3.3.4. Chest Radiography II

Question 1

Describe the search pattern in order to interpret a normal adult chest radiograph

Answer 1

1. Preliminary:
   a. ID: verify patient info, date, time, and position marker
   b. quality: note quality of film (position, rotation, penetration)
   c. Gestalt: note overall impression of film for abnormality
2. Frontal View
   a. evaluate any lines/tubes
   b. check periphery of lungs for pneumothorax/effusion
   c. study lungs up and down. Include volume and symmetry of markings.
   d. evaluate mediastinal contours, edges, and shape
   e. follow airways: trachea to carina and main bronchi
   f. evaluate hila for abnormal bulges/enlargement
   g. Trace periphery of chest and abdomen for air collection
3. Lateral View
   a. Judge the size/shape of lungs and diaphragm
   b. Follow airway from the neck to hilum. Note size/ shape of pulmonary arteries
   c. Note back of heart and increasing lucency towards diaphragm
   d. Look for increasing lucency of mediastinum behind sternum and towards the neck
   e. Follow spine inferiorly for increasing lucency
   f. evaluate diaphragm, then trace periphery of image forward through abdomen, up anterior chest and down posterior ribs to costophrenic angles

Question 2

List aspects of quality to look for within the preliminary radiographic search pattern.

Answer 2

1. Positioning: parts not seen?
2. Rotation: clavicles equidistant from spinous processes.
3. x-ray penetration: should see intervertebral disc space through heart shadow
4. inspiration: adequate if anterior 6th rip and posterior 9th rib above diaphragm shadow
5. Marker in upper right: patient left