CXR How To Flashcards
What are the two options for projection?
AP vs PA
Which projection is more common?
PA
When is AP done?
haemodynamically unstable (sick patients) crAP
What position is a patient in for AP and PA?
PA: standing/sitting
AP: supine
What is the scapulae like in PA and AP?
PA: scapulae not overlapping lung fields
AP: scapulae overlapping lung fields
What is the heart like in PA and AP
PA: no cardiac magnification
AP: cardiac magnification
Can you comment on heart size in AP?
NOOO
What is the air fluid level like in AP vs PA?
PA: air fluid level seen in stomach
AP: no air fluid level seen in stomach
What must you mention in patient details?
- Name
- DOB/Age
- When film taken
- Indication for film
What do you need to check for in technical quality?
- Can you see lung apices?
- Can you see lateral border of ribs?
- Can you see costophrenic angle?
What does RIP stand for?
Rotation, Inspiration and Penetration
What do you look for in rotation?
Medial end of clavicle should be equidistant from spinous process of vertebral bodies
What do you look for in inspiration?
adequate inspiratory effect: can see 6 anterior ribs and 10 posterior ribs
What is good penetration?
able to see vertebral bodies behind the heart
What colour would an overpenetrated film be?
black
Why is it important to comment on rotation?
If patient is rotated makes it harder to comment on mediastinum shift
How should the heart occupy the chest on a CXR?
1/3 right side and 2/3 left side
What is an example of an opening phrase?
- This is a frontal chest radiograph of a young make patients
- The patient has taken a good inspiration and is not rotated and the film is well penetrated
What obvious abnormalities should you look for?
- Which lung?
- Which zone/lobe
- Size?
- Shape: well/poorly demaracted
- Density/texture: uniform/patchy/dense
What is the ABCDE approach for CXR?
- Airway
- Breathing
- Circulation
- Diaphragm
- Extras
What do you comment on in airway?
Is trachea deviated
When would trachea be deviated away?
- Tension pneumothorax
2. Large pleural effusion
When would trachea be deviated towards?
- Collapsed lung
2. Pulmonary fibrosis
How do you assess ‘breathing’?
start from apices and work down to costophrenic angle comparing the right and left field
What must you inspect in the breathing category?
- Apices
- Hila
- Mediastinum
- Edges of lung
Which hilum is always higher?
left hilum should always be higher than right
Which hila is denser?
hila should be same density
What goes under circulation?
- Cardiomegaly
- Cardiac borders
- Cardiophrenic angle
When is it cardiomegaly?
heart shadow more than 50% width of chest cavity on PA film
What should the cardiac border and cardiophrenic borders be like?
clear
Which hemidiaphragm should always be higher?
Right
What should you look for in the diaphragm section?
- Note the shape and curvature
- Costophrenic angles clear/blunted?
- Air under diaphragm?
What could air under diaphragm suggest?
pneumoperitoneum
What is a good example of a chest summary?
- Trachea is central
- Mediastinum is not displaced
- Mediastinal contours and hila appear normal
- Lungs appear clear with no pneumothroax
- No free air under the diaphragm
- Bones and soft tissue appear normal
- If find nothing look at review areas
What are review areas?
- Apices
- Periphery of lungs
- Under/beneath hemidipahragm
- Behind the heart
What are examples of extras?
leads, pacemakers, surgical emphysema
What is an example of how to present finding?
- This is an AP chest radiography of X taken on Y
- It is a technically adequate film: not rotated has adequate rotation, and good inspiratory effort. There are no important areas cut off at the edges of the film
- Most striking abnormality is X
- Reviewing the rest of the film…
- In summary this chest radiograph shows X
- The most likely diagnosis is X although A, B and C may also be likely
