Xrays

Question 1

Outline the approach to Xray interpretation

Answer 1

DR(s) ABCDE

Details - name, age, DOB, AP/PA, when & where
RIPE - Rotation, inspiration, picture, exposure
Soft tissues and bones

Airway and mediastinum
Breathing
Circulation
Diaphragm
Extras (ETT, CVP, NG tube, PA catheters, ECG electrodes, PICC line, chest tube, PPM, AIDC, metalwork)

Question 2

What is included in the initial ‘D’?

Answer 2

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

Question 3

What does the R include?

Answer 3

Image quality

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.

Question 4

What does S include?

Answer 4

Soft tissue and bones

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

Question 5

What do you assess in A?

Answer 5

Trachea – central or slightly to right lung as crosses aortic arch

Paratracheal/mediastinal masses or adenopathy
Carina & RMB/LMB
Mediastinal width

Question 6

What do you assess for B?

Answer 6

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

Question 7

What are looking for C?

Answer 7

Circulation

Heart position –⅔ to left, ⅓ to right
Heart size – measure cardiothoracic ratio on PA film (normal

Question 8

What do you include for D? (Diaphragm)

Answer 8

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

Question 9

What extras?

Answer 9

ETT, CVP line, NG tube, PA catheters, ECG electrodes, PICC line, chest tube, PPM, AIDC, metalwork