CXR Interpretation

Question 1

First things to do when doing CXR interpretation? (demographics)

Answer 1

Patient name, DOB, hospital number, age, sex

Previous films

Question 2

What details do you want to figure out before starting to interpret?

Answer 2

Date

Type (AP or PA, inspiration or expiration, standing or supine)

Question 3

How to assess the adequacy of the film?

Answer 3

RIPE

Rotation - medial borders of clavicles equidistant from a spinous process
Inspiration - at least 5-6 anterior ribs visible above the diaphragm
Picture area - lung apices, costodiaphragmatic recesses, scapula out of the way.
Exposure - vertebral bodies should be just visible through lower part of cardiac shadow

Question 4

What does ABCDE stand for in interpretation?

Answer 4

Airway
Breathing
Circulation
Diaphragm
Extra things

Question 5

What looking for in A?

Answer 5

Tracheal deviation - may indicate rotation, pneumothorax or large effusion

Question 6

What looking for in B?

Answer 6

Compare the lung fields in thirds (upper, middle and lower zones)

• Air (in pneumothorax)
• Fluid (effusions)
• Consolidation (inflammation in infection)
• Lobar collapse
• Lesions

Pleural thickening
Hilar region - for lymphadenopathy, masses and calcification

Question 7

What looking for in C?

Answer 7

• Heart size -

Question 8

What looking for in D?

Answer 8

Position and shape - right slightly higher due to liver, flat in COPD
Costaphrenic angles - blunting indicates effusions
Air below diaphragm - abdominal viscus perforation

Question 9

What looking for in E?

Answer 9

Bones - trace around ribs for fractures if clinically suspicious
Soft tissues - look for swelling, subcutaneous air, masses, calcification of aorta

Question 10

What are the review areas?

Answer 10

Apices, peripheries of lungs, under hemidiaphragms and behind heart.

Question 11

How do you describe the density of an abnormality?

Answer 11

Bone/soft tissue/fat/air density

Uniform or non-uniform density

Question 12

How do you describe the position of an abnormality?

Answer 12

Left or right
Upper, middle or lower zone
Anatomical position (lung parenchyma or pleural space)
Size
Borders

Question 13

What does a collapse look like?

Answer 13

Uniform soft tissue density (pure white)
Affected lobe smaller
Other structures move into empty space

Question 14

What does consolidation look like?

Answer 14

Non-uniform soft tissue density (blotchy white)

Question 15

What does effusion look like?

Answer 15

Uniform soft tissue density
Meniscus sign
Blunting of costophrenic angles

Question 16

What does pneumothorax look like?

Answer 16

Normal lung lobes but partially deflated
Uniform air density lateral to the pleura
Seen better on expiration film

Question 17

Differentiate between a collapse and an effusion?

Answer 17

• Both uniform soft tissue density
• Effusion has a meniscus
• Surrounding structures pulled TOWARDS a COLLAPSE but AWAY from an effusion