Mild fecal loading throughout the colon, predominantly in the sigmoid colon and rectum. No dilated bowel loops. No pneumoperitoneum. Nonobstructive bowel gas pattern.

Moderate fecal loading throughout the large bowel with distension of the sigmoid colon and rectum. No small bowel dilatation. No pneumoperitoneum. Nonobstructive pattern without features of large bowel obstruction.

Severe fecal impaction with marked distension of the colon, most pronounced in the sigmoid colon and rectum. No pneumoperitoneum or small bowel dilatation. Clinical correlation recommended to exclude obstructive aetiology.

Radioopaque calculus in the region of the [right / left] kidney / ureter at [location]. Correlation with CT KUB recommended for characterisation.

Multiple [renal / vesical] calcifications noted. Urological referral.

Multiple radioopaque calcifications projecting over the right upper quadrant in the gallbladder fossa, consistent with gallstones.

Vascular calcification along the course of the aorta and iliac vessels, consistent with atherosclerosis. No abnormal soft tissue mass.

Punctate calcifications in the epigastric region along the expected course of the pancreas, consistent with chronic pancreatitis.

Mild fecal loading throughout the colon, predominantly in the sigmoid colon and rectum. No dilated bowel loops or pneumoperitoneum. Nonobstructive bowel gas pattern.

Moderate fecal loading throughout the large bowel with distension of the sigmoid colon and rectum. No small bowel dilatation or pneumoperitoneum. Nonobstructive pattern without features of large bowel obstruction.

Severe fecal impaction with marked distension of the colon, most pronounced in the sigmoid colon and rectum. No pneumoperitoneum or small bowel dilatation. Clinical correlation recommended to exclude obstructive aetiology.

Free subdiaphragmatic air identified under both hemidiaphragms, consistent with pneumoperitoneum. Urgent surgical consultation for suspected hollow viscus perforation.

Linear branching lucencies in the periphery of the liver consistent with portal venous gas. Implies mesenteric ischemia or bowel perforation. Emergent CT and surgical consultation.

Linear intramural gas within bowel wall segments, consistent with pneumatosis intestinalis. Suggests ischemia or infarction. Emergent CT abdomen and surgical review.

Diffuse dilatation of small and large bowel without a transition point, consistent with adynamic (paralytic) ileus. No pneumoperitoneum.

Normal bowel gas pattern. No dilated bowel loops, free air, or soft tissue masses. No abnormal calcification. Visible osseous structures unremarkable.

Non-specific bowel gas pattern without features of obstruction or perforation.

Multiple dilated small bowel loops up to [x] cm with central positioning, valvulae conniventes, and air-fluid levels consistent with small bowel obstruction. No free air. Surgical review.

Distended large bowel to [x] cm with haustra markings and a transition point at [hepatic / splenic flexure / sigmoid]. No free air. Urgent surgical review.

Massively dilated sigmoid colon with inverted U-shape and "coffee bean" sign with the apex at the right upper quadrant, consistent with sigmoid volvulus. Urgent surgical consultation.

Markedly dilated caecum in ectopic position in the [left upper quadrant / mid-abdomen], consistent with caecal volvulus. Urgent surgical management.

Marked dilatation of the transverse colon ([x] cm) with mucosal irregularity and loss of haustra, consistent with toxic megacolon. Emergent surgical consultation.

Right knee arthroplasty is noted with prosthetic components in expected alignment without complication.

Left knee arthroplasty is present with components in appropriate position.

Right hip arthroplasty is seen with femoral and acetabular components in expected alignment.

Left hip arthroplasty is present with satisfactory positioning of components.

Findings are consistent with aspiration pneumonitis, showing dependent patchy airspace opacities, more pronounced in the lower lobes.

There is a large right-sided pleural effusion with homogeneous opacity and contralateral mediastinal shift.

Right-sided tension pneumothorax is present with complete lung collapse, absent peripheral lung markings, and leftward mediastinal shift.

Multiple rib fractures are identified with cortical discontinuities and step deformities involving the affected ribs.

Clavicular fracture is seen with cortical break and displacement along the clavicular shaft.

Bibasilar atelectasis is seen as linear to wedge-shaped opacities in both lower lung zones with volume loss.

Left basilar atelectasis is present with a band-like opacity in the left lower zone and mild ipsilateral volume loss.

Mild to moderate COPD changes are seen with hyperinflated lungs, flattened diaphragms, and increased retrosternal lucency.

Moderate to severe COPD is present with marked hyperinflation, attenuated vascular markings, and diaphragmatic flattening.

COPD with acute exacerbation is suggested by underlying hyperinflation with superimposed peribronchial thickening and patchy increased opacities.

Emphysematous changes are noted with hyperlucent lungs, reduced vascular markings, and increased lung volumes.

Median sternotomy wires are present in expected midline position without complication.

Left-sided external cardiac pacemaker is noted with leads projecting over the cardiac silhouette.

A small intracardiac pacing device without visible transvenous leads is seen projecting over the right ventricle, compatible with a leadless pacemaker.

Implantable loop recorder is noted projecting over the left anterior chest wall.

Left atrial appendage closure device is visualized projecting over the expected location of the left atrial appendage.

Left ventricular assist device components are visualized projecting over the cardiac silhouette with expected positioning.

Preterm neonatal chest demonstrates bilateral diffuse ground-glass opacities with partial obscuration of cardiac and diaphragmatic borders, consistent with surfactant deficiency.

Postoperative day 0 status post CABG with expected median sternotomy wires, mediastinal drains, and chest tubes in situ without immediate complication.

Mild pulmonary oedema is present with subtle bilateral perihilar haziness and vascular indistinctness without overt alveolar consolidation.

Moderate pulmonary oedema is noted with bilateral perihilar and lower zone airspace opacities, vascular congestion, and early interstitial thickening.

Severe pulmonary oedema is seen with diffuse bilateral alveolar opacities in a perihilar bat-wing distribution with near-complete obscuration of cardiac and diaphragmatic borders.

Findings are consistent with ARDS, demonstrating diffuse bilateral ground-glass to consolidative opacities with reduced lung volumes and no cardiomegaly.

Mixed interstitial and alveolar oedema pattern is present with coexisting reticular opacities and patchy airspace consolidation.

Normal cervical vertebral alignment in neutral position. Disc spaces and posterior elements intact. Prevertebral soft tissues normal. No fracture or subluxation.

Multilevel disc space narrowing, osteophyte formation, and end-plate sclerosis consistent with cervical spondylosis, most marked at [C5–6 / C6–7]. No acute fracture.

Multilevel cervical spondylosis with uncovertebral joint hypertrophy and foraminal narrowing at [C5–6 / C6–7]. No acute fracture or subluxation.

No acute fracture or subluxation identified. Alignment maintained in neutral position. Prevertebral soft tissues unremarkable. Adequate 7-level cervical spine visualised.

Limited cervical spine views obtained. C7–T1 junction not fully visualised on this study. CT cervical spine recommended for complete assessment if high clinical suspicion for injury.

Widened atlantodental interval (>3 mm in adult, >5 mm in child) on lateral flexion view, consistent with atlantoaxial subluxation. Urgent CT and neurosurgical evaluation.

Two views of the chest radiograph are obtained. The lungs are clear bilaterally. No focal consolidation, pleural effusion, or pneumothorax. Cardiomediastinal silhouette within normal limits. Bony thorax intact.

Lungs clear bilaterally. No consolidation, effusion, or pneumothorax. Cardiomediastinal contour stable. All devices in satisfactory position.

Homogeneous airspace consolidation in the [right middle / left lower] lobe with air bronchograms, consistent with lobar pneumonia. No pleural effusion or cavitation.

Patchy peribronchial and subsegmental airspace opacities, consistent with bronchopneumonia. No cavitation or significant effusion.

Dense consolidation in [right lower lobe] with adjacent small pleural effusion, compatible with bacterial pneumonia with parapneumonic effusion.

Bilateral basal airspace opacification, right greater than left, in the dependent lower lobe segments. Consistent with aspiration pneumonitis. A superimposed aspiration pneumonia cannot be excluded.

Mild hyperinflation with subtle flattening of the hemidiaphragms and mildly increased anteroposterior thoracic diameter, consistent with early chronic obstructive pulmonary disease. No acute superimposed process.

Moderate hyperinflation with flattened hemidiaphragms and increased anteroposterior diameter consistent with COPD. Increased peribronchial markings. No acute consolidation, effusion, or pneumothorax.

Severe hyperinflation with markedly flattened hemidiaphragms, increased AP diameter, and attenuated peripheral vascular markings. The cardiac silhouette is narrow and vertical. No acute superimposed process identified.

Bilateral perihilar ground-glass opacities with interlobular septal thickening and peribronchial cuffing, consistent with cardiogenic pulmonary edema. Cardiothoracic ratio increased. Small bilateral pleural effusions.

Cardiothoracic ratio exceeds 50%, consistent with cardiomegaly. Upper-lobe vascular redistribution and mild interstitial prominence. No alveolar edema.

Interval decrease in vascular congestion and perihilar opacities compared to prior study dated [date], consistent with resolving pulmonary edema.

Small [right-sided] pleural effusion with blunting of the costophrenic angle. No mediastinal shift.

Moderate [left-sided] pleural effusion with compressive lower-lobe atelectasis. No contralateral shift.

[Right]-sided pneumothorax with [2 cm] pleural separation at apex. No mediastinal shift or tension features.

Large [left]-sided pneumothorax with mediastinal shift to the right and depression of the ipsilateral hemidiaphragm. Consistent with tension pneumothorax. Urgent clinical attention required.

Mild hyperinflation with subtle flattening of the hemidiaphragms and mildly increased anteroposterior thoracic diameter, consistent with early chronic obstructive pulmonary disease. No acute superimposed pulmonary process.

Moderate hyperinflation with flattened hemidiaphragms and increased anteroposterior thoracic diameter consistent with COPD. Increased peribronchial markings. No acute consolidation, effusion, or pneumothorax.

Severe hyperinflation with markedly flattened hemidiaphragms, increased AP thoracic diameter, and attenuated peripheral vascular markings consistent with advanced COPD. The cardiac silhouette is narrow and vertical. No acute superimposed pulmonary process.

Background emphysematous changes with new bilateral peribronchial opacities and increased interstitial markings superimposed, suggesting acute exacerbation of COPD. No lobar consolidation or pneumothorax.

Bilateral apical bullae with thin walls. No pneumothorax on this study. Background emphysematous changes.

Cardiothoracic ratio exceeds 50%, consistent with cardiomegaly. No vascular congestion or effusion.

Mild cardiomegaly with upper lobe vascular redistribution and mild perihilar haze. Consistent with early cardiac failure. No frank alveolar edema or significant effusion.

Cardiomegaly with bilateral perihilar bat-wing opacities, Kerley B lines, and bilateral small pleural effusions. Consistent with moderate cardiogenic pulmonary edema.

Severe cardiomegaly with extensive bilateral alveolar opacification in a perihilar and basal distribution with bilateral pleural effusions and Kerley B lines. Consistent with severe cardiogenic pulmonary edema.

Interval decrease in vascular congestion and perihilar opacities compared to prior study dated [date], consistent with resolving pulmonary edema.

Enlarged cardiac silhouette with redistribution of blood flow to upper lobes, peribronchial cuffing, and bilateral interstitial opacities. Left heart failure pattern.

Bilateral diffuse alveolar opacification without cardiomegaly or Kerley lines. In the appropriate clinical context, consistent with ARDS or non-cardiogenic pulmonary edema.

Mild pulmonary edema is present with subtle bilateral perihilar haziness.

Moderate pulmonary edema is noted with bilateral perihilar airspace opacities.

Severe pulmonary edema is seen with diffuse alveolar opacities.

Findings are consistent with ARDS with diffuse bilateral ground-glass opacities.

Endotracheal tube tip [3 cm] above the carina, midline; satisfactory position. No barotrauma.

Endotracheal tube tip approaches the carina; recommend withdrawal by approximately [2 cm].

Right IJ central line with tip at the cavoatrial junction. No pneumothorax post-insertion.

NG tube courses below the diaphragm with tip and side-hole in the stomach; satisfactory position.

Chest tube in the pleural space with side-holes intrathoracic; satisfactory position for drainage.

Dual-lead pacemaker with right atrial and right ventricular leads in expected positions. Generator in stable subclavicular position. No pneumothorax or lead fracture.

An external cardiac pacing device is present. Pacing leads/electrodes overlie the [anterior chest wall / cardiac silhouette]. No pneumothorax. This represents a temporary/transcutaneous configuration; clinical correlation with device status is recommended.

A pacemaker generator is present in the [left / right] [infraclavicular / pectoral] region without identifiable intracardiac leads. Consistent with lead-free/leadless device configuration or prior lead extraction. Clinical correlation with device records is recommended.

ETT tip [3 cm] above carina; NG tube below diaphragm; right IJ CVC tip at cavoatrial junction; left chest tube intrapleural. All lines, tubes, and devices in satisfactory position. No device-related complication.

Endotracheal tube tip [3 cm] above the carina, midline; satisfactory position. No barotrauma.

Endotracheal tube tip approaches the carina; recommend withdrawal by approximately [2 cm].

Endotracheal tube tip in the right main bronchus with resultant left lung atelectasis. Tube should be withdrawn by approximately [3 cm].

NG tube courses below the diaphragm with tip and side-hole in the stomach; satisfactory position.

NG tube tip does not cross the diaphragm. Position is unsatisfactory; repositioning required before tube feeding.

Right IJ central venous catheter tip at the cavoatrial junction. No pneumothorax post-insertion.

Left subclavian central venous catheter tip in the distal SVC at the cavoatrial junction. No pneumothorax.

Central venous catheter tip in the proximal SVC/internal jugular junction. Recommend advancing to cavoatrial junction.

Chest tube in the pleural space with side-holes intrathoracic; satisfactory position for drainage.

Chest tube appears kinked at the chest wall entry site; may impede drainage. Clinical review recommended.

Dual-lead pacemaker with right atrial and right ventricular leads in expected positions. Generator in stable subclavicular position. No pneumothorax or lead fracture.

Single-lead pacemaker with right ventricular lead in expected position. Generator in stable [left / right] subclavicular position. No pneumothorax.

An external cardiac pacing device is present. Pacing leads/electrodes overlie the [anterior chest wall / cardiac silhouette]. No pneumothorax. Temporary/transcutaneous pacing configuration; clinical correlation with device status recommended.

A pacemaker generator is present in the [left / right] [infraclavicular / pectoral] region without identifiable intracardiac leads. Consistent with lead-free/leadless device configuration or prior lead extraction. Clinical correlation with device records recommended.

PICC line via the [right / left] arm with tip at the cavoatrial junction. Satisfactory position.

Tracheostomy tube in situ with tip [x] cm above the carina; satisfactory position. No subcutaneous emphysema.

ETT tip [3 cm] above carina; NG tube below diaphragm; right IJ CVC tip at cavoatrial junction; left chest tube intrapleural. All lines, tubes, and devices in satisfactory position. No device-related complication.

Intra-aortic balloon pump tip at the level of the aortic knuckle, 2 cm below the left subclavian origin; satisfactory position.

Left ventricular assist device (LVAD) in situ with outflow graft in expected position. No pneumothorax or mediastinal widening.

Homogeneous airspace consolidation with air bronchograms involving the [right middle / left lower] lobe, consistent with lobar pneumonia. No pleural effusion or cavitation.

Increased density in the right lower lobe with obscuration of the right hemidiaphragm (silhouette sign positive). Consistent with right lower lobe pneumonia. No effusion.

Retrocardiac airspace density in the left lower lobe with positive silhouette sign at the left heart border. Consistent with left lower lobe consolidation/pneumonia.

Loss of right heart border and increased density in the right middle lobe region consistent with right middle lobe pneumonia.

Patchy peribronchial and subsegmental airspace opacities bilaterally, consistent with bronchopneumonia. No cavitation or pleural effusion.

Consolidation in the [right / left] lower lobe with adjacent pleural effusion, compatible with bacterial pneumonia with parapneumonic effusion.

Bilateral basal airspace opacification, right greater than left, in the dependent lower lobe segments. Consistent with aspiration pneumonitis. A superimposed aspiration pneumonia cannot be excluded.

Airspace opacity in the right lower lobe in a dependent aspirate distribution, consistent with aspiration pneumonitis/pneumonia.

Thick-walled cavitary lesion in the [right upper / left upper] lobe with internal lucency. Differential includes lung abscess, cavitary tuberculosis, and cavitating neoplasm. CT chest recommended for further characterization.

Small nodular opacity in the right mid-zone with ipsilateral hilar lymphadenopathy, consistent with a Ghon complex. Correlation with clinical and microbiological findings.

Innumerable 1–3 mm nodular opacities distributed uniformly throughout both lungs, consistent with miliary tuberculosis or other miliary dissemination. Urgent clinical correlation and infectious disease consultation.

Bilateral peripheral and basal predominant ground-glass and consolidative opacities. In the clinical context of COVID-19 infection, these findings are consistent with COVID-19 pneumonia.

Mediastinal widening up to [x] cm at the level of the aortic knuckle. CT chest/angiography recommended to exclude aortic pathology or mediastinal mass.

Bilateral symmetric hilar lymphadenopathy without associated consolidation. Differential includes sarcoidosis, lymphoma, and infection. CT chest recommended for further evaluation.

Irregular opacity in the [right upper / left upper / right lower] lobe, [x] cm, without prior imaging for comparison. Suspicious for primary bronchogenic malignancy. Urgent CT chest recommended.

Solitary pulmonary nodule in the [right / left] [upper / lower] lobe, [x] cm. CT chest recommended for characterisation and comparison with prior imaging; follow-up per Fleischner Society guidelines.

Elevated [right / left] hemidiaphragm. Differential includes subphrenic pathology, diaphragmatic palsy, or adjacent pulmonary collapse. Clinical correlation and further evaluation as appropriate.

Subcutaneous emphysema in the [cervical / thoracic] region and chest wall. Associated pneumomediastinum noted. Correlate for barotrauma or tracheobronchial injury.

Two views of the chest radiograph are obtained. The lungs are clear bilaterally. No focal consolidation, pleural effusion, or pneumothorax. Cardiomediastinal silhouette within normal limits. Cardiothoracic ratio within normal limits. Bony thorax intact.

Single view chest radiograph obtained. Lungs clear. No consolidation, effusion, or pneumothorax. Cardiomediastinal contour normal.

AP portable radiograph obtained. Technical limitations of supine AP projection noted. Lungs clear. No consolidation, effusion, or pneumothorax identified. Cardiomediastinal silhouette within expected limits for AP projection.

Technically adequate study. Adequate inspiration and exposure. No rotation.

Small right pleural effusion with blunting of the right costophrenic angle. No mediastinal shift.

Small left pleural effusion with blunting of the left costophrenic angle. No mediastinal shift.

Moderate [left / right] pleural effusion with compressive lower-lobe atelectasis. No contralateral mediastinal shift.

Large [left / right] pleural effusion with near-complete opacification of the hemithorax and contralateral mediastinal shift.

Bilateral pleural effusions with blunting of both costophrenic angles, [left / right] greater. No significant mediastinal shift.

Loculated pleural collection with lenticular opacity along the [right / left] lateral chest wall. CT chest for further characterisation and drainage planning.

Bilateral/unilateral apical pleural thickening. No pleural effusion. Correlate with clinical history for prior infection or asbestos exposure.

Bilateral calcified pleural plaques along the diaphragmatic and lateral chest wall pleural surfaces, consistent with prior asbestos exposure.

Small [right / left]-sided pneumothorax with [1–2 cm] pleural separation at the apex. No mediastinal shift or tension features.

Moderate [right / left]-sided pneumothorax with [x] cm pleural separation and partial lung collapse. No mediastinal shift.

Large [left / right]-sided pneumothorax with complete lung collapse, contralateral mediastinal shift, and ipsilateral hemidiaphragm depression, consistent with tension pneumothorax. Urgent needle decompression required.

Residual small [right / left]-sided pneumothorax following chest drain insertion. Lung expanded to [x]%. Drain in situ.

Fractures of the [left / right] [posterior / lateral / anterior] ribs [#–#] with [minimal / moderate] displacement. No pneumothorax or hemothorax on this study. Analgesia and respiratory physiotherapy.

Multiple consecutive rib fractures ([ribs #]) on the [left / right] creating a flail segment. Associated pulmonary contusion. ICU-level monitoring.

Fracture of the [right / left] clavicle [medial / midshaft / lateral third] with [minimal / significant] displacement. No pneumothorax.

Fracture of the [manubrium / sternal body] with minimal displacement. No pneumomediastinum. Correlate for cardiac contusion.

Anterior wedge deformity of [T#] vertebral body, likely representing a compression fracture. Lateral thoracic spine or CT for further assessment.

Lytic lesion in the [right / left] [rib #] with cortical destruction. Suspicious for metastatic disease or myeloma. CT chest and oncology review.

Flowing ossification along the anterolateral aspect of at least four contiguous vertebral bodies (right side of thoracic spine), with preserved disc height and absence of apophyseal joint ankylosis or sacroiliac joint erosion. Consistent with diffuse idiopathic skeletal hyperostosis (DISH / Forestier disease). Resnick criteria met.

Large flowing ossification bridging vertebral bodies T5 through T10 anterolaterally, candle-wax pattern. Disc spaces preserved. No facet joint erosion. DISH pattern (Resnick criteria: ≥4 contiguous levels, disc height preserved, no apophyseal/SI ankylosis). Dysphagia assessment if cervical involvement.

Calcification of the [knee menisci / triangular fibrocartilage / pubic symphysis / hip labrum], consistent with calcium pyrophosphate deposition (CPPD / chondrocalcinosis). Correlate with serum calcium, magnesium, and ferritin. Rheumatology correlation if symptomatic.

Dense homogeneous / fluffy calcification within the [supraspinatus / gluteus medius / infraspinatus] tendon, consistent with hydroxyapatite deposition disease (HADD). Ultrasound-guided barbotage / aspiration if symptomatic.

Expansion and coarsening of bony trabeculae with mixed lytic and sclerotic areas in the [pelvis / femur / skull / tibia], consistent with Paget's disease of bone. Cotton-wool skull pattern / blade of grass lytic front / picture frame vertebra / brim sign pelvis as applicable. Alkaline phosphatase and bone scan recommended.

Paget's disease of bone features: Lytic phase: osteoporosis circumscripta (skull) / blade of grass lysis Mixed phase: coarse trabecular thickening, bone expansion, cortical thickening Sclerotic phase: ivory vertebra / cotton-wool skull Current stage: [lytic / mixed / sclerotic]. Complications: pathological fracture, spinal stenosis, high-output cardiac failure, sarcomatous change (rare — soft tissue mass raises concern). Bisphosphonate therapy and orthopaedic review.

Aggressive cortical destruction with periosteal reaction and soft tissue mass arising within known pagetic bone, raising concern for Paget sarcoma (osteosarcoma). Urgent MRI and oncology referral. Biopsy required for tissue diagnosis.

Subchondral lucency with overlying articular flattening in the medial femoral condyle of an osteoporotic knee, consistent with subchondral insufficiency fracture (SIFK). MRI recommended for full assessment. Non-weight-bearing; orthopaedic review.

Crescent sign / subchondral fracture with articular surface collapse and secondary degenerative change in the [right / left] femoral head, consistent with advanced osteonecrosis (Steinberg stage IV–V). Orthopaedic review for arthroplasty planning.

Fracture through the [subcapital / transcervical / basicervical] femoral neck. Garden classification: I — incomplete / valgus-impacted (trabecular pattern intact) II — complete, non-displaced (trabecular malalignment) III — complete, partial displacement IV — complete, full displacement Current fracture: Garden [I / II / III / IV]. Undisplaced (I–II): percutaneous fixation. Displaced (III–IV): hemiarthroplasty or THR per age and physiological status. Urgent orthopaedic review.

Fracture extending between the greater and lesser trochanters. AO/OTA classification 31-A: A1 — simple two-part, stable medial buttress intact A2 — multifragmentary, posteromedial comminution A3 — reverse oblique / transverse, unstable Current fracture: AO [A1 / A2 / A3]. Dynamic hip screw (A1/A2) or proximal femoral nail (A2/A3 unstable). Urgent orthopaedic review.

Fracture at the subtrochanteric level with [minimal / significant] displacement and medial comminution. In the osteoporotic skeleton, atypical femoral fracture morphology should be considered (transverse, medial spike, cortical thickening). Long intramedullary nail preferred. Bisphosphonate history should be reviewed.

Transverse or short oblique fracture of the subtrochanteric / diaphyseal femur with lateral cortical beaking, medial spike, and bilateral cortical thickening. Consistent with atypical femoral fracture (ASBMR task force criteria). Bisphosphonate therapy should be reviewed and suspended. Contralateral femur radiograph recommended. Intramedullary nail fixation.

Generalised reduction in bone mineral density with cortical thinning and accentuation of primary trabeculae. Appearances consistent with osteopenia (WHO T-score between −1.0 and −2.5). DXA scan recommended for formal quantification.

Marked generalised reduction in bone mineral density with pencil-thin cortices and prominent vertical trabecular striations. Appearances consistent with osteoporosis (WHO T-score < −2.5). DXA scan, falls risk assessment, and bone protection therapy recommended.

Anterior wedge / biconcave / crush deformity of the [T/L#] vertebral body. Genant semi-quantitative grading: Grade 1 (mild): 20–25% height loss Grade 2 (moderate): 25–40% height loss Grade 3 (severe): >40% height loss Current fracture graded [1 / 2 / 3]. No posterior element involvement or significant retropulsion. MRI for marrow signal if acute vs chronic uncertain.

Multiple vertebral body deformities at [T6, T8, T12, L1] with anterior wedging and height loss, consistent with osteoporotic compression fractures of varying ages. Genant grades [1–3] as detailed. Thoracic kyphosis accentuated. Bone protection therapy and falls risk assessment recommended.

Biconcave vertebral body deformities throughout the thoracic and lumbar spine with ballooning of intervertebral discs, producing the classic codfish appearance of osteoporosis. No acute fracture identified.

Subtle sclerotic vertical bands through the sacral alae bilaterally, consistent with sacral insufficiency fractures. H-pattern (Honda sign) may be present on further imaging. MRI or bone scan recommended for confirmation. Orthopaedic and metabolic bone review.

Linear sclerosis through the [right / left / bilateral] superior and inferior pubic rami without significant displacement, consistent with pubic rami insufficiency fractures in the context of osteoporosis. No evidence of pathological fracture or pelvic ring disruption.

Subtle cortical irregularity / sclerotic band at the inferomedial femoral neck in an osteoporotic skeleton, suspicious for a femoral neck insufficiency fracture. MRI hip recommended for confirmation. Non-weight-bearing until MRI obtained.

Intramedullary nail is present with proximal and distal interlocking screws.

Dynamic hip screw construct is present with lag screw and side plate.

Locking compression plate is seen with fixed-angle screw construct.

External fixation device is present with pins and connecting rods.

Cephalomedullary nail is seen with femoral head screw fixation.

Posterior spinal fusion hardware is present with pedicle screws and rods.

Anterior cervical discectomy and fusion hardware is present with plate and interbody graft.

Interbody fusion cage is noted within the disc space.

Vertebroplasty changes are present with cement augmentation.

Spinal cord stimulator is seen with epidural leads and generator.

Anterior cervical discectomy and fusion (ACDF) at C__/__ with interbody cage and anterior plate; hardware intact and in expected position. Fusion progressing.

Transforaminal/posterior lumbar interbody fusion (TLIF/PLIF) at L__/__ with pedicle screws, rods, and interbody cage; no hardware failure. Bridging bone present.

Vertebroplasty/kyphoplasty at __ with polymethylmethacrylate (PMMA) cement fill; no significant cement extravasation. Vertebral height maintained.

Pedicle screw loosening at __ with lucent halo around screw; no acute hardware failure. Clinical correlation and orthopaedic spine review recommended.

Rheumatoid arthritis demonstrates symmetric joint space narrowing, marginal erosions, and periarticular osteopenia.

Advanced rheumatoid arthritis shows deformities and ulnar deviation.

Psoriatic arthritis demonstrates asymmetric erosions with pencil-in-cup deformities.

Gout shows punched-out erosions with overhanging edges and possible tophi.

CPPD demonstrates chondrocalcinosis involving the TFCC and radiocarpal joint.

Erosive osteoarthritis shows central erosions with gull-wing appearance.

Septic arthritis should be considered with rapid joint space loss and soft tissue swelling.

Bilateral sacroiliac joint changes. New York / modified New York grading: 0 — normal 1 — suspicious changes 2 — minimal: small erosions or sclerosis without joint space alteration 3 — moderate: erosions, sclerosis, joint space narrowing/widening, or partial ankylosis 4 — complete SI joint ankylosis (bilateral grade 3 or 4 = mNY criteria met) Current grade: bilateral [3 / 4]. Modified New York criteria met. Rheumatology review.

Bilateral symmetrical syndesmophytes bridging vertebral bodies throughout the thoracolumbar spine producing the classic bamboo spine appearance. Squared vertebral bodies (Romanus lesion sequelae) and trolley-track sign (posterior element ossification) noted. Bilateral sacroiliac joint ankylosis. Established ankylosing spondylitis.

Fine vertical syndesmophytes bridging [T10–L2] vertebral bodies, with squaring of vertebral bodies and Romanus lesion erosions at anterior vertebral corners. Early spondylitis changes. Bilateral mild SI joint sclerosis. Rheumatology review.

Transverse fracture through the fused / ankylosed thoracic / lumbar spine at [level]. In a completely ankylosed spine, even minor trauma produces unstable three-column injuries (chalk-stick fracture). High risk of cord injury. Urgent CT and MRI spine; spine surgical consultation. Handle with extreme care — spine board immobilisation.

Concentric bilateral hip joint space narrowing with periarticular osteopenia and axial femoral head migration, consistent with hip involvement in ankylosing spondylitis. No osteophytes (inflammatory pattern). Rheumatology and orthopaedic review.

Asymmetric joint involvement with well-defined punched-out erosions with sclerotic margins and overhanging edges (Martel's sign) at the [1st MTPJ / PIPJs / wrist]. Soft tissue tophi producing eccentric nodular densities adjacent to joints. Preserved joint space until late. Periarticular osteopenia minimal or absent. Consistent with chronic tophaceous gout. Rheumatology review and urate-lowering therapy.

Erosions with overhanging edge and soft tissue tophi at the 1st metatarsophalangeal joint. Preserved joint space. Consistent with chronic tophaceous gout (podagra distribution). Serum urate and rheumatology review.

Soft tissue density tophi within and around the [knee / elbow / wrist] joint with adjacent pressure erosions. Chronic tophaceous gout. No acute fracture. Rheumatology review.

Erosions and new bone formation at the DIP joints with periosteal reaction and pencil-in-cup deformity at [fingers]. Sausage digit (dactylitis) pattern. Asymmetric joint involvement without periarticular osteopenia. Consistent with psoriatic arthritis (CASPAR criteria require: psoriasis + one of: nail dystrophy, RF negativity, dactylitis, juxta-articular new bone). Rheumatology correlation.

Marked distal phalangeal erosion with cuplike proximal concavity and pencil-point tapering of the middle phalanx at [DIPJs], producing the classic pencil-in-cup deformity. Mutilans pattern psoriatic arthritis. Rheumatology review.

Fluffy periosteal new bone formation (whiskering) at the ischial tuberosities, iliac crests, calcanei, and patellar poles, consistent with enthesitis in psoriatic arthritis. Rheumatology review.

Asymmetric sacroiliitis with erosions, sclerosis, and joint space irregularity at the [right / left / bilateral asymmetric] sacroiliac joints. Asymmetric SI involvement favours psoriatic arthritis or reactive arthritis over ankylosing spondylitis (which is bilateral and symmetric). Rheumatology correlation.

Asymmetric lower limb oligoarthritis with periostitis of the calcaneus (fluffy posterior and inferior calcaneal spurs) and toe dactylitis. SI joint changes asymmetric. Pattern consistent with reactive arthritis (formerly Reiter syndrome). Rheumatology correlation with GU/GI infection history.

Fluffy / ill-defined calcaneal spur at the plantar fascial and Achilles insertion, consistent with enthesitis in inflammatory spondyloarthropathy. Contrast with well-defined benign plantar spur of degenerative aetiology. Rheumatology correlation.

Symmetrical periarticular osteopenia with soft tissue swelling, joint space narrowing, and marginal erosions at the [MCPJs / PIPJs / MTPs] bilaterally. Larsen grading: 0 — normal 1 — periarticular soft tissue swelling, osteopenia 2 — slight joint space narrowing, one small erosion 3 — marked erosions, joint space narrowing 4 — severe erosions, joint space <50% normal 5 — mutilating changes, joint destroyed Current grade: Larsen [0–5]. Rheumatology correlation.

Marginal erosions at [right 2nd MCP / left 3rd MCP / bilateral MTPs] with periarticular osteopenia and joint space narrowing. Modified Sharp/van der Heijde erosion score estimated [x] on this study. Comparison with prior films and rheumatology review for disease progression assessment.

Periarticular osteopenia and soft tissue swelling at the MCPJs and PIPJs bilaterally with preservation of joint spaces. No marginal erosions identified on this study. Findings consistent with early inflammatory arthropathy. Rheumatology correlation and MRI for erosion detection if clinically indicated.

Established rheumatoid arthritis changes: bilateral symmetrical periarticular osteopenia, marginal erosions at MCPJs and PIPJs, joint space narrowing, ulnar deviation at MCPJs, and boutonniere / swan-neck deformities at [fingers listed]. No acute fracture.

Widened atlantodental interval ([x] mm; normal <3 mm adult / <5 mm child) on lateral flexion cervical view, consistent with atlantoaxial subluxation secondary to rheumatoid pannus. MRI cervical spine to assess cord compression. Neurosurgical review if myelopathic symptoms.

Multilevel anterior subluxations at C3–4, C4–5, and C5–6 producing a stepladder appearance, consistent with rheumatoid cervical spine disease. MRI for cord assessment. Neurosurgical / spine surgical review.

Marginal erosions at bilateral 5th metatarsal heads and hallux MTP joints with periarticular osteopenia, fibular deviation of toes, and hallux valgus. Classic early RA forefoot changes. Rheumatology review.

Bilateral symmetrical axial migration of the femoral heads with concentric joint space narrowing, acetabular protrusion, and periarticular osteopenia. Consistent with rheumatoid hip involvement. No marginal osteophytes (contrasting with OA). Rheumatology and orthopaedic review.

Colles fracture is present as a distal radius fracture with dorsal angulation.

Smith fracture is seen as a distal radius fracture with volar angulation.

Monteggia fracture-dislocation is noted with proximal ulnar fracture and radial head dislocation.

Galeazzi fracture-dislocation is seen with distal radial fracture and DRUJ disruption.

Segond fracture is present as an avulsion of the lateral tibial plateau associated with ACL injury.

Maisonneuve fracture is seen as proximal fibular fracture with syndesmotic injury.

Normal lumbar vertebral alignment and height. Disc spaces maintained. No acute fracture, subluxation, or significant spondylolisthesis. Posterior elements intact.

Multilevel disc space narrowing, marginal osteophyte formation, and end-plate sclerosis consistent with lumbar spondylosis, most marked at [L4–5 / L5–S1]. No fracture.

Grade I anterior spondylolisthesis of [L4 on L5 / L5 on S1] with [x] mm anterior slip. Posterior element [intact / pars defects bilaterally]. Conservative management.

Grade II anterior spondylolisthesis of [L4 on L5] with [x] mm anterior slip ([x]% vertebral body width). Bilateral pars interarticularis defects. Spine surgical consultation.

Anterior wedge compression deformity of [L#] with approximately [x]% height loss. Posterior wall appears intact. Stable compression fracture. MRI recommended for marrow signal and further assessment.

Sclerosis and irregularity of the bilateral sacroiliac joints, consistent with sacroiliitis or degenerative change. MRI SI joints for further characterisation.

Lumbarization of S1 / Sacralization of L5 noted. Transitional lumbosacral anatomy. Numbering adjusted accordingly; correlation with whole-spine imaging for surgical planning.

Intravertebral disc herniation (Schmorl's nodes) at multiple thoracolumbar levels, consistent with degenerative disc disease. No acute fracture.

Post-[L4–5 / L3–S1] fusion with pedicle screw-rod construct. Hardware in satisfactory position. No hardware lucency, migration, or fracture. Stable post-operative appearances.

Normal ankle mortise alignment. No fracture or joint space narrowing. Soft tissues unremarkable.

Transverse fracture of the lateral malleolus below the level of the ankle mortise; medial side intact. Stable Weber A fracture. Conservative management.

Oblique fracture of the lateral malleolus at the level of the ankle mortise. Weber B fracture. No talar shift. Walking boot; operative fixation if unstable.

Fibula fracture above the level of the ankle mortise with possible syndesmotic disruption. Weber C fracture. ORIF and syndesmotic stabilisation.

Fractures of medial and lateral malleoli with [maintained / widened] ankle mortise. Bimalleolar fracture. ORIF.

Medial malleolar, lateral malleolar, and posterior malleolar fractures with posterior subluxation of the talus. Trimalleolar fracture. Surgical fixation.

Comminuted intra-articular calcaneal fracture with depression of the posterior facet and reduced Bohler's angle. CT for Sanders classification and surgical planning.

Transverse fracture at the metaphyseal-diaphyseal junction of the 5th metatarsal (Jones fracture zone). Non-weight-bearing immobilisation; surgical fixation in athletes.

Avulsion fracture at the base of the 5th metatarsal at the peroneus brevis insertion (dancer's fracture). Conservative management with buddy strapping/boot.

Subtle widening of the 1st–2nd intermetatarsal space and loss of alignment at the Lisfranc joint on weight-bearing views, suspicious for Lisfranc injury. CT/MRI for confirmation.

Post-traumatic ankle osteoarthritis with joint space narrowing, subchondral sclerosis, and osteophytes. Orthopaedic assessment for bracing or fusion.

Normal elbow alignment. No fracture or joint effusion (no anterior / posterior fat pad sign). Radial head-capitellum alignment maintained.

Raised anterior and posterior fat pads (sail sign), indicating a joint effusion. No visible fracture on this study. In the setting of trauma, an occult radial head fracture should be excluded; CT or clinical review.

Fracture through the [right / left] radial head with [minimal / significant] articular step-off. No posterior dislocation. Orthopaedic assessment.

Small cortical avulsion fracture at the lateral epicondyle of the distal humerus in this child, consistent with a lateral epicondyle avulsion. Orthopaedic assessment.

Medial epicondyle avulsion fracture with __ mm displacement; assess for incarceration within joint. Orthopaedic review.

Fracture through the neck of the 5th metacarpal with volar angulation [x°]. Boxer fracture. Neighbour strapping; reduction if angulation >40°.

Intra-articular fracture at the base of the first metacarpal with subluxation of the main metacarpal fragment. Bennett fracture. Orthopaedic referral for percutaneous fixation.

[Undisplaced / displaced] fracture through the [proximal / middle / distal] phalanx of the [x] digit, [right / left] hand. Neighbour strapping / buddy taping; orthopaedic review if displaced.

Dorsal dislocation of the DIP joint of the [x] digit. Reduction and splinting.

Normal joint space medially and laterally. No fracture, dislocation, or significant osteoarthritic change. No calcification.

Medial compartment joint space narrowing with osteophytes, subchondral sclerosis, and mild varus angulation. Medial compartment knee osteoarthritis. Conservative/surgical management depending on severity.

Tricompartmental joint space narrowing with marginal osteophytes and subchondral sclerosis. Advanced tricompartmental osteoarthritis. Orthopaedic referral for total knee arthroplasty consideration.

Fracture of the lateral tibial plateau with articular depression. CT for fracture characterisation and Schatzker classification. Orthopaedic referral.

Small avulsion fracture at the lateral tibial margin, consistent with a Segond fracture. Highly associated with ACL tear. MRI recommended.

Transverse fracture through the patella with [minimal / significant] distraction. Orthopaedic assessment for tension band wiring if displaced.

Total knee replacement with femoral and tibial components in satisfactory alignment. No periprosthetic lucency, fracture, or dislocation.

Calcification of the medial and lateral menisci consistent with chondrocalcinosis (calcium pyrophosphate deposition). Clinical correlation for CPPD arthropathy.

Irregular fragmentation of the tibial tuberosity apophysis in this adolescent, consistent with Osgood-Schlatter disease. Conservative management.

Total hip arthroplasty with acetabular cup inclination [x°] and femoral stem in satisfactory alignment. No periprosthetic lucency, fracture, or dislocation. Stable post-operative appearances.

Intramedullary nail in the [tibia / femur] with proximal and distal interlocking screws in satisfactory position. Fracture site [aligned / bridging callus forming]. Stable post-operative appearances.

Dynamic hip screw with compression plate along the lateral femur; lag screw in the femoral head in satisfactory position within the inferior-central quadrant. No cut-out or hardware failure.

Proximal femoral nail with cephalomedullary screw in satisfactory position. Fracture aligned. No hardware failure.

Lateral malleolar plate and screw fixation in satisfactory position. Ankle mortise restored. No hardware complication.

Posterior pedicle screw-rod construct from [L3–S1] in satisfactory position. No hardware fracture, migration, or lucency at screw-bone interface. Stable post-operative appearances.

Fracture adjacent to the [hip / knee] prosthesis at the [stem tip] level. Periprosthetic fracture. Revision orthopaedic surgery referral.

Lucency at the [acetabular cup / femoral stem / tibial plate] bone interface suggestive of hardware loosening. Orthopaedic review for revision.

Normal glenohumeral alignment. No fracture, dislocation, or significant osteoarthritic change. Acromioclavicular joint preserved.

Anterior dislocation of the [right / left] glenohumeral joint with the humeral head displaced anterior and inferior to the glenoid. No associated fracture on this view.

Anterior shoulder dislocation with impaction defect at the posterolateral humeral head, consistent with a Hill-Sachs deformity. Reduction; post-reduction views and MRI for labral assessment.

Fracture through the surgical neck of the [right / left] humerus with [minimal / significant] displacement. Two-part proximal humerus fracture. Orthopaedic evaluation.

Calcific deposit projected over the supraspinatus tendon insertion. Consistent with calcific tendinitis. Conservative management; ultrasound-guided needling if symptomatic.

Glenohumeral joint space narrowing with inferior osteophytes and subchondral sclerosis, consistent with glenohumeral osteoarthritis. Orthopaedic assessment.

Normal carpal alignment and radiocarpal joint space. No acute fracture.

Extra-articular distal radius fracture with dorsal angulation and impaction; intact ulnar styloid. Colles fracture. Closed reduction and cast immobilisation.

Volarly displaced distal radius fracture, extra-articular. Smith fracture. ORIF as indicated.

Linear scaphoid fracture at the waist on dedicated scaphoid views. Thumb spica immobilisation; orthopaedic follow-up.

No definite fracture visible on plain radiographs. In the setting of anatomical snuffbox tenderness, an occult scaphoid fracture cannot be excluded. MRI recommended for definitive assessment.

Disrupted carpal alignment with lunate volar dislocation (spilled teacup sign); capitate alignment disrupted. Urgent orthopaedic reduction.

Scapholunate advanced collapse (SLAC) wrist with radioscaphoid degeneration and increased scapholunate interval.

Dorsal intercalated segment instability (DISI) with dorsal tilt of the lunate; scapholunate angle increased (>60°).

Volar intercalated segment instability (VISI) with volar lunate tilt; lunotriquetral dissociation suspected.

Perilunate dislocation with dorsal displacement of the carpus relative to the lunate; lunate remains articulated with the radius. Urgent orthopaedic review.

Lytic lesion in the [proximal humerus / proximal femur / diaphysis] without significant cortical destruction. Consistent with myeloma deposit. Mirels score assessment for impending fracture risk recommended.

Lytic lesion in the [proximal femur / humerus / tibia]. Mirels score (each category 1–3): Site: upper limb (1) / lower limb (2) / peritrochanteric (3) Pain: mild (1) / moderate (2) / functional (3) Lesion: blastic (1) / mixed (2) / lytic (3) Size: <1/3 (1) / 1/3–2/3 (2) / >2/3 cortex (3) Total score [x]/12. Score ≥9 → prophylactic fixation recommended. Score ≤7 → radiotherapy. Score 8 → individualise. Orthopaedic oncology review.

Pathological fracture through a myeloma lytic deposit in the [proximal femur / humerus / tibia]. Urgent orthopaedic and haematology review. Intramedullary fixation preferred for long-bone pathological fractures to provide complete skeletal stabilisation.

Multiple well-defined non-sclerotic lytic lesions within the iliac wings, ischium, and pubic rami bilaterally, consistent with myeloma deposits. No pathological fracture. Haematology correlation.

Lytic lesion in the [ilium / acetabulum] with cortical breach, raising concern for impending pathological fracture. Orthopaedic and haematology review for prophylactic fixation consideration.

Multiple lytic lesions of varying sizes within the ribs bilaterally without sclerotic margin or periosteal reaction, consistent with myeloma deposits. No pathological rib fracture. Haematology review.

Pathological fracture through a lytic rib lesion at [rib #]. Haematology review; analgesia and respiratory physiotherapy. No pneumothorax.

Multiple well-defined, non-sclerotic, circular lytic lesions of varying sizes throughout the calvarium, consistent with myeloma deposits (rain-drop skull). No bevelled edge or periosteal reaction. Haematology correlation.

Generalised reduction in calvarial density without discrete lytic lesions. Ground-glass osteopenia pattern; diffuse marrow infiltration cannot be excluded on plain film alone. MRI spine/whole-body MRI for staging recommended.

No discrete lytic lesion identified in the calvarium on this lateral skull radiograph. Diffuse osteopenia may be present. Whole-body MRI for more sensitive staging recommended.

Compression fracture of [T/L#] with [x]% height loss (Genant grade [1/2/3]). T1 signal on MRI (if available) will help distinguish myelomatous from osteoporotic fracture. Multiple vertebral involvement increases suspicion for myeloma. Haematology and spine surgical review.

Generalised vertebral osteopenia with biconcave deformities throughout the thoracolumbar spine, consistent with diffuse myeloma marrow infiltration. No focal lytic lesion visible on plain film. Whole-body MRI recommended for staging (superior sensitivity to skeletal survey for spinal disease).

Severe collapse of [T#] with posterior wall involvement and encroachment on the spinal canal. Risk of cord compression in the context of myeloma. Urgent MRI spine and haematology/neurosurgical consultation.

Skeletal survey (skull, spine, pelvis, both humeri, both femora, ribs): Multiple well-defined non-sclerotic lytic lesions at [sites listed]. [x] vertebral compression fractures identified (Genant grades as above). No pathological long-bone fracture. Findings consistent with myeloma bone disease (IMWG bone lesion criteria met: ≥1 lytic lesion ≥5 mm on CT / skeletal survey). Haematology and multidisciplinary oncology review recommended.

Skeletal survey (skull, spine, pelvis, both humeri, both femora, ribs): No discrete lytic lesion identified on this plain film skeletal survey. Generalised osteopenia is present. Plain film sensitivity is limited; whole-body low-dose CT or whole-body MRI is recommended for staging (superior sensitivity per IMWG 2014 criteria).

Whole-body MRI (WBMRI) is the preferred modality for myeloma staging per IMWG 2014 guidelines (sensitivity superior to skeletal survey for spinal and axial disease, and for diffuse marrow infiltration). PET-CT is an alternative for extramedullary disease. Skeletal survey findings above are supplementary.

Radiological stages of fracture healing (approximate — overlapping, affected by age, nutrition, fracture site): 0–7 days: Acute — no periosteal reaction, sharp fracture margins 7–14 days: Early callus — periosteal reaction visible, soft callus 14–21 days: Soft callus — bridging callus, margins blurring 3–6 weeks: Hard callus — bridging, fracture line fading 6–12 weeks: Remodelling — fracture line gone, callus consolidating >3 months: Old — healed, remodelled Note: dating is inherently imprecise; ranges may be broadened in medicolegal reports.

Periosteal new bone formation along the [femoral / tibial / humeral] diaphysis without an acute fracture line, suggesting a healing subperiosteal haemorrhage from prior trauma. Dating: periosteal reaction visible from approximately 7–10 days post-injury. Correlate with clinical history and consider NAI if unexplained. Safeguarding referral if no accidental mechanism.

Transverse metaphyseal fracture with peripheral fragments at the [distal femur / proximal tibia / distal tibia], producing a corner fracture or bucket-handle appearance. Classic metaphyseal lesion (CML) — HIGH SPECIFICITY for non-accidental injury. Mechanism: torsion/traction forces applied to immature metaphyseal bone. Safeguarding referral mandatory. Skeletal survey and multidisciplinary child protection review required.

Fractures involving the posterior costovertebral junctions of ribs [#] bilaterally, consistent with posterior rib fractures. These are HIGH SPECIFICITY fractures for non-accidental injury, resulting from squeezing forces applied to the chest. Safeguarding referral and multidisciplinary child protection review mandatory. Skeletal survey, bone scan, and ophthalmology (for retinal haemorrhages) recommended.

Fracture through the body of the [right / left] scapula without a clear accidental mechanism. Scapular body fractures are HIGH SPECIFICITY for non-accidental injury in infants and young children. Safeguarding referral mandatory. Full skeletal survey required.

Fracture through the spinous process of [C/T/L#] in a child without clear accidental mechanism. Spinous process fractures are of HIGH SPECIFICITY for non-accidental injury. Safeguarding referral mandatory.

Fracture through the sternal body in this child without explanation for significant force. HIGH SPECIFICITY for non-accidental injury. Safeguarding referral and multidisciplinary review required.

Fractures in multiple sites at varying stages of healing — acute fractures (no callus) alongside healing fractures (periosteal new bone / soft callus / hard callus), indicating injuries at different time points inconsistent with a single accidental event. Moderate-to-high specificity for non-accidental injury when inconsistent with stated history. Safeguarding referral mandatory. Multidisciplinary child protection review.

Fractures of bilateral [femora / humeri / tibiae] without a plausible single accidental mechanism, at the same or different stages of healing. Moderate specificity for non-accidental injury. Safeguarding referral and skeletal survey required.

Spiral / oblique fracture of the [femoral / tibial / humeral] diaphysis in a [x]-month-old non-ambulant infant. In a non-ambulant child, diaphyseal spiral fractures have MODERATE SPECIFICITY for non-accidental injury (torsion mechanism requires a force not self-applied at this age). Correlate with stated history. Safeguarding referral if history inconsistent.

Fractures of anterior and lateral ribs [#]. Less specific than posterior rib fractures but still suspicious for inflicted injury in an infant. Safeguarding referral and multidisciplinary review recommended in the absence of a plausible accidental mechanism.

The combination of fracture type, distribution, and inconsistency with stated mechanism raises serious concern for non-accidental injury. This case has been / should be referred to the child protection team as per local safeguarding protocol. Radiological findings will be made available for the multidisciplinary review.

Skeletal survey performed per RCR / ACR NAI protocol: skull AP and lateral, chest AP, abdomen AP, spine lateral, pelvis AP, both upper limbs, both lower limbs, hands, feet. Findings: [as detailed above]. Follow-up skeletal survey at 11–14 days recommended (detects healing fractures not visible acutely). Multidisciplinary child protection team referral and radiology lead consultation mandatory.

Complex, branching or bilateral parietal skull fracture with associated subdural haematoma on CT, inconsistent with stated accidental mechanism. Skull fractures in NAI are typically wide, complex, bilateral, or involve the occipital bone (vs. simple linear parietal fractures from low-height falls). Safeguarding referral mandatory. Head CT and ophthalmology assessment.

Fracture involving the occipital bone in this infant. Occipital skull fractures in isolation or association with intracranial injury are suspicious for non-accidental injury in the absence of a clear high-energy accidental mechanism. Safeguarding referral and multidisciplinary child protection review.

Tibiotalar joint space narrowing with marginal osteophytes, subchondral sclerosis, and anterior tibial and talar spurring. Post-traumatic ankle OA following prior [fracture / ligamentous injury]. Orthosis / injection therapy; ankle arthrodesis or total ankle replacement if advanced.

1st MTP joint space narrowing with dorsal osteophyte formation (dorsal spur), subchondral sclerosis, and flattening of the metatarsal head. Hallux rigidus grading (Coughlin-Shurnas): 0 — normal / mild pain 1 — stiffness, loss of dorsiflexion, x-ray normal 2 — moderate: osteophytes, JSN <50% 3 — severe: JSN >50–75%, dorsal and periarticular osteophytes 4 — ankylosis Current grade: [1–4]. Chiropody / joint injection / cheilectomy / arthrodesis depending on grade.

Subtalar joint space narrowing at the posterior and middle facets with subchondral sclerosis and periarticular osteophytes, consistent with subtalar arthritis. Post-traumatic (calcaneal fracture / ligamentous) aetiology likely. Subtalar arthrodesis if refractory.

Reduced radiocapitellar and ulnohumeral joint spaces with osteophyte formation at the olecranon and coronoid tips, radial head enlargement, and loose body formation in the olecranon / coronoid fossa. Primary elbow osteoarthritis. Orthopaedic review for débridement or arthroplasty if advanced.

Radio-opaque loose bodies in the [anterior / posterior / both] compartments of the elbow, likely osteocartilagenous fragments in the context of degenerative disease. Orthopaedic review for arthroscopic removal if locking.

Degenerative changes are bilateral but asymmetric, worse on the [right / left]. [Right] knee: K-L grade [3–4]. [Left] knee: K-L grade [1–2]. Arthroplasty planning should prioritise the more severely affected side.

No significant interval change in the degenerative changes compared to prior study dated [date]. No acute fracture or new loose body identified.

[Degree: mild / moderate / severe] osteoarthritis of the [joint] (Kellgren-Lawrence grade [1–4]), characterised by joint space narrowing, marginal osteophytes, subchondral sclerosis, and [subchondral cysts / deformity if present]. Conservative management appropriate for grades 1–2; orthopaedic review recommended for grades 3–4 or functionally limiting disease.

Elderly degenerative osteoarthritis of the hand and wrist is present with joint space narrowing, marginal osteophyte formation, subchondral sclerosis, and cystic changes predominantly involving the distal interphalangeal and first carpometacarpal joints.

Findings are consistent with advanced degenerative osteoarthritis of the hand and wrist, demonstrating marked joint space loss, osteophytes, subchondral sclerosis, and deformity, most pronounced at the distal interphalangeal and first carpometacarpal joints.

Degenerative osteoarthritis of the hand is noted with predominant involvement of the distal and proximal interphalangeal joints, showing joint space narrowing and osteophyte formation with relative sparing of the metacarpophalangeal joints.

First carpometacarpal joint osteoarthritis is present with joint space narrowing, osteophytes, subchondral sclerosis, and mild subluxation.

Severe degenerative osteoarthritis of the wrist is seen with radiocarpal joint space narrowing, subchondral sclerosis, and carpal degenerative changes.

Erosive osteoarthritis is suggested with central erosions, joint space narrowing, and characteristic gull-wing deformities involving the interphalangeal joints.

Degenerative changes of the hand and wrist are present with osteopenia, joint space narrowing, and osteophyte formation in an age-related distribution.

Chronic osteoarthritic changes are noted with deformity, osteophytes, and subchondral cysts involving the interphalangeal joints and first carpometacarpal joint.

Degenerative changes at the [DIPJs / PIPJs / CMC1 / MCPJs]. Kellgren-Lawrence grading: 0 — no features 1 — doubtful narrowing, possible osteophytes 2 — definite osteophytes, possible narrowing 3 — moderate multiple osteophytes, definite narrowing, some sclerosis, possible deformity 4 — large osteophytes, marked narrowing, severe sclerosis, definite deformity Current grade: [1–4]. Heberden's nodes (DIPJs) / Bouchard's nodes (PIPJs) as applicable. Rheumatology / hand surgery referral if symptomatic.

Erosive changes at the DIPJs and PIPJs with gull-wing / sawteeth deformity of articular surfaces, characteristic of erosive (inflammatory) osteoarthritis. Periarticular osteopenia minimal. Distinction from RA: DIP involvement, no periarticular osteopenia, gull-wing erosion pattern. Rheumatology correlation.

Degenerative changes at the 1st carpometacarpal joint. Eaton-Littler staging: I — normal / widened joint space, minimal articular changes II — joint space narrowing, osteophytes <2 mm, mild subluxation III — significant joint space narrowing, osteophytes >2 mm, subluxation, sclerosis IV — pantrapezial arthritis, STT joint involved Current stage: [I–IV]. Splinting / injection / trapeziectomy depending on stage and symptoms.

Progressive degeneration at the radial styloid-scaphoid articulation extending to the radioscaphoid and then midcarpal joints, consistent with scapholunate advanced collapse (SLAC wrist). SLAC staging: I — radiostyloid arthrosis II — entire radioscaphoid joint III — capitolunate joint involvement Current stage: SLAC [I / II / III]. Hand surgery referral for salvage procedure.

Degenerative changes at the radioscaphoid and midcarpal joints in the context of scaphoid non-union with proximal pole fragmentation, consistent with SNAC wrist. SNAC staging mirrors SLAC (I–III). Current stage: SNAC [I / II / III]. Hand surgery referral.

Degenerative changes at the [right / left / bilateral] hip. Kellgren-Lawrence grading: 0 — normal 1 — doubtful: possible osteophyte 2 — mild: definite osteophyte, possible joint space narrowing 3 — moderate: moderate osteophytes, definite narrowing, some sclerosis 4 — severe: large osteophytes, marked narrowing, severe sclerosis, deformity Current grade: K-L [1–4]. Migration pattern: [superior / medial / axial / global]. Orthopaedic referral for grades 3–4 if symptomatic.

Superior joint space narrowing with superior migration of the femoral head, osteophyte formation at the acetabular rim and femoral head-neck junction, and subchondral sclerosis. Superior pole hip OA pattern. Orthopaedic review for arthroplasty.

Medial migration of the femoral head with acetabular protrusion (medial wall of acetabulum medial to the ilioischial line). Axial / medial pattern hip OA. No features of Paget's disease or rheumatoid arthritis. Orthopaedic review.

Bilateral hip OA with worse involvement on the [right / left] producing apparent leg length discrepancy secondary to fixed flexion/adduction contracture. Orthopaedic review for bilateral arthroplasty planning.

Degenerative changes at the [medial / lateral / patellofemoral / tricompartmental] knee. Kellgren-Lawrence grading: 0 — no OA features 1 — doubtful: possible osteophytes, no definite space narrowing 2 — mild: definite osteophytes, possible joint space narrowing 3 — moderate: moderate osteophytes, definite narrowing, some sclerosis 4 — severe: large osteophytes, marked narrowing, severe sclerosis, possible deformity Current grade: K-L [1–4], [compartment] worst affected. Weight-bearing views preferred for grading.

Medial compartment knee osteoarthritis. Ahlback grading: I — joint space narrowing (<3 mm) II — joint space obliteration III — minor bone attrition (<5 mm) IV — moderate bone attrition (5–10 mm) V — severe bone attrition (>10 mm) with subluxation Current grade: Ahlback [I–V]. Varus deformity [x°] on standing AP view. Orthopaedic review for arthroplasty if grades III–V.

Lateral patellofemoral joint space narrowing with patellar osteophytes, subchondral sclerosis, and lateral patellar tilt on skyline / merchant view. Isolated patellofemoral OA. Tibiofemoral compartments relatively preserved. Patellofemoral replacement consideration if refractory.

Medial compartment joint space narrowing with varus deformity measuring [x°] on full-length standing AP film (mechanical axis deviating medially by [x] mm from the knee centre). [Lateral compartment preserved.] Consistent with varus gonarthrosis. High tibial osteotomy or arthroplasty depending on age and activity level.

Multiple subchondral cysts in the medial tibial plateau and medial femoral condyle with adjacent sclerosis and joint space narrowing. Advanced medial compartment OA (K-L grade [3/4]) with subchondral cyst formation. Orthopaedic review.

Glenohumeral degenerative change. Samilson-Prieto grading: 0 — normal 1 — mild: inferior humeral or glenoid spur <3 mm 2 — moderate: spur 3–7 mm ± mild JSN 3 — severe: spur >7 mm, marked JSN, sclerosis, deformity Current grade: [1–3]. Posterior glenoid erosion / glenoid retroversion: [present / absent]. Orthopaedic review for arthroplasty planning.

Superior migration of the humeral head with decreased acromiohumeral interval (<7 mm), acetabularisation of the acromion, femoralization of the humeral head, and glenohumeral joint space narrowing. Consistent with rotator cuff arthropathy (Hamada grade [1–5]). Reverse total shoulder arthroplasty evaluation recommended.

Multilevel disc space narrowing with end-plate sclerosis and marginal osteophyte formation (spondylosis deformans) at [C5–6, C6–7 / L4–5, L5–S1]. Pfirrmann disc grading (MRI correlate, for reference): I — normal, bright disc II — inhomogeneous, normal height III — grey, slight height loss IV — dark, collapsed V — collapsed space, end-plate contact Plain film reflects stages III–V. Conservative management; MRI for canal/cord assessment if neurological symptoms.

Hypertrophic facet joint changes with osteophyte formation and joint space narrowing at [C5–6 / L4–5 / L5–S1] bilaterally, consistent with facet joint arthropathy. No acute fracture. Conservative management; image-guided injection if symptomatic.

Hypertrophy of the uncovertebral joints of Luschka at [C5–6 / C6–7] with encroachment on the neural foramina. Degenerative uncovertebral arthrosis. MRI for foraminal nerve root impingement assessment if radicular symptoms.

Anterior spondylolisthesis at [L4–5]. Meyerding grading (slip as % of vertebral body AP diameter): I — 0–25% II — 25–50% III — 50–75% IV — 75–100% V — spondyloptosis (>100%) Current slip: Meyerding grade [I / II] ([x]% slip, [x] mm). Facet arthropathy bilateral. Conservative management; surgical stabilisation if grade III–IV or neurological compromise.

Weber type A fracture is identified below the level of the syndesmosis.

Weber type B fracture is present at the level of the syndesmosis.

Weber type C fracture is identified above the level of the syndesmosis with likely instability.

Tuft fracture is present as a comminuted distal phalanx fracture.

Seymour fracture is identified as a juxta-epiphyseal distal phalanx fracture with nail bed injury.

Mallet finger is seen as dorsal avulsion fracture of distal phalanx.

Jersey finger is present as volar avulsion fracture of distal phalanx.

Volar plate avulsion fracture is noted at the base of the middle phalanx.

Schatzker type I tibial plateau fracture is identified as a lateral plateau split fracture without significant depression.

Schatzker type II tibial plateau fracture is present with a lateral plateau split component and associated articular depression.

Schatzker type III tibial plateau fracture is noted with isolated lateral plateau depression.

Schatzker type IV tibial plateau fracture is seen involving the medial plateau.

Schatzker type V tibial plateau fracture is present with bicondylar involvement.

Age-appropriate thymic shadow. Lungs clear. No consolidation or effusion. Cardiac silhouette within normal limits for age.

Subglottic tracheal narrowing with loss of the normal shoulder appearance on AP neck view (steeple sign), consistent with croup (laryngotracheobronchitis).

Thickened, thumb-shaped epiglottis on lateral neck view, consistent with epiglottitis. Urgent ENT airway management.

Radio-opaque foreign body at the level of the [cricopharyngeus / thoracic oesophagus / stomach]. Gastroenterology / ENT review.

Greenstick fracture of the [distal radius / ulna] with cortical buckling on the tension side and intact opposite cortex. Cast immobilisation.

Subtle oblique fracture through the distal tibial shaft in this toddler, consistent with a toddler's fracture. Cast immobilisation.

Fracture through the physis with associated metaphyseal fragment (Thurston-Holland sign). Salter-Harris type II fracture. Orthopaedic assessment; generally favourable prognosis.

Flattening and increased density of the [right / left] femoral head epiphysis with widened joint space, consistent with Legg-Calvé-Perthes disease. Orthopaedic referral for containment management.

Lateral displacement of the femoral head with shallow acetabulum and disrupted Shenton's line. Features consistent with developmental dysplasia of the hip. Orthopaedic referral.

Torus (buckle) fracture of the distal radius/ulna with cortical buckling; no displacement. Splinting recommended.

Greenstick fracture with incomplete cortical break; anterior cortex intact. Minimal angulation. Orthopaedic review advised.

Salter-Harris type I physeal injury with widening of the physis; no metaphyseal fracture line. Correlate clinically with point tenderness.

Salter-Harris type II fracture with metaphyseal fragment (Thurston-Holland sign); physeal involvement. Orthopaedic review.

Salter-Harris type III epiphyseal fracture extending to the articular surface; intra-articular involvement. Orthopaedic review.

Salter-Harris type IV fracture traversing metaphysis, physis, and epiphysis; risk of growth disturbance. Orthopaedic referral.

Plastic bowing fracture with curvature of the ulna/fibula without discrete fracture line; periosteal reaction consistent with subacute injury.

Normal pelvic ring integrity. Acetabular contours, femoral heads, and hip joints symmetric. No fracture or significant osteoarthritic change.

[Left / Right / Bilateral] hip joint space narrowing with subchondral sclerosis and osteophyte formation. [Mild / Moderate / Severe] osteoarthritis. Orthopaedic referral if symptomatic.

Fractures of the [superior and inferior pubic rami] on the [left / right] side. Posterior pelvic ring appears intact on this projection. CT pelvis recommended for complete ring assessment.

Displaced fracture at the [subcapital / transcervical / basicervical] level with varus angulation and shortening. Displaced femoral neck fracture. Urgent orthopaedic consultation for fixation.

Subtle valgus impaction / undisplaced subcapital fracture of the [right / left] femoral neck. Undisplaced femoral neck fracture (Garden I/II). Orthopaedic assessment for percutaneous fixation.

Fracture through the [right / left] intertrochanteric region with [minimal / significant] displacement. Intertrochanteric fracture. Orthopaedic consultation for dynamic hip screw or nail fixation.

Fracture adjacent to the hip prosthesis at the [stem tip / shaft] level. Periprosthetic fracture (Vancouver type [B2 / C]). Revision orthopaedic surgery referral.

Posterior dislocation of the [right / left] femoral head with femoral head overlying the posterior acetabular rim. No acetabular fracture on this view. Urgent reduction; CT post-reduction for fracture assessment.

Increased sclerosis and subchondral fracture line (crescent sign) in the [right / left] femoral head consistent with avascular necrosis. Orthopaedic referral.

Total hip replacement with acetabular cup and femoral component in satisfactory position. No periprosthetic lucency, fracture, or dislocation.

Post-reduction imaging demonstrates anatomic alignment with restoration of normal bony contours.

Post-reduction shows near-anatomic alignment with minimal residual displacement.

Post-reduction demonstrates acceptable alignment with mild residual angulation.

Post-reduction shows persistent displacement despite interval improvement.

Post-reduction demonstrates residual articular step-off suggesting incomplete reduction.

Post-reduction alignment is suboptimal and may require further orthopaedic intervention.

Post-traumatic soft tissue contusion is seen with mild focal swelling.

Post-traumatic soft tissue contusion is present with moderate oedema and soft tissue stranding.

Post-traumatic soft tissue contusion is noted with intramuscular oedema and small haematoma.

Shoulder: periarticular soft tissue swelling is present.

Knee: periarticular oedema with possible joint effusion.

Ankle: circumferential soft tissue swelling is identified.

Wrist/Hand: dorsal soft tissue swelling is present.

Normal thoracic vertebral alignment and height. No acute fracture or subluxation. Disc spaces maintained. Costovertebral junctions intact.

Multilevel anterior osteophyte formation consistent with thoracic spondylosis. Vertebral heights maintained. No acute fracture.

Anterior wedge deformity of [T#] with [x]% height loss. The posterior wall appears intact. Stable compression fracture. MRI recommended for marrow signal and cord assessment.

Dextroscoliosis of the thoracic spine with an apex at [T#]. Cobb angle [x°]. No vertebral segmentation anomaly. Orthopaedic/spine referral for scoliosis management.

No significant interval change compared to prior study dated [date].

Interval improvement of [finding] compared to prior study dated [date].

Interval progression of [finding] compared to prior study dated [date].

A [fracture / significant abnormality] cannot be excluded on plain radiography. CT recommended for further characterisation.

No prior imaging available for comparison at this institution.

Radiographic assessment limited by [patient positioning / body habitus / inadequate views]. Further views or cross-sectional imaging may be required for complete evaluation.