How To Read CXR Flashcards
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
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.
Soft tissue & bone
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
Airway & mediastinun
Trachea – central or slightly to right lung as crosses aortic arch
Paratracheal/mediastinal masses or adenopathy
Carina & RMB/LMB
Mediastinal width
Breathing
1- Lung fields
Vascularity – to ~2cm of pleural surface (~3cm in apices), vessels in bases > apices
Pneumothorax – don’t forget apices
Lung field outlines – abnormal opacity/lucency, atelectasis, collapse, consolidation, bullae
Horizontal fissure on Right Lung
Pulmonary infiltrates – interstitial vs alveolar pattern
Coin lesions
Cavitary lesions
2- Pleura
Pleural reflections
Pleural thickening
Circulation
Heart position –⅔ to left, ⅓ to right
Heart size – measure cardiothoracic ratio on PA film (normal
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)
Extras
ETT, CVP line, NG tube, PA catheters, ECG electrodes, PICC line, chest tube
PPM, AIDC, metalwork
How to read CXR?
DETAILS RIPE Soft tissue & bone Airway & mediastinum Breathing Circulation Diaphragm Extra
