Chest X-Rays

Question 1

Centering and density of film

Answer 1

• The sternal ends of the two clavicles should be equidistant from the shadow of the vertebral spinds. The assessment of the density of the film can only be learned by experience but in a normal film the bony cage should be clearly outline and the larger vessels in the lung fields clearly visible.

Question 2

General shape

Answer 2

Any abnormalities in the general form of the thorax should always be noted before other abnormalities are described

Question 3

Bony cage

Answer 3

The thoracic vertebrae should be examined first and then each of the ribs inturn and finally clavicles and scapulae.

Question 4

The domes of the diaphragm

Answer 4

These should be examined for height and symmetry and the nature of the cardiophrenic and costophrenic angles observed

Question 5

The mediastinum

Answer 5

The outline of the mediastinum should be traced systematically

Question 6

Lung fields

Answer 6

Again, systematic examination of the lung fields visible in each intercostal space necessary if slight difference between two sides are not to be overlooked

Question 7

How to examine chest x-rays: It May Prove Quite Right but Stop And Be Certain How Lungs Appear

Answer 7

I: identification (name, age, sex, indication for X-ray)
M: Markers (left or right)
P: postion - the spinous process of T4 should be between the heads of the clavicle
Q: quality- is the film penetrated properly behind the central shadow
R: respiration- chest X-rays are typically done with full inspiration
S: soft tissue, look for subcutaneous emphysema, soft tissue swelling
A: abdomen, for free abdominal air
B: bone, fractures that tend to be at the lateral aspects because of the mechanics
C: Central shadow greater than 50% of lateral distance in frontal view at the diaphragm suggest cardiac enlargement
H: hila can be affected in lung disease, malignant processes and infection
L: lungs for consolidation, interstitial lung disease
A: Absent structures/ apices of the lung