CXR

Question 1

What acronym is used for CXR interpretation?

Answer 1

DR (ripe) ABCDE

Question 2

CXR: DR ABCDE

Answer 2

Details - patient details

AP/PA refers to Anteroposterior and Posteroanterior positions.

Question 3

CXR: DR(ripe) ABCDE

Answer 3

Rotation:
Clavicles equidistant from vertebral spinous processes

Question 4

CXR: DR(ripe) ABCDE

Answer 4

Inspiration:
Count the anterior ribs (normal = 5-6 anterior, 8-10 posterior)

Question 5

CXR: DR(ripe) ABCDE

Answer 5

Position:
AP (heart looks bigger, clear scapular borders) or PA (assume, most common)

Question 6

CXR: DR(ripe) ABCDE

Answer 6

Exposure - underexposed (XR looks too white), overexposed (dark film) - vertebral bodies should be seen behind cardiac body

Question 7

CXR: DR ABCDE

Answer 7

Airway
* Trachea deviation (pushed away or pulled towards)
* Hila of the lungs (may enlarge in certain conditions e.g. LN enlargement)
* Carena - bifurcation of bronchi (R bronchus straighter then L)
Pushed away or pulled towards

Question 8

What might an enlarged hila of the lungs suggest?

Answer 8

Lymph node enlargement e.g. scarcoidosis

Question 9

Which bronchus is straighter, the right or left?

Answer 9

Right bronchus

Question 10

How are lung fields split?

Answer 10

Into 3 ZONES - superior, middle, inferior

Question 11

CXR: DR ABCDE

Answer 11

Breathing
* Lung fields (split into 3 ZONES - superior, middle, inferior)
* Description: diffuse/dense + location
* Pleura (can you see it? = mesothelioma)Diffuse/dense + location

Question 12

What condition can be indicated if the pleura is visible?

Answer 12

Mesothelioma

Question 13

How is cardiomegaly diagnosed?

Answer 13

Over 50% of the chest = enlarged - cannot be diagnosed on an AP film

Question 14

What is the normal position of the heart?

Answer 14

1/3 right, 2/3 left

Question 15

CXR: DR ABCDE

Answer 15

Cardiac
* Cardiomegaly (over 50% of the chest = enlarged) - cannot be diagnosed on an AP film
* Position (1/3 right, 2/3 left)
* Cardiac margins - RA (right), LV(left)
* Shape e.g. cardiomyopathy, pericardial effusion
* Mediastinum (widening - aortic dissection)RA (right), LV (left)

Question 16

What does widening of the mediastinum indicate?

Answer 16

Aortic dissection

Question 17

What condition is indicated by pneumoperitoneum?

Answer 17

Air under the diaphragm due to perforation

Question 18

CXR: DR ABCDE

Answer 18

Diaphragm
* Blunting of costo-phrenic angles?
* Pneumoperitoneum (air under the diaphragm due to perforation)

Question 19

CXR: DR ABCDE

Answer 19

Everything else
* Bones (fractures)
* Aortic knuckle distention? - arch of the aorta (calcification)
* Medical interventions?
* Soft tissue?