FMT VIVA
X- RAYS
R.G. KAR MEDICAL COLLEGE BOY’S HOSTEL,
MANIKTALA
BATCH OF 2020
3RD PROFESSIONAL PART I MBBS (2023-’24)
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“The North Remembers….”
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CHECKLIST FOR X-RAY PLATE [ELBOW JOINT]
SL.NO POINTS OF EVALUATION
(CHECK)
1. Holding the X-Ray plates properly/placing in view box correctly. [1]
2. Describe the X-Ray plate correctly (which area, which view, showing which
structures) [3]
3. Demonstrate the secondary ossification centers required for estimation of age.
[4]
4. Opinion regarding age of the person. [2]
NOTE:
SECONDARY OSSIFICATION CENTERS FOR:
Elbow Joint: Medial Epicondyle, Lateral Epicondyle, Head of Radius, Tip of Olecranon
Process.
1. Holding the X-Ray plate properly:
The lower end of humerus should be upwards and the upper end of radius
and ulna should be downwards.
Note the writing mentioning the details of the patient. It should be always in
proper orientation.
2. Describing the X-Ray plate correctly:
Say, “This is a skiagram of elbow joint (anteroposterior/ lateral view) showing lower
end of humerus and upper ends of radius and ulna.”
3. The secondary centers for ossification are
Medial epicondyle of humerus
Lateral epicondyle of humerus
Trochlea of humerus
Capitulum of humerus
Head of radius
Tip of olecranon of ulna.
Demonstrate them to the examiner as shown in the image below:
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Source: Marrow
4. Opinion Regarding Age: The following points have to be considered in this
regard-
As per Gallstaun’s chart, the age of appearance and fusion of the ossification
centers are given in the table below:
(Note: At least memorize the age of appearance and fusion of epiphysis of
female elbow joint.)
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Remember the sequence: Age of appearance of the secondary ossification
centres can be remembered by this sequence--
Mnemonic: CIRTEO
Inner External Olecrano
Capitulum( (medial) Radius (6 Trochlea (lateral) n process
1 year) epicondyle years) (10 years) epicondyle tip (9-12
(5 years (10 years) years)
Medial epicondyle fuses separately with the shaft at 14 years.
Lateral epicondyle, capitulum and trochlea fuses together to form the conjoint
epiphysis at the age of 10-13 years.
Complete fusion of the lower end of humerus occurs at the age of 14 years
Examples of Age Estimation from X-rays given in practical Exams:
1.
Let the age of the person be ‘X’.
Points of importance in this X-Ray (Follow the sequence):
Appearance of epiphysis- Olecranon tip which is the last to appear, has appeared
but hasn’t fused with the ulna so 12 years< X < 15 years.
Conjoint epiphysis (lateral epicondyle, capitulum and trochlea) formed completely,
so age is in the range of 10-13 years.
Medial epicondyle has not fused with the shaft of humerus, so age is below 14
years.
Radial head has not completely fused with the shaft, so age is below 14 years.
Therefore the age of the person is 12 to 13 years.
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Note: All estimations are according to Gallstaun’s chart that is followed for Bengali
Population and approved by the Kolkata High Court.
2.
Let the age of the person be ‘X’.
Points of importance in this X-Ray (Follow the sequence):
Appearance of epiphysis- Lateral epicondyle has appeared but has not fused so age
is around 10 years. Olecranon tip has not appeared so X<12 years.
Conjoint epiphysis (lateral epicondyle, capitulum and trochlea) not formed
completely, so X<10-13 years.
Medial epicondyle has not fused with the shaft of humerus, so age is below 14
years.
Radial head has not completely fused with the shaft, so age is below 14 years.
Therefore the age of the person 9-10 years.
Note: All estimations are according to Gallstaun’s chart that is followed for Bengali
Population and approved by the Kolkata High Court.
3.
Olecranon process has appeared and fused with ulna so age is 15 years.
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CHECKLIST FOR X-RAY PLATE [WRIST JOINT]
SL.NO POINTS OF EVALUATION
(CHECK)
1. Holding the X-Ray plates properly/placing in view box correctly. [1]
2. Describe the X-Ray plate correctly (which area, which view, showing which
structures) [3]
3. Demonstrate the secondary ossification centers required for estimation of age.
[4]
4. Opinion regarding age of the person. [2]
NOTE:
SECONDARY OSSIFICATION CENTERS FOR:
Wrist Joint: Lower End of Radius, Lower End of Ulna, Pisiform, Base of First Metacarpal.
1. Holding the X-Ray plate properly:
The lower end of radius and ulna should be downwards and the carpal bones
should be upwards.
Note the writing mentioning the details of the patient. It should be always in
proper orientation.
2. Describing the X-Ray plate correctly:
Say, “This is a skiagram of wrist joint (anteroposterior/ lateral view) showing lower
ends of radius and ulna and carpal bones.”
3. The secondary centers for ossification are
Lower end of radius
Lower end of ulna
Base of 1st metacarpal
Pisiform
Capitate
Hamate
Triquetral
Lunate
Scaphoid
Trapezium
Trapezoid
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Mnemonic for carpal Bones:
She Looks Too Pretty Try To Catch Her (S- Scaphoid, L- Lunate, T- Triquetral,
P- Pisiform, T- Trapezium, T- Trapezoid, C- Capitate, H- Hamate)
Demonstrate them to the examiner as shown in the image below:
4. Opinion Regarding Age: The following points have to be considered in this
regard-
As per Gallstaun’s chart, the age of appearance and fusion of the ossification
centers are given in the table below:
(Note: At least memorize the age of appearance and fusion of epiphysis of
female wrist joint namely lower end of radius, lower end of ulna, pisiform and
base of 1st metacarpal.
Base of 1st 4 years 16-18 years 3 years 14-15 years
metacarpal
Remember the sequence: Age of fusion of the secondary ossification centres
can be remembered by this sequence.
Base of 1st
Pisiform (9-12 Lower end of ulna( Lower end of radius
metacarpal (14-15
years) 17-18 years) (16.5 18years)
years)
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Capitate, the largest carpal bone appears around 2 months and hamate at
3months to 1 year.
If only the carpal bones have appeared without fusion of the epiphysis, the
general rule of thumb to estimate age is to simply count the number of carpal
bones. The number corresponds to the age in years.
Examples of Age Estimation from X-rays given in practical Exams:
1.
Points of importance in this X-Ray (Follow the sequence):
Appearance of epiphysis- All the carpal bones have appeared so age is around 9-
12 years.
Base of 1st metacarpal has not fused, so age is below 14-15 years.
Lower end of radius and ulna have not fused with the shaft, so age is below 17-18
years.
Therefore the age of the person is 9-12 years.
Note: All estimations are according to Gallstaun’s chart that is followed for Bengali
Population and approved by the Kolkata High Court.
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2.
Points of importance in this X-Ray (Follow the sequence):
Appearance of epiphysis- All the carpal bones have appeared so age is around 9-
12 years.
Base of 1st metacarpal has not fused, so age is below 14-15 years.
Lower end of radius and ulna have not fused with the shaft, so age is below 17-18
years.
Therefore the age of the person is 9-12 years.
Note: All estimations are according to Gallstaun’s chart that is followed for Bengali
Population and approved by the Kolkata High Court.
3.
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Points of importance in this X-Ray (Follow the sequence):
Appearance of epiphysis- All the carpal bones have appeared so person has
attained the age of 12 years.
Base of 1st metacarpal has fused, so person has attained 15 years.
Lower end of radius and ulna have fused with the shaft, so age is 17-18 years.
Therefore the age of the person is 17-18 years.
Note: All estimations are according to Gallstaun’s chart that is followed for Bengali
Population and approved by the Kolkata High Court.
3.
Points of importance in this X-Ray (Follow the sequence):
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Appearance of epiphysis- All the carpal bones have appeared so person has
attained the age of 12 years.
Base of 1st metacarpal has not fused completely, so age of person < 14-15years.
Lower end of radius and ulna have not fused with the shaft, so age is below 17-18
years.
Therefore the age of the person is 12-14 years.
Note: All estimations are according to Gallstaun’s chart that is followed for Bengali
Population and approved by the Kolkata High Court.
4.
Points of importance in this X-Ray:
Appearance of epiphysis- Only 3 carpal bones have appeared so age of the person
is 3 years.
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CHECKLIST FOR X-RAY PLATE [ PELVIS]
SL.NO POINTS OF EVALUATION
(CHECK)
1. Holding the X-Ray plates properly/placing in view box correctly. [1]
2. Describe the X-Ray plate correctly (which area, which view, showing which
structures) [3]
3. Demonstrate the secondary ossification centers required for estimation of age.
[4]
4. Opinion regarding age of the person. [2]
NOTE:
SECONDARY OSSIFICATION CENTERS FOR:
Pelvis: Iliac Crests, Ischial Tuberosities, Triradiate Cartilages, Head of Femur/Greater
trochanter.
1. Holding the X-Ray plate properly:
The hip bones should be upwards and the femurs should be downwards.
Note the writing mentioning the details of the patient. It should be always in
proper orientation.
2. Describing the X-Ray plate correctly:
Say, “This is a skiagram of Pelvis (anteroposterior view) showing iliac crest, ischial
tuberosity; head, greater trochanter and lesser trochanter of femur.”
3. The secondary centers for ossification are
Ischiopubic rami
Iliac crest
Ischial Tuberosity
Head of femur
Greater trochanter
Lesser trochanter
Demonstrate them to the examiner as shown in the image below:
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4. Opinion Regarding Age: The following points have to be considered in this
regard-
As per Gallstaun’s chart, the age of appearance and fusion of the ossification
centers are given in the table below:
(Note: At least memorize the age of appearance and fusion of epiphysis of
female pelvis)
Ischiopubic rami --- 8.5 years --- 8.5 years
Greater trochanter and lesser trochanter appear at the age of 4 and 14 years
respectively for both male and females (missed in the table).
Remember the sequence: Age of fusion of the secondary ossification centres
can be remembered by this sequence.
Disappearance Fusion of head Fusion of the
Fusion of the Fusion of ischial
of triradiate and greater lesser
iliac crest (17-19 tuberosity (20
cartilage (14 trochanter (14- trochanter (15-
years) years)
years) 15 years) 17 years)
Triradiate cartilage ossifies to form acetabulum.
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Examples of Age Estimation from X-rays given in practical
Exams:
1.
Points of importance in this X-Ray (Follow the sequence):
Disappearance of triradiate cartilage- attained the age of 14 years.
Fusion of the head and greater trochanter, attained the age of 15 years.
Iliac crest has not fused (note the faint radiolucent line in the lateral part of iliac
crest)- age< 17 years.
Therefore the age of the person is 15-16 years.
Note: All estimations are according to Gallstaun’s chart that is followed for Bengali
Population and approved by the Kolkata High Court.
2.
Points of importance in this X-Ray (Follow the sequence):
Ischopubic ramus has fused so age> 9 years.
Lesser trochanter has appeared so person has attained 14 years
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Persistence of triradiate cartilage- age below 15 years.
Therefore the age of the person is 14-15years.
Note: All estimations are according to Gallstaun’s chart that is followed for Bengali
Population and approved by the Kolkata High Court.
3.
Points of importance in this X-Ray (Follow the sequence):
Ischopubic ramus has fused so age> 9 years.
Lesser trochanter has appeared so person has attained 14 years
Persistence of triradiate cartilage (likely to disappear)- age below 14 years.
Therefore the age of the person is 12-14years.
Note: All estimations are according to Gallstaun’s chart that is followed for Bengali
Population and approved by the Kolkata High Court.
4.
Points of importance in this X-Ray (Follow the sequence):
Disappearance of triradiate cartilage- attained the age of 14 years.
Fusion of the head and greater trochanter, attained the age of 15 years.
Iliac crest has not fused (note the faint radiolucent line in the lateral part of iliac
crest)- age< 17 years.
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Therefore the age of the person is 15-16 years.
5.
Points of importance in this X-Ray (Follow the sequence):
Ischopubic ramus has fused so age> 9 years.
Lesser trochanter has not appeared completely so person has age<14 years
Persistence of triradiate cartilage- age below 15 years.
Therefore the age of the person is 9-14years.
Note: All estimations are according to Gallstaun’s chart that is followed for Bengali
Population and approved by the Kolkata High Court.
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