Chest X Ray

Question 1

First thing to check on x ray

Answer 1

Patient details,
Date and film
Previous imaging

Question 2

2. Assess image quality

Answer 2

RIPE:
Rotation: clavicles equal distance from spine
Inspiration: 5-6 anterior ribs costophrenic angles
Projection: AP or PA, if you can’t see scapulas it’s PA (most in itu are AP)
Exposure: vertebrae should be visible behind the heart

Question 3

3. ABCDE approach

Answer 3

A-trachea (central) carina (T4), bronchi and hilar structures
B-lungs and pleura
C-heart size and borders
D-diaphragm, costophrenic angles
E-everything else, bones, tissue, tubes, valves, pacemakers, REVIEW again

Question 4

What are hilar structures

Answer 4

Main pulmonary vasculature and major bronchi
Contains lymph nodes
Should be symmetrical

Question 5

What are lung areas referred to as

Answer 5

Zones 1,2 & 3
Top, middle bottom..

Question 6

What indicates pneumothorax

Answer 6

Lack of lung markings

Question 7

Pleura

Answer 7

Not usually visible in healthy individuals
Ensure lung markings extent to the edges

Question 8

Cardiac

Answer 8

Assess heart size, should be less than 50% in PA film

Question 9

Diaphragm

Answer 9

Right hemidiaphragm higher than left due to the liver. Left hemidiaphragm can be identified by an underlying stomach with air gastric bubble
Should never be air in right side

Question 10

Costophrenic angles

Answer 10

In healthy pts should be acute well defined angle between hemidiaphragm and chest wall
Loss of angle / costophrenic blunting can indicate fluid or consolidation.
May also be present in COPD

Question 11

Everything else

Answer 11

Aortic knuckle
Aorta pulmonary window
Bones
Tubes, valves, pacemakers, lines,