As always, utilize whatever system works best for you! Here is one example. If you haven’t read, System for Reading Wrist Xrays, that is a good place to start!

We follow the same approach: Say what views you are seeing, skeletal maturity, and what the most to-the-point correct description of the main problem going on.

Example: This is an AP pelvis in a skeletally mature individual, and there are no apparent fractures, some mild osteoarthritis in hip joints present.

Next, after you have stated what you can from quick glance it is a good practice to go through the whole image systematically. 

System for Reading Pelvis Xrays

• Check for correct patient and image date

• Check quality of image

•  spinous processes should be lined up in center of vertebral bodies in between pedicles

• Pubic symphysis should be 2-3cm distal to the tip of the sacrum

• I like to start superior and work my way distal (Proximal to distal)

• Look at the spine, L5 spinous process fractures can tell you that there is pelvis instability from a high energy injury. L5 spinous processes are attachment sites for the iliolumbar ligaments, which is part of the posterior ligamentous complex of the pelvis. The strongest ligaments holding the pelvis together.

• Review Joint spaces

• Bilateral SI joints

• Bilateral hip joints

• Pubic symphysis

• Review Foramen

• Sacral foramen

• Pelvic ring

• Obturator foramen

• Review Lines (Letournel lines)

• Iliopectineal line – anterior column

• Ilioischial line – posterior column

• Teardrop (aka. Kohler’s teardrop) – floor of acetabular fossa, communicates acetabulum congruity

• Acetabular roof (aka. Sourcil, latin word for eyebrow)

• Anterior acetabular wall

• Posterior acetabular wall

• Shenton’s line (not part of the letournel lines, but still helpful)

• Review outside cortices of ilium, rami, femurs

• Look inside bones for radioopaque or radiolucent lesions

• Review soft tissue

References:

Letournal lines picture