X-ray interpretation

Diagnostic test

CT has a better ___ Than chest x-ray

Common

Chest x-ray is more ____ than CT

• History of patient

• Physical exam

What else do we look at other than chest x-ray to interpretation the chest-x ray

Common and accurate

PA view is more

Common. For patient that cannot stand up right

AP is less

• patient name and date of birth

• Film markers (Left or right)

• Film technique (Upright, supine, PA, AP)

First Thing you do and look at the x-ray

• penetration

• Inspiration

• Rotation

• Completeness

PIRC stands for

Look for lower thoracic vertebrate and Visible through heart

Penetration

Full inspiration (10-11 ribs)

inspiration

Correct position ( Center point between clavicular heads lines up with tips of spinous process

Rotation

Need to be able to visualize everything on the film

Completeness

Make the mediastinum appear widened or displaced, Make give the appearance of pleural effusion

Supine Film Can be inaccurate due to

• Geographic

• Targeted

• ABC’s

Different approach to interpretation

dividing the image into distinct regions or zones. This ensures all areas are reviewed for pathology, reducing the chances of missing an abnormality

Geographic approach

Uses image the precisely identify and focus on a specific area or target within a patient or object

Targeted approach

A mnemonic or memory aid that guides a systematic review of various components of the image to ensure nothing is missed

ABC’s approach

• airway

• Bone

• Cardio mediastinum

• Diaphragm

• Everything else

• Lung fields

ABC’s stands for

Formed when there is loss of normal air/fluid interface possible location.

• RML: Loss of right heart border

• RLL: Loss of right hemidiaphragm

• Lingula: Loss of left upper Heart border

Silhouette Signs

• consolidation

• Silhouette signs

• Spine sign

• Air bronchograms

• Increase interstitial Markings

Pneumonia hallmarks

• Kerley B lines

• Thickened interlobar fissure

• Perihilar (Fullness)

• Cardiomegaly

• Effusion

Pulmonary edema

Lateral decubitus (88%)

Best X-ray

Upright, CXR 59%

Supine AP 37%

Next best x-ray are

• Upright position look for air apically

• Supine look for deep sulcus

Pneumothorax hallmarks

Patient that performing force exhalation against a closed glottis

Pneumomediastinum caused by

• THC

• Cocaine

• Athlete

• Asthmatic

• Severe coughing

Pneumomediastinum can find in pt that has/use

Boehaave’s sundrome

Pneumomediastinum and pleural effusion on x-ray