Chest X-Ray Basics

Question 1

In PA view are the scapula visible or clear of the lung fields?

Answer 1

Clear of the lung fields

Question 2

What is important to remember about AP X-rays?

Answer 2

Report with caution.

Question 3

What should be noted about the heart and mediastinum in AP X-rays?

Answer 3

The heart and mediastinum can appear magnified due to increased distance of the heart from the detector and beam divergence. You should therefore never comment that the heart is enlarged on an AP view.

Question 4

Outline D for details in CXR interpretation.

Answer 4

D - Details of patient & radiograph (check labelling):

Projection (PA, AP)
Patient name, DOB, hospital no.
Date image taken (& note if any previous for comparison)
Side marker R/L noted

Question 5

Outline R for radiograph quality in CXR interpretation.

Answer 5

R - Radiograph quality (RIPE):

 Rotation (spinous process should be midpoint between medial heads of clavicle)
 Inspiration (5th - 7th anterior rib should intersect the diaphragm mid-clavicular line). 
 Penetration (vertebral bodies just visible behind the heart)
 Enough included (apices, costophrenic angles & lateral edges of ribs)

Question 6

Outline A for airway in CXR interpretation.

Answer 6

A - Airway:

Trachea - trace trachea & main bronchi

Question 7

Outline B for breathing in CXR intrepretation.

Answer 7

B - Breathing:

Lungs - zonal symmetry & normal lung markings. Second glance 4 lung areas- apices, hilar,
retrocardiac, bases below diaphragm
Pleura – trace pleural cavity

Question 8

Outline C for circulation in CXR interpretation.

Answer 8

C - Circulation (Cardiomediastinum):

Heart size - should be <50% thoracic diameter on PA.
Heart borders - well defined
Mediastinal contours - right paratracheal stripe (<3mm), aortic knuckle, aortopulmonary window
Hila – trace both hilar outlines – should be similar in size, density & concave contour

Question 9

Outline D for diaphragm in CXR interpretation.

Answer 9

D - Diaphragm, costophrenic angles (well defined) & below diaphragm

Question 10

Outline D for disability in CXR interpretation.

Answer 10

D - Disability -Bones & soft tissues:

Bones- vertebrae, ribs, clavicles, scapulae, humeri
Soft tissues – breast shadows, subcutaneous tissues

Question 11

Outline E for extras in CXR interpretation.

Answer 11

• Extras (lines, tubes, artefacts)