CXR (DRSABCDE) Flashcards
D
Details
Patient name, age / DOB, sex
Type of film – PA or AP, erect or supine, correct L/R marker, inspiratory/expiratory series
Date and time of study
R
RIPE
Rotation – medial clavicle ends equidistant from spinous process
Inspiration – 5-6 anterior ribs in MCL or 8-10 posterior ribs above diaphragm, poor inspiration?, hyperexpanded?
Picture – straight vs oblique, entire lung fields, scapulae outside lung fields, angulation (ie ’tilt’ in vertical plane)
Exposure (Penetration) – IV disc spaces, spinous processes to ~T4, L) hemidiaphragm visible through cardiac shadow.
Define exposure
Exposure refers to the concentration, in air, of x-rays at a specific point and is the ionisation produced in a specific volume of air: E = Q / m where E is exposure, Q is the quantity of charge on the ions and m is the unit mass of air.
S
Soft tissue/bones
Ribs, sternum, spine, clavicles – symmetry, fractures, dislocations, lytic lesions, density
Soft tissues – looking for symmetry, swelling, loss of tissue planes, subcutaneous air, masses
Breast shadows
Calcification – great vessels, carotids
A
Airway and mediastinum
Start at the top in the midline and review the airways.
Trachea
- is it straight and midline?
- is there any narrowing?
- Paratracheal/mediastinal masses or adenopathy
Carina >100º?
- RMB/LMB narrowing?
- Inhaled foreign bodies?
Mediastinal width <8cm on PA film
- Aortic knob
Hilum – T6-7 IV disc level, left hilum is usually higher (2cm) and squarer than the V-shaped right hilum.
Check vessels, calcification.
B
Breathing
Lung Fields
Both lungs should be well expanded and similar in volume
Compare the apical, upper, middle and lower zones in turn
- Pneumothorax?
- Check outlines for abnormal opacity/lucency, atelectasis, collapse, consolidation, bullae
Horizontal fissure on Right Lung
Pulmonary infiltrates – interstitial vs alveolar pattern
Coin lesions
Cavitary lesions
Pleural thickening/reflection
Mediastinum
trace the cardiac borders
can you clearly see the left and right heart border?
can you see the descending aorta?
C
Circulation
Heart position –⅔ to left, ⅓ to right
Heart size – measure cardiothoracic ratio on PA film (normal <0.5)
Heart borders – R) border is R) atrium, L) border is L) ventricle & atrium
Heart shape
Aortic stripe - interface of the pleural surface of the anterior segment of the left upper lobe contacting the mediastinal fat that is anterolateral to the pulmonary trunk or left pulmonary artery and aortic arch
D
Diaphragm
Hemidiaphragm levels – Right Lung higher than Left Lung (~2.5cm / 1 intercostal space)
Diaphragm shape/contour
Cardiophrenic and costophrenic angles – clear and sharp
Gastric bubble / colonic air
Subdiaphragmatic air (pneumoperitoneum)
E
Everything else
Pneumoperitoneum
Gastric bubble
ETT, CVP line, NG tube, PA catheters
ECG electrodes, PICC line, chest tube
PPM, AIDC, metalwork
