feet towards the head and as it killed itself, fantastic. If you look at one slide in isolation, it can be very misleading because a lot of the gubbins look the same. So whenever you see people looking at CTs, if you ever see a radiologist looking at a CT, what you'll see is them pressing to loop it forwards, looking at the pictures, and then pressing to loop it back and looking at the same pictures and continually pressing the two buttons to decide on whether it's normal or not. Most of the time they get it right. Sometimes they don't. Right. So this is the main part of today. It's going to be interactive. If you get it right, you will get a silly sticker. I have silly stickers here. And if you get them right after the show, you can come and collect them from me. So are we all ready? Yeah. OK, first picture. What are you looking at? It is a chest well done. Is it normal? Who's saying yes, who's saying no? Yes. No. The yeses have it. This is a normal chest x-ray. Everyone will look slightly different. And actually this is a bloody fantastic chest x-ray. You will find quite often the scapula, so those triangle bits to the side, have not cleared the chest. Now, the way that you have to stand in order to clear the chest is like this. No one likes to do that. So when you have a patient and you're like, can you bring your elbows forward? They all go. And you're not allowed to budge people anymore. So this is a bloody excellent one. Right, so I'd forgotten that I'd actually done another slide for this. Yes, it is normal. How about this? What are we looking at? Yes, it's a clavicle, right then. We are going to do hands up first. How do we think it's looking? Is it broken? Is it not? It is broken. It is broken. A little red line for anyone who couldn't see before. And this is how a normal one's supposed to look just in case. OK, so it is... I wouldn't say that was actually particularly displaced, to be honest, but it is pointing upwards a bit. That would be quite painful, right then. This one. What are we looking at? How of this? Is it normal? There is a big white blob. Is that normal? Is it normal in an x-ray? There you go. So who knows what that is, hands up. It is a shield. Well done. It's a shield. Is there anything not normal about this? Is there... Do we know? Is it a normal pelvis? Is it a not normal pelvis? Looks pretty squished. It looks pretty tiny. It does look pretty tiny. Why would it be tiny? It's a child. It is a child. There is no break there. But what you can see, if I go back again, is can you see the little lines of the femoral heads there, how they're separate from the rest of the femur? Now that's the epithysis, that's the growth plate. The growth plate is not bone yet, so it doesn't show up on x-rays. Now you can imagine mum of Timmy coming in and being allowed behind the screen while they take the picture and their kid is crying and screaming and it's all awful. And then the picture shows up and there's two great massive breaks. Oh, my God! My child has broken both of their legs. No, they haven't. But me as a radiographer, I'm not allowed to tell you that they haven't either. So I can't tell you that they have. I can't tell you that they haven't. It is completely normal x-ray for a child, but this is why quite often in x-raying kids will not have family members come round where they can see the pictures. Because I can't tell you whether it's normal or not and you don't know. Right then. Okay, this one is going to be hands up. All right? First hand in the air. Yes! What are we looking at? We are! Well done! Okay, is it normal or not? Hands up. What's wrong? It is! Do we know what the name of the break is? Someone said, collies, you are not right, but that is a wrist fracture. There is another one. One is a fall that way, which is a collies. One is a fall that way, which is this one. It's a smith. So, yeah, that's an ouch. They would go to theatre for that. They would put a metal plate in. They would sew you up and call it a day. There's not a hell of a lot else you could do. This is a fairly elderly patient. And chances are it's not going to fully heal in the time that they're alive. Because the older you get, the less osteoblast and osteoclast you have. And that means the longer it takes for bone to mend itself and it gets to the point where you're not gonna. So, as you get older, get careful. Yeah, good, okay. What are we looking at? It is a knee and is it normal that you get a sticker? Well done. Now then, there is something missing on this. Hands up, what's missing? Patella, yes, why is it missing? It's not calcified yet. This is a two-year-old, I believe. So, they are not old enough yet to have a kneecap. And if any of you have toddlers and fancy fondling their legs as they grow up, you might actually start to notice a bone forming that wasn't there before. If you do not have a toddler, do not do this. Just had to point that out. Hands up, what are we looking at? Ankle, yes, is it normal? It's not. It's not dislocated either. So, this is a fracture, and it is of a child. Children are very difficult to fracture, I must be honest, but this is a fracture. It's quite hard, as you can see, because you have the epithysis again at the bottom, but the epithysis aren't fractures. There it is. So, this is what we call a solter Harris. And to make it easier on us, solter actually works as the levels from one to five of how serious the injury is. Now, this is a two because it goes above the growth plate. So, it's a solter if it involves that growth plate. And you have slipped where the two, in fact I've got a picture, makes it a lot easier. So, type one, they slide. Okay, you're pushing back, it's fine. Type two, it goes through the growth plate and then up. Type three, it goes below or lower. Type four, it goes straight through. And type five is the one that doesn't look as bad as the others, but it is by far the worst. And that is a ram. So, in a ram, the two sides crush that growth plate. There is generally no way of fixing that. And so, the part after that generally stops growing. So, if you imagine you've got a five-year-old that crushes the finger, that anything past that point is not going to grow any more. So, that bone is just, it's that size for the rest of the time. It's very, very hard to fix that. So, you know, you can end up with some really hard things that you know a parent's going to have to go through once they've left you. And you can't tell them. So, it's not a job for the faint-hearted, especially anything to do with pediatrics. Are we normal? What are we looking at? Hands up. What is it? It's a wrist. Yeah, I'll make it a bit easier for you. There's many bones of the wrist. The purple one is a scaphoid. The blue one is a lunate. The lighter green is a triquetral. The pink is a pisiform. You've got your trapezium and your trapezoid as your orange and green. Yellow is capitate. Red is hammock. Are any of them broken? You can say the colour. I'm not expecting you to have remembered. Orange. Orange is not broken. Anyone else? Red is not broken. Now. Can you see the break now? It is purple. Yeah? So, that is why if we expect that there's a scaphoid fracture, we have to do a scaphoid view where you turn the wrist. And I can tell you now, anyone who has a scaphoid fracture is going to scream when you get them to do that. Because, as you can imagine, we're essentially opening up that break. Yeah, yeah, yeah. What's even better about this is it's a particularly nasty fracture because the one and only archery for your thumb goes through the waist of scaphoid right there. So, if you do that and you accidentally sever that archery, your thumb dies. And that is why, even if we cannot see that fracture, because it is very difficult to pick up, this is a very, very clear one, but they're not always that clear. You will be treated clinically as though you have it. And then in six to eight weeks, when the bone has started to heal itself, we'll X-ray you again. And the ossification creates like a ground glass sort of look outside of it. And so we can go, okay, yes, no, you did have a scaphoid fracture, but sometimes you can't see it even then and they'll send you for an MRI. And in the MRI, you will see it. So, even if they don't see the fracture, sometimes they treat it as though it is. But it's only if the outcome otherwise is quite drastic. Now this is my favourite. What am I looking at? Pelvis, now hands up. What's wrong? Okay, so only one of those cracks is not normal. So, there is always going to be a gap of the pubic between the two pubic ramai at the bottom. Not that big though. So, this is what we call an open book fracture. It is normally trauma. It can also be childbirth though, ladies. So, this is where the pelvis has essentially splayed. And it is another really nasty injury and what they will do is they will immobilise the pelvis. I don't know if you've ever seen one of those and if you haven't and fancy a giggle, I would definitely suggest googling it. They're not fun at all. They're incredibly difficult to sort out and I have been told very painful. So, if you didn't know what you were looking at though, it'd be very easy to miss. And this is why A&A doctors miss it. Here are where some warnings come in. So, not all of these are PG. We good with that? Yeah, cool. Right, some of them do have kids in, but not the not PG ones, all right? There are lines I'll not cross. So, what I want to know for these ones, and again we can do hands up and whoever's first hands up I'll pick, is I just want to know what the foreign body is. Glows, but no. A what? No, think something more wearable. Yeah, an earring. Just in case you couldn't tell. So, this is an infant. This has swallowed parents' earring and it has got stuck and so it is partway between the larynx and pharynx. It is sort of part obstructing the airway, part obstructing the esophagus. And I'm going to be honest with you for that one, they will have probably gone in with a scope and pulled it out that way because you don't want to be fishing your fingers down at a child's throat. You don't know what you're going to damage and you're more likely of pushing it further in. So they'll just knock them out, put a scope down, bring it back. Hands up, what is it? No. No. I'll make it a bit nicer for you. What is it? See the shoe? Yes, this person will have been x-rayed with the shoe on because we're not taking the shoe off. Just in case. And this is why you always do two pictures in x-ray. Because from the top down, you don't see the full picture and from the side, you don't see that it's not. It's gone between the bones. So that's why you do two. All right, okay. I feel like I really must have a warning on this one. If you feel like you do have to leave, just walk out, don't tell me. Okay? We good? Let's go shoe, it is a shoe. Now this is actually a really interesting case because they went to theatre, they pulled it out and the chap kept his eyesight. And that is because eyes are very squishy and bouncy. But I wouldn't recommend trying it. It's not a battery, thank fuck. Bit smaller, think smaller. Not a magnet either, again, thank fuck. A coin, yeah, it is a coin. Now we, I'm not gonna say we like coins because this has appeared, this is a kid again. Not gonna say we like seeing coins on x-rays, but we like them a hell of a lot more than seeing batteries. Now, I don't know if any of you saw in the papers, I can't remember if it was last year or the year before, there was a young child that died from swallowing coin batteries, button batteries. They are nasty. And I can say, if any of you, again, if you've got kids, keep them away from magnets and batteries because even if you think they are old enough to not swallow them, they're not old enough to know better until they're about 25. Some of them I'd say 30. So I have seen myself, I have seen neodynium magnets that have attached the gut together, essentially, because they've gone round at separate points and when they have come close to each other again, that took surgery and also a section of the gut removed because it did also kill off all that section. So it is really, really, really, really important that if you've got kids and you've got batteries, you keep them separate. Nice one. It is in the stomach. I have seen them go past the stomach and I really don't know how the body does it. And this is a singular one. The most I saw was a patient with 12 forks. 12 forks all the way around, it had got past and it was in the small intestine and I still to this day do not know how that worked. But it again took surgery to get them out. All right. So we sort of understand what we're doing now, yeah? Yeah? To wing it that way. It is, and it's a bloke just in case you were wondering. And in case you couldn't see it. I know a really, really, really interesting thing about gut motility. When you get scared, it goes in reverse. And once again, I have seen myself, someone who had a deal that not quite as big as this, I must admit, but it had gone through sigmoid colon, through descending, through transverse and was down the other side. Yeah. Because they had waited until the next day to come in and had been scared shitless the entire time. Literally scared shitless, yeah. So if you do accidentally get something up your ass, please just come straight away because we do not want to be having to fish it out from the other side. Now this one I really like. Hands up when you see it. Again, amazing, really. And yeah, that is rectal as well. This one, it's not. Now I would hazard a guess that this one is actually an incidental. I know all of the others are incidental, but out of all of them I would say this one is most likely to be incidental. And there is more than just the clear white metal bit. You have to really look to see the rest of it. I'll circle it because these are not particularly good screens. It's a catheter, it is. So I would assume that this is someone who self-categorises, who's just in some way accidentally lost the end. And it is not rectal, it is in the bladder. And unfortunately this would also be another surgery trip to receive because they are not sending something up the urethra to try and fish it back. Do we know? It is. Well if it tastes like shit possibly. Exactly. Right then. Last one, this is my last one. I have time this actually, far better than I anticipated. Light bulb. Yeah, now then. If you are planning on putting anything inside you that is not something that's supposed to be there, please for the love of God, don't make it glass. Like, don't do this. Because trying to get this out is an absolute nightmare, right? And if it breaks, you're going to get glass splinters all up inside you and there is no way on earth that we're going to get them all out. So just make it rubber, make it silicone, I don't care, just not glass. So, the sun may not shine out of his ass. He was trying to create a techie alternative. Don't. And this, for people not in the UK, this is going to be slightly different. I don't know how other countries do it. But for us, if you have done yourself a stupid and got some pictures, you can get them, they are yours. All right? Hospitals tend to be quite sometimes arsy about it, but it is yours. You are allowed them and it's a freedom of access request to get your medical records. Depending on if they are digital or on file and normally nowadays it's digital, it is a fee and it's the fee to access them. It's not you paying for your pictures, if that makes sense. So, you go either, if you're there, when you're there, that is the best time to ask because they can get you the form, whatever it is, there and then. Otherwise, just send an email to their info, whatever email, and they will bounce you around for four weeks and then you'll find out where to do it. Viewing pictures, if it is an x-ray, generally it is just a JPEG, a PNG, something like that, nice and easy. If it is a CT, an MRI, ultrasound, anything else that is DICOM, then you'll need a DICOM viewer. Fortunately, there are loads and loads of free ones available online, depending if it's Linux, if it's Windows, if it's Mac. If you don't want to download anything at all and you want to have it in your browser, there is a browser one as well. So, it is really, really simple to get the software to look at your pictures. It is a lot harder to read them. But, you know, just for intrigue, and in fact, I do know there are some people that got their brain MRIs and were able to 3D print them. So, things like that, really fun, you can do modelling with them. And what I will say is I'll do Q&A and all that jazz, but outside the tent. So, that was a very quick little romp into X-ray. We generally, most of our job is horrendous, particularly mine, ideal in oncology, but you've got to have a laugh about it somehow. So, please, if you do hear the radiographers snickering in the background, pretend we're not, we're having a bad time and we need a laugh and if someone's done something stupid, I think we're allowed to. All right, that's me done, thank you.