Chest X-ray Flashcards
Begin chest X-ray interpretation by checking.….. (4)
Patient details
Date and time the film was taken
Type of film
Previous imaging
Why need to check Previous?
useful for comparison
To Assess image quality (4)
RIPE
Projection
Rotation
Degree of inspiration
Exposure
Projection
Is the image AP or PA
The image is PA when (2)
there is no label
the scapulae are not projected within the chest
To check for rotation see (2)
The medial aspect of each clavicle should be equidistant from the spinous processes
Spinous processes should also be vertically orientated against the vertebral bodies
Degree of Inspiration
The depth is
The 5 - 6 anterior ribs or 9 -10 posterior ribs
Degree of Inspiration
Field
Lung apices,
both costophrenic angles,
and the lateral rib edges
should be visible
Exposure (Penetration)
Left hemidiaphragm should be visible to the spine and the vertebrae should be visible behind the heart
ABCDE Approach
Airway: trachea, carina, bronchi and hilar structures
Breathing: lungs and pleura
Circulation: Heart position, Heart size, Heart borders, Heart shape, Aortic stripe
Diaphragm: including assessment of costophrenic angles
Everything else: mediastinal contours, bones, soft tissues, tubes, valves, pacemakers, and review areas
Trachea is normally located
centrally or deviating very slightly to the right
Carina is
A cartilage situated at the
tracheal bifurcation
Rt main bronchus is .….. than the Lt.
wider, shorter & more vertical
Hila are
usually the same size
Lt hilum is .….. Than the Rt
often slightly higher
Hilar lymph nodes are
Not usually visible
Bilateral/ symmetrical enlargement (4)
sarcoidosis, Lymphoma, metastatic disease & tuberculosis
Unilateral/asymmetrical enlargement of hilar (2)
Breast cancer, metastatic disease
Abnormal hilar position
Being pushed
enlarging soft tissue mass
Abnormal hilar position
Being Pulled (2)
lobar collapse or fibrosis
Breathing check for
lungs and pleura
pleura is
Normally not visible
Heart position
2⁄3 to left, 1⁄3 to right
Heart Size
occupies no more than 50% of chest width
Heart’s borders
Right atrium makes up most of the right heart border &Left ventricle makes up most of the left heart border.
Abnormal Heart shapes (3)
Global
Boot
Egg
Aortic stripe are
bands that result from air outlining thicker intervening mediastinal structures
Aortic stripe (3)
Rt &Lt paraspinal stripes
Aortopulmonary stripe
Rt &Lt paratracheal stripes
right hemidiaphragm is ……. than the left
higher
Stomach underlies the
left hemidiaphragm
Diaphragm is indistinguishable from the underlying
Liver
Costophrenic angles are
formed from the dome of each hemidiaphragm and the lateral chest wall.
Loss of this acute angle called
blunting
Loss of this acute angle can be due to (2)
Effusion
Hyperinflation
Mediastinum contains (4)
heart, great vessels, lymphoid tissue & several potential spaces
Aortic knuckle
can occur in the context of an aneurysm
Aortopulmonary window is lost as a result of
mediastinal lymphadenopathy eg: malignancy
Ribs, sternum, spine, clavicles
Look for (5)
symmetry, fractures, dislocations, lytic lesions, density
Soft tissues
Look for (5)
symmetry, swelling, loss of tissue planes, subcutaneous air, masses
great vessels, carotids
Look for
Calcification
After checking Soft tissues check
Breast shadows
