Skull AP/Lat   [Yes/No]

Cervical and Thoracolumbar spine   [Yes/No]

Chest X-Ray   [Yes/No]

Ribs – Left/Right Oblique   [Yes/No]

Abdominal X-Ray   [Yes/No]

Pelvis with both hips   [Yes/No]

Bilateral Humerus, Forearm, Hand   [Yes/No]

Bilateral Femur, Tibia/fibula, feet   [Yes/No]

Any additional lateral views of the extremities   [Yes/No]

The exam is over or under penetrated.   [Yes/No]

The exam may or may not be limited by overlying structures or soft tissues, body habitus, patient positioning, support devices, or motion.   [Yes/No]

The area of concern is indicated by the patient, technologist, or care provider.   [Yes/No]

The area of concern is included on the exam.   [Yes/No]

There is soft tissue swelling, indistinctness of fat/muscle planes, gas, or laceration in the area of clinical concern.   [Yes/No]

There is an effusion, fat pad displacement, or fat fluid level.   [Yes/No]

There is a radiodense or lucent foreign body.   [Yes/No]

There are other densities, calcifications, post-surgical changes, or support devices in the soft tissues.   [Yes/No]

Any support lines/tubes.   [Yes/No]

There is a break or interruption of the continuity of the cortical or cancellous bone.   [Yes/No]

There is overriding of the trabeculae with apparent sclerosis.   [Yes/No]

There is displacement of a fracture fragment.   [Yes/No]

There is bowing of the bone in addition to the fracture at the apex of the bowed bone concerning for the greenstick.   [Yes/No]

There is a spiral fracture of the leg concerning for toddler’s fracture.   [Yes/No]

There is abnormal angulation or bulging of the cortical surface relative to the normal cortex which could be from a buckle or torus fracture.   [Yes/No]

There is a displaced fragment which may be from avulsion by a tendon, ligament, or joint capsule or from a comminuted or other fracture.   [Yes/No]

The stress trabeculae or other trabeculae of the cancellous bone are interrupted or otherwise abnormal.   [Yes/No]

There is subperiosteal or endosteal reaction which could indicate a healing or subacute fracture or other abnormality.   [Yes/No]

There is hard/soft callus formation.   [Yes/No]

There is remodeling of the bone.   [Yes/No]

There is a corner fracture or metaphyseal lesion that could be from nonaccidental trauma.   [Yes/No]

There are multiple fractures of different ages.   [Yes/No]

There are vertebral body/spinous process fractures.   [Yes/No]

There are rib fractures. Location - posterior or lateral.   [Yes/No]

There is scapular/sternal fracture.   [Yes/No]

There are fractures of the digits.   [Yes/No]

There are wormian bones.   [Yes/No]

There are intrasutural bones.   [Yes/No]

There is metaphyseal abnormality (lucencies, increased density, erosion) which may be from something other than injury such as stress, metabolic disease (e.g. rickets with loss or distortion of the zone of the provisional calcification), neoplasm (e.g. leukemia), heavy metals, inflammation, or infection.   [Yes/No]

There are metaphyseal spurs.   [Yes/No]

There are bony deformities involving multiple bones.   [Yes/No]

The bones are gracile.   [Yes/No]

There are non-healing fractures.   [Yes/No]

There is/are focal or multifocal lytic/lucent, blastic/sclerotic or mixed density lesion(s) or other abnormality.   [Yes/No]

Overall bone density is increased or decreased with or without thinning or thickening of the cortical or cancellous bone.   [Yes/No]

The growth plate(s) is/are abnormal.   [Yes/No]

There is widening of the physis from a fracture with or without displacement of the epiphysis (Salter-Harris I).   [Yes/No]

There is a fracture through the physis which then extends into the metaphysis with or without angulation or displacement (S-H II).   [Yes/No]

There is a fracture through the physis which then extends into the epiphysis and is intra-articular, with or without angulation or displacement (S-H III).   [Yes/No]

There is a fracture through the metaphysis, physis, and epiphysis which extends into the joint space with or without angulation or displacement (S-H IV).   [Yes/No]

There is narrowing of the physis from a compression fracture (S-H V).   [Yes/No]

The apophysis, epicondyle, secondary ossification center, or accessory ossicle is displaced or otherwise abnormal.   [Yes/No]

The ossification centers are underdeveloped.   [Yes/No]

There is an effusion, fat pad displacement, or fat fluid level.   [Yes/No]

The epiphysis or subchondral bone is fractured, interrupted, flattened, compressed, impacted, displaced, or otherwise abnormal.   [Yes/No]

There is an intra-articular loose body or chondrocalcinosis.   [Yes/No]

The joint is widened, narrowed, dislocated, malaligned, or incongruent.   [Yes/No]

There is pseudoarthrosis.   [Yes/No]

There are developmental changes or other anatomic variants or other existing conditions that may or may not be contributing to symptoms which can or should be further evaluated non-emergently or are otherwise incidental.   [Yes/No]

The remainder of the exam is abnormal for age.   [Yes/No]

The lungs show focal airspace opacity.   [Yes/No]

There is pneumothorax.   [Yes/No]

There is organomegaly.   [Yes/No]

There is intra-abdominal calcification.   [Yes/No]

There is displacement of the bowel loops.   [Yes/No]

There is paraspinal soft tissue abnormality.   [Yes/No]

There is free intraperitoneal air.   [Yes/No]

The bowel loops are dilated/obstructed.   [Yes/No]