CXR Flashcards
What do you check before ABCDE?
Name of patient
Date of x ray
AP/PA
RIP
What is the ABCDE approach?
Airways lung and pleura Bones Circulation Diaphragm Extras
What is B?
Bones
Ribs, clavicles, humourous, spine
Fractures
Metastatic deposits
Arthitis/dislocation in shouldert
What is C?
Circulation: heart and mediastinum
Assess size, shape and border.
Cardio:thoracic ratio - less than 50% in PA
What is D?
Diaphragm
Dome with a sharp white edge
Right is normally higher than left due to liver.
Look at costophrenic and cardiophrenic angles. Left cardiophrenic angle can be blurred - NW!
What is E?
Extra features and review.
E.g. monitoring, pacemaker, tubes
Look at apex and hilums, soft tissues, under diaphragm
Left hilum is either higher than right or at same level
How do you know if it is a PA or AP?
If it is PA the scapulae should be out of the way, whereas in AP the scapulae will the overlapping the rib cage
Which is better, PA or AP?
PA because the heart is magnified in AP so it is not as reliable
What is A?
Airway, lungs, pleura
Look at the trachea, is it central?
The lungs on an xray are divided into upper, middle and lower zones (not correlated with lobes).
Look at the lung space working from the apex down - check for differences in either side - too black or too white?
Look for the lung markings and make sure they go all the way to the edges of the lung. If there is a lung edge, suspect pneumothorax.
If you see something but don’t know how to describe it, what do you say?
Increased/abnormal density
What is RIP?
Rotation: spinous processes between the collar bones
Inspiration: 5-7 ribs should be visible
Penetration: Is the spine visible behind heart?
What structures make up the left border of the heart in a CXR?
top-down Aortic knuckle Pulmonary outflow artery Left atrial appendage Left ventricle
What structures make up the right border of the heart in a CXR?
SVC
Right atrium
IVC
How to summarise a CXR?
In summary this is a PA chest x-ray of Mr Smith. The film is technically adequate (or over/underexposed). On review of the film there is XYZ. I would now like to review the patient clinically.
