X-Ray follow-up

• Routine follow-up not required in fully recovered adults <50 with no risk factors.
• Repeat CXR 6 weeks for smokers ≥50 or persistent symptoms — exclude underlying malignancy.
• Consider CT if persistent consolidation or atypical features.

Source: BTS / ACR guidance

• Negative initial scaphoid series with clinical suspicion → immobilize + repeat XR in 10–14 days, or MRI.
• MRI is most sensitive and shortens immobilization in confirmed-negative cases.

Source: ACR Appropriateness Criteria

• Positive fat pad sign on lateral elbow → presume occult supracondylar / radial neck fracture.
• Splint and follow-up 7–10 days for repeat radiographs.

Source: ACR Appropriateness Criteria — Pediatric

• Any new or indeterminate nodule on CXR → low-dose chest CT for characterization.
• Subsequent management follows Fleischner 2017 by size and solid/sub-solid character.

Source: Fleischner Society 2017 / ACR

• Ankle XR indicated only with malleolar pain plus bony tenderness or inability to bear weight.
• Foot XR only with midfoot pain plus tenderness at navicular / 5th metatarsal base or inability to bear weight.
• Validated to reduce unnecessary imaging by ~30% with near-100% sensitivity for clinically significant fractures.

Source: Ottawa Ankle Rules — Stiell et al.

• XR indicated if any: age ≥55, isolated patellar tenderness, fibular head tenderness, inability to flex 90°, or inability to bear weight (4 steps) immediately and in ED.
• Otherwise plain films can be safely deferred.

Source: Ottawa Knee Rule

• Typical mechanism + posture: no XR needed if clinical reduction is attempted first.
• Image if atypical mechanism, swelling, or failed reduction to exclude fracture.

Source: ACR Appropriateness Criteria — Pediatric

• Mandatory skeletal survey in children <2 with suspected abuse; follow-up survey at 2 weeks improves detection.
• High-specificity injuries: classic metaphyseal lesions, posterior rib fractures, scapular/sternal fractures.
• Report to child protection team per local pathway.

Source: ACR–SPR practice parameter

• Aggressive features (wide zone of transition, periosteal reaction, soft-tissue mass) → MRI + oncology referral.
• Classic benign 'don't touch' lesions (NOF, bone island, fibrous cortical defect) need no follow-up.
• Indeterminate solitary lesion in adult → CT chest/abdomen/pelvis and bone scan to assess for metastatic disease.

Source: ACR Appropriateness Criteria

• Age >50 with new fracture and no high-energy trauma → DXA and osteoporosis workup.
• MRI if neurologic symptoms, suspected pathologic fracture, or to date acuity before vertebroplasty.

Source: ACR Appropriateness Criteria