Being able to describe a lesion on an X-ray is not only important for passing VIVAs and OSCEs as a student, but also for communicating with other professionals out in general practice. This article aims to give a few hints and tips for describing lesions on a radiograph.
I have always been told to describe a radiograph as if I was on the phone to someone and they could not see it. Develop a systematic approach so you never miss a thing.
So, before you get to the lesion, before you get to even the radiograph itself, make sure you have the right one. Audibly check patient’s name, gender and DOB.
Then you’ll have to say what type of radiograph it is. So, is it a bitewing? periapical? OPT (if so is it full, 1/2, 1/4?) or something else? Is it the patients left or right side? Is the patient in primary, mixed or permanent dentition?
Once you’ve deciphered that, then you want to start describing the structures that are normal, in an ortho/paeds case it may be prudent to count the teeth. Again, develop a methodological approach, make sure you dont miss anything, if the lesion sits on the side that you normally start on, describe as you would but say something like “…there is a lesion there that I will come back to shortly…” and go back to your systematic approach.
Your examiners will stop you once they are satisfied you know the normal anatomy, and direct you back to the lesion, at which point, these are the points you need to think about:
- Where is the lesion? Left, right, central, crossing the midline? What structures or teeth does it encompass or extend to?
Doesn’t have to be exact, give an estimation in centimetres through its diameter, or greatest dimension (longest part), OR say where it starts and ends i.e. “Extends from the apex of the LL3 to the left angle of the mandible.”
Is it round, oval or irregular? Unilocular, multilocular or pseudolocular (part of the border is invaginated like a peach)
Look at the edge, is it well defined or ill defined from the surrounding bone, is it corticated? (a white line that goes around the lesion, suggesting slow growth that allows the body to lay down bone which “walls off” the lesion. Note: Well-defined and corticated are NOT synonyms)
Radiopaque? (White in the middle)
Radiolucent? (black in the middle)
6) Effect on adjacent structures
This is where your knowledge of normal comes into play, look around the lesion, does it do anything to the structures its replaced? Has it expanded bone? Perforated bone? Displaced or resorbed teeth? Look for the PDL, ID canal, mental foramen and other anatomical structures.
Don’t forget to develop your systematic approach.
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