4-29. METASTATIC SURVEY
a. The usual sequence of a highly virulent disease, such as tuberculosis or
cancer, is to involve not only the immediately affected area but also other areas of the
body. This transfer of a disease from one organ or area to another is referred to as
metastasis. When disease metastasizes to bone, usually the shafts or bodies of bony
structures are the areas primarily involved. Accordingly, the x-ray procedure will be
compensated to stress the primary areas of involvement. Here, too, because
metastasis to any area is possible, a clinical routine must be established as to what
specific views are to be taken and how many specific bones are to be included.
Suggested routine: lateral skull, PA chest, AP and lateral dorsal and lumbar spines,
and AP pelvis.
b. In addition, radiographs of organs or soft tissue surrounding the diseased
areas must be made in order to establish whether or not the pathology has spread to
adjacent tissues. The lungs constitute one of the most common areas of involvement.
These organs are very receptive to metastatic action. Long bone survey may be done
in conjunction with matastic survey.
4-30. LONG BONE SERIES
This examination is usually done for the purpose of diagnosing malformations of
long bones caused by disease, a retardation of bone growth, or a stoppage of the
normal bone growth process. The patient will usually exhibit various symptoms such as
curvature of the extremities (bowlegs, knock-knee, etc.) or a shortening of one of the
extremities. When shortening does occur, differentiation can be established as to
whether the shortening is functional or anatomical. This is accomplished by
measurements of both related extremities to determine actual figures. An anatomically
short extremity will show a shorter measurement of the bones than the other.
Conversely, a functionally short extremity, usually due to occupation or bad posture, will
have the same bone measurement as the other comparative extremity. The shortening
in the latter case is due to the carrying angle of the body. A long bone series, then, is a
comparative study in which both related extremities are examined. Suggested routine:
AP only, bilateral, full-length humerus, distal femurs, legs, and AP pelvis.
4-31. BONE AGE
Normally, the body follows an average bone pattern with regard to ossification of
certain areas at specific time intervals. Any gross deviation from this average is
considered abnormal and may be the means by which certain pathologies are
diagnosed. Ideally, radiographic of the entire skeleton would be studied before the
skeletal age is estimated. In daily clinical practice, however, the time-consuming,
expensive radiographic examination of all of the bones cannot be carried out except in
special cases. For this reason, a small and convenient portion of the skeleton,
commonly the wrist and hand, is considered representative of the entire skeleton in the