CXR

Question 1

What are the first things you should check on a CXR?

Answer 1

Patient identity

Check if it’s an AP or PA

Question 2

How do you check the technical quality of a CXR?

Answer 2

Rotation: the heads of the clavicles should be equidistant from the spinus process of the vertebrae.
Inspiration: should be able to see 6 anterior ribs as a deep breath has to be taken for a PA film

Question 3

When looking at a CXR what structures should you look at?

Answer 3

Trachea
Mediastinum
Hila
Heart 
Diaphragm

Question 4

What should you be looking for when checking the trachea and why?

Answer 4

If it’s central
If it’s deviated by collapse
Or by tension pneumothorax

Question 5

What should you be looking for when checking the mediastinum and why?

Answer 5

On the left border:
- the aortic knuckle
- the pulmonary outflow tract
- the left ventricle
These things may be shifted towards the collapsed lung or away due to increased lung volume (eg: in an effusion)

Question 6

What should you look for when checking the hilum?

Answer 6

If they are symmetrical (in size and density)

If there is any calcification

Question 7

What should you check when looking at the heart?

Answer 7

The size: id should be approx half the width of the thorax with one third lying to the right and 2/3 to the left

Question 8

What are you looking at when checking the diaphragm?

Answer 8

The costophrenic angles (making sure they are well defined)

Noting that the right side is often higher due to the liver

Question 9

What would you see on a CXR if a patient had pneumonia?

Answer 9

Consolidation as the airway is full of pus

You may also see shadowing and the heart border can be obscured.