Evaluation of CXR

Question 1

What should you do upon first seeing a radiograph?

Answer 1

• Verify patient information and date on both films
• Verify position of the left/right marker
• Note adequacy of penetration, rotation, inspiration, and assess for any technical defects like motion blur
• Look briefly for any glaring abnormalities

Question 2

What should you do with a frontal radiograph?

Answer 2

• Study the lungs up and down and side to side
• Note lung volumes and symmetry of lung markings
• Check periphery of lungs for pneumothorax or effusions
• Evaluate mediastinal contours, edges, and shape
• Follow trachea, carina, and main bronchi
• Look at both hila for enlargement and abnormal bulges
• Trace periphery of chest well, bones, diaphragms, and upper abdomen for free gas

Question 3

What should you do with a lateral radiograph?

Answer 3

• Judge the size and shape of the lungs and diaphragms
• Follow the airway from the neck to the hilum
• Note shape of pulmonary arteries
• Note behind the heart, look for more lucency toward the diaphragm
• Look upward in the anterior chest wall for darkening
• Follow spine downward for vertebral bodies and darkening
• Evaluate diaphragm contours
• Trace periphery up through abdomen, up anterior chest wall, down posterior ribs to costophrenic angles