cxr Flashcards
from geeky medics
List the steps of going through an xray
- Confirm details
- Asses Image quality (RIPE)
- CXR Interpretation (ABCDE)
What does RIPE stand for?
Rotation
Inspiration
Projection
Exposure
What does ABCDE stand for?
Airway Breathing Cardiac Diaphragm Everything else
How do you asses rotation?
The medial aspect of each clavicle should be equidistant from the spinous processes
The spinous processes should also be in vertically orientated against the vertebral bodies
How do you asses inspiration?
5-6 anterior ribs
The lung apices
Both costophrenic angles
Lateral rib edges should be visible
How do you asses projection?
AP vs PA film
Tip- if there is no label, then assume it’s a PA. Also, if the scapulae are not projected within the chest, it’s PA.
How do you asses exposure?
Left hemidiaphragm visible to the spine and vertebrae visible behind heart
List the things you should interpret for AIRWAYS
Trachea
Carina and Bronchi
Hilar structures
How do you asses the trachea?
The trachea is normally located centrally or just slightly off to the right
If the trachea is deviated, look for anything that could be pushing or pulling at the trachea.
Also inspect for any paratracheal masses/lymphadenopathy
What do abnormal tracheal deviation findings mean?
Pushing of trachea – e.g. large pleural effusion / tension pneumothorax
Pulling of trachea – e.g. consolidation with lobar collapse
Rotation of the patient can give the appearance of a deviated trachea, so as mentioned above, check the clavicles to rule out rotation as the cause.
How do you asses the carina and bronchi?
The carina is located at the point at which the trachea divides into the left and right main bronchus.
On a good quality CXR this division should be visible and is an important landmark when assessing nasogastric tube placement, as the NG tube should bisect the carina if it is correctly placed
Which bronchus is wider?
The right main bronchus is generally wider, shorter and more vertical than the left main bronchus. As a result it is more common for inhaled foreign objects to become lodged here (as the route is more direct).
How do you asses hilar structures?
The hilar consist of the main pulmonary vasculature and the major bronchi.
The hilar are usually the same size, so asymmetry should raise suspicion of pathology
What do bilaterally symmetrical enlarged hila mean?
Associated with sarcoidosis.
What do unilaterally asymmetrical enlarged hila mean?
Underlying malignancy