Reading a CXR

Question 1

Useful way to remeber the steps of reading a CXR

Answer 1

A-G

Assessment of quality, air where it shouldn’t be

Bones, body wall

Cardiac silhouette and size

Diaphragm

Equipment, effusion

Fields

Great vessels

Question 2

The first steps of reading a CXR

Answer 2

Confirm details

Patient name, date of birth

When image taken

Previous images available?

Question 3

How can we assess the quality of a CXR?

Answer 3

RIPE

R - rotation: medial aspect of each clavicle should be equidistant from the spinous processes

I - inspiration: 5-6 anterior ribs should be visible as well as lateral rib edges and costophrenic angles

P - projection: Note if it is a PA or an AP view - if there is no label assume it is PA

E - exposure: left hemidiaphragm should be visible and the vertebrae should be visible behind the heart

Question 4

‘A’ of CXRs

Answer 4

A = assessment and airway

Assessment: assess the quality of the image e.g. rotation (rotation intoroduces unwanted variation), inspiration (if the lungs are not fully inflated we may miss important diseases)

Air: where it should not be e.g. pneumothorax, pneumomediastinum, pneumoperitoneem and subcutaneous emphysema

Airway: e.g. tracheal deviation

Question 5

‘B’ of CXRs

Answer 5

B = Bones + body wall

Start by looking at clavicles then each rib sequentially to rule out fractures etc

Body wall: look at sft tissue outside of ribs for swelling, masses etc

Question 6

‘C’ of CXRs

Answer 6

C = cardiac silhouette and size

The diameter of the heart should be <50% of the total diameter of the rib cage

Question 7

‘D’ of CXRs

Answer 7

D = diaphragm

Look for symmetrical diaphragm appearance - the right is often higher than the left due to the liver

Look for costo-phrenic and cardio-phrenic angles