Chest X-ray Flashcards
What are the first things that must be done when interpreting a CXR?
Confirm patient details
Date and time film was taken
Any previous images for comparison
After checking the patient details, date and time etc. what should be done next when looking at a CXR?
Assess image quality
What pnemonic can be used to assess image quality?
RIPE
R - Rotation
I - Inspiration
P - Projection
E - Exposure
How can you tell if a patient has rotated during the x-ray?
The medial aspect of each clavicle should be equidistant from the spinous processes
The spinous processes should always be vertically orientated against the vertebral bodies
How can you tell if a patient has fully inspired during their x-ray?
The following are visible:
- 5-6 anterior ribs
- lung apices
- both costophrenic angles
- lateral rib edges
What are the 2 different types of CXR projection?
AP - Anterior posterior
PA - Posterior anterior
If the scapulae are NOT projected on a CXR, then what orientation must the image be?
PA
What are the different steps of interpreting a CXR?
A - Airway
B - Breathing
C - Cardiac
D - Diaphragm
E - Everything else
What are the components of the airway assessment in a CXR?
Trachea - is it deviated?
Carina - A good landmark to use when assessing NG tube placement (NG tube should bisect carina as it passes through oesophagus)
Hilar structures - lymph nodes (not visible in health), size asymmetry (symmetrical enlargement = sarcoidosis, asymmetrical = malignancy)
What are the components of assessing breathing in a CXR?
Lungs - each lung divided into 3 zones and inspect each zone in turn, comparing sides
Pleura - Should not be visible in health, if visible this could be a pleural thickening
Lung borders - should extend all the way out to edge of lung fields, if not then this could be a pneumothorax
What are the components of cardiac assessment of a CXR?
Cardiac size - can only be assessed when PA film is used and the heart should only occupy 50% of the thoracic width
Assess heart borders - should be well defined
What are the components of the diaphragm assessment in CXR’s?
Right hemidiaphragm - higher than the left due to the liver and should be indistinguishable from the underlying liver (if free gas is present between liver and diaphragm this could indicate bowel perforation)
Left hemidiaphragm - located above the stomach (which can be identified by a gastric bubble)
Costophrenic angles - should be clearly visible in health as a well defined acute angle. Loss of costophrenic angle can suggest fluid or consolidation, or it can also be seen in COPD due to hyperinflation of the lung.
What are the components of the ‘everything else’ part of CXR interpretation?
Mediastinal contours - aortic knuckle (loss of knuckle can be caused by aneurysm), aorto-pulmonary window (loss of space between pulmonary arteries and arch of aorta caused by lymphadenopathy)
Bones - Rib fractures/lytic lesions
Soft tissues - haematoma
Tubes/valves/pacemakers - NG tubes, central line, ECG cables, pacemaker
