X-ray learning library

Structured guides that take you from how an X-ray image is made to confidently describing chest, abdominal and skeletal radiographs. Start with the core skills, then work through each region. Every module ends with real cases and a quiz.

Start here: core skills

How radiographs are made and how to read any film systematically.

How X-ray images are made

Attenuation, the five densities, kV, mAs and magnification: the physics you actually need to read a film.

X-ray projections

PA, AP, lateral, decubitus and horizontal-beam views: what each shows and how it changes the film.

Image quality: RIPE

Rotation, inspiration, projection and exposure: decide whether the film is fit to read before you read it.

How to read a chest X-ray

Pre-checks, RIPE, ABCDE and the review areas: a system that works on every film.

How to read an abdominal X-ray

Gas pattern, 3-6-9, small versus large bowel, extraluminal gas, calcification and bones: a system for every AXR.

How to describe a fracture

Location, pattern, displacement, angulation and joints: a template that makes every fracture description clear.

How to present an X-ray

Open, assess quality, describe, summarise and plan: a presentation script for OSCEs, ward rounds and phone referrals.

Artefacts and mimics

Skin folds, nipple shadows, Mach bands, Chilaiditi and growth plates: how not to be fooled.

Radiation dose and protection

How much radiation is a chest X-ray? Doses, IR(ME)R justification, pregnancy checks and why shielding has changed.

Chest

Lungs, heart, mediastinum, pleura and chest wall.

Beginner

Normal chest X-ray anatomy

Heart borders, mediastinal contours, hila, fissures and the lateral film: know normal before you call abnormal.

Beginner

Silhouette sign

Which border is lost tells you which lobe is diseased: the most useful localising tool on a chest film.

Beginner

Pneumothorax

Pleural line, deep sulcus sign, BTS sizing and tension: find the pneumothorax and know when to act.

Beginner

Pleural effusion

Meniscus, supine veil, subpulmonic and massive effusions, and how to work out a white hemithorax.

Beginner

Pneumonia and consolidation

Air bronchograms, silhouette sign, lobar versus patchy patterns, aspiration and the six-week follow-up film.

Intermediate

Lobar collapse

Volume loss, Golden S, sail sign and luftsichel: the five lobar collapse patterns and what to do next.

Beginner

Heart failure and pulmonary oedema

Alveolar oedema, Kerley B lines, cardiomegaly, diversion and effusions: the ABCDE of heart failure.

Intermediate

Lung nodules and masses

Nodule versus mass, benign and malignant features, the mimics, and why the chest X-ray never characterises a nodule alone.

Intermediate

Mediastinum and hila

Normal contours, the widened mediastinum, the compartments and their masses, and how to read an abnormal hilum.

Intermediate

Tuberculosis

Primary, post-primary, miliary and healed TB: the patterns, the mimics, and why a normal film does not exclude TB.

Advanced

Interstitial lung disease

Pattern, zone and volume: a structured way to read fibrotic lungs, and why HRCT makes the diagnosis.

Intermediate

COPD and airways disease

Hyperinflation, bullae, tram-tracks and the complications of asthma: what the film can and cannot show.

Intermediate

Chest trauma

The supine trauma film: life threats first, then ribs, lungs, diaphragm and mediastinum, and when to go straight to CT.

Intermediate

Pneumomediastinum and surgical emphysema

Gas where it shouldn't be: the signs, telling it from pneumopericardium, and when it means a ruptured oesophagus.

Lines & tubes

ETT, NG tubes, central lines, drains and devices.

Beginner

NG tube position

pH first, then the four radiographic criteria: how a misplaced NG tube is spotted before harm is done.

Beginner

ETT position

Tip about 5 cm above the carina, the tip follows the chin, and why the film never proves tracheal placement.

Intermediate

Central lines and PICCs

Lower SVC or cavo-atrial junction, the carina as a rough landmark, and the malpositions you must not miss.

Intermediate

Chest drain position

Every side hole inside the pleura, a drain that works, and the complications that follow insertion.

Intermediate

Pacemakers and cardiac devices

Generator, leads and tips: tell a pacemaker from an ICD or CRT device and spot displacement, fracture and Twiddler.

Abdomen

Bowel gas patterns, obstruction, free air and calcification.

Beginner

Small bowel obstruction

Dilated central loops with valvulae conniventes and a collapsed colon, and why CT usually comes next.

Beginner

Large bowel obstruction

Peripheral dilated colon with haustra, the role of the ileocaecal valve, and the caecum at risk of perforation.

Intermediate

Volvulus

Coffee bean or kidney bean: which way the loop points, who gets which volvulus, and why it matters for treatment.

Beginner

Pneumoperitoneum

Free gas on the erect chest film and the supine abdomen: the signs, Chilaiditi and other mimics, and when CT is needed.

Intermediate

Toxic megacolon

A dilated, featureless transverse colon in a very unwell patient with colitis: the thresholds, the signs and the urgency.

Intermediate

Calcification and stones

Which stones show on a plain film, how to follow the ureter, and how to name every other white spot on the abdomen.

Beginner

Foreign bodies

What shows on a film and what doesn't, the dangerous objects (batteries, magnets, sharps) and when CT is the right test.

Upper limb

Shoulder, elbow, forearm, wrist and hand.

Beginner

Shoulder dislocation

Anterior, posterior and inferior dislocation, and why one view is never enough.

Beginner

Shoulder and clavicle fractures

Proximal humerus, clavicle, AC joint and scapula injuries, with the normal distances.

Intermediate

Elbow fractures

Fat pads, the two key lines and the fractures they reveal.

Intermediate

Forearm fractures

The forearm is a ring: Monteggia, Galeazzi and why you image both joints.

Beginner

Distal radius fractures

Colles, Smith, Barton and the three measurements that describe them.

Beginner

Scaphoid fracture

The scaphoid series, AVN risk, and why a normal film doesn't exclude a fracture.

Beginner

Hand fractures

Metacarpals, phalanges and the thumb: the named injuries and how to spot them.

Lower limb

Pelvis, hip, knee, ankle and foot.

Beginner

Hip fracture

Neck of femur fractures, Garden grading and the occult fracture a normal film can hide.

Intermediate

Pelvic fractures

The pelvis is a ring: find the second break, and recognise the injuries that bleed.

Intermediate

Knee fractures

Ottawa knee rule, lipohaemarthrosis and the small fragments that mean big injuries.

Beginner

Ankle fractures

Ottawa ankle rules, Weber A/B/C and the mortise measurements that show instability.

Intermediate

Foot fractures

Lisfranc alignment, the 5th metatarsal base and the calcaneal angles.

Spine

Cervical, thoracic and lumbar spine.

Intermediate

Cervical spine X-ray

ABCS, the four lines, and why adults in the UK now go to CT first.

Intermediate

Thoracolumbar fractures

Wedge, burst and Chance fractures, and the osteoporotic fracture nobody reports.

Intermediate

Spondylolisthesis and degenerative spine

Disc degeneration, the Scottie dog's collar and Meyerding grades.

Skull, facial bones, mandible and sinuses.

Beginner

Skull X-ray indications

Head injury means CT. Here is where skull films still matter, and how to read them.

Intermediate

Facial fractures

OM views, the three lines, and the blow-out, tripod, mandible and Le Fort patterns.

Paediatric

Children's radiographs and growth-plate injuries.

Beginner

Salter-Harris fractures

Growth plate fractures, types I–V, SALTR and why type II is the one you will see most.

Intermediate

Paediatric elbow

CRITOE, fat pads and two lines: the system that finds supracondylar and condylar fractures.

Intermediate

Paediatric hip

The limping child by age: DDH lines, Perthes signs and Klein's line for SUFE.

Advanced

Non-accidental injury

Which fractures raise concern, how the skeletal survey works and what to do next.

Beginner

Swallowed foreign bodies

Coin or button battery? The halo sign, where objects stick and why batteries are an emergency.

Advanced

Neonatal chest X-ray

Lung volume first: RDS, TTN, meconium aspiration, CDH and the neonatal lines.

Advanced

Paediatric abdomen

NEC, the double bubble, malrotation and intussusception: what the film shows and when it can't.

Beginner

Buckle and greenstick

Why children's bones bend and buckle, and how to tell a buckle from a greenstick fracture.

Bone & joint disease

Arthritis, tumours, metabolic bone disease.

Beginner

Osteoarthritis

LOSS, the joints it picks, and why the X-ray often isn't needed to diagnose it.

Intermediate

Inflammatory arthritis

Rheumatoid, psoriatic and ankylosing spondylitis: erosions, distribution and the spine.

Intermediate

Gout and crystal arthritis

Overhanging edges, tophi and chondrocalcinosis: crystal disease on the plain film.

Advanced

Bone tumours

Age, site, margin, periosteum and matrix: a seven-step approach to any bone lesion.

Intermediate

Bone and joint infection

Why the early film is normal, what late infection looks like, and when to go straight to MRI.

Advanced

Metabolic bone disease

Osteoporosis, Looser zones, rickets, hyperparathyroidism and Paget disease on the plain film.