Introduction to Trauma X-ray
Foreign bodies

Key points

  • X-rays can detect radio-opaque foreign bodies such as glass and metal

Following traumatic breach of the skin X-rays can be used to identify and locate residual foreign bodies. Materials which are radio-opaque such as glass or metal are usually seen easily. Other less dense substances such as wood are not readily detected with X-rays.

The requester should inform the radiographer acquiring the image that the purpose of performing the X-ray is to identify a foreign body. This is so that specific image settings can be used, and views acquired depending on the nature and site of injury. At least 2 views are required with an external metallic marker to indicate the point of skin entry.

As well as locating foreign bodies within soft tissues, X-rays can show if a foreign body is lodged within bone. Antibiotics may be appropriate in this scenario to prevent bone infection.

Glass foreign bodies

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Glass foreign bodies

  • The lateral image clearly shows one foreign body and suggests a second which is partly obscured by bone
  • The AP image shows both glass fragments clearly
  • Note: Glass has a similar density to cortical bone and so is readily identified within soft tissue

Metal foreign body example - Fish hook

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Metal foreign body example - Fish hook

  • Lateral image suggests bone penetration
  • AP image shows no penetration of bone

Metal foreign body example - Nail

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Metal foreign body example - Nail

  • Lateral image suggests bone penetration
  • AP image confirms bone penetration