The radiological examination after trauma in a limb is prescribed in the clinical suspicion of a fracture and must be routinely performed only on the traumatized side and segment, including at least one of the two adjacent joints. Only in cases in which the radiologist has a well-founded diagnostic doubt due to the presence of a non-univocal radiological sign, can it be indicated to perform a comparison with the healthy contralateral side, only in the projection in which the doubtful sign is present rather than an X-ray in targeted projection on the site of suspected injury. In this case, the additional exposure of the patient is justified in accordance with the Legislative Decree 101/2020.
The routine execution of both sides, even if performed with a single exposure and much more if performed in two successive exposures (1 per side and per projection), however, leads to an increase in the dose of ionizing radiation to the single, superfluous very often for diagnosis, especially if already evident without the need for comparison.
The individual dose increase, specifically concerning the paediatric patient, refers to the age group with the greatest radiosensitivity of the tissues and with a long-life expectancy. Inappropriate exposure also leads to an increase in the dose to the population. The use of additional projections on the affected side or on the healthy side may be indicated but only in cases selected by the radiologist to resolve diagnostic doubts, especially when the suspected fracture is close to or involves the growth plate.
In certain types of fractures, particularly in younger patients, ultrasound examination of the affected side can also be considered to resolve a diagnostic doubt, as a first-line alternative to repeating radiographic imaging, whether for an additional view of the affected side or for assessment of the contralateral side.

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