How to read CXR (copy)

What is the first thing you should always do when interpreting an Xray?

patient’s identifies, age, sex, and relevant medical history

What is anteroposterior (AP) film?

XR beam passes front to back; common in portable xrays

XR beam is anterior (pt’s chest)

XR film is posterior (pt’s back)

What is posteroanterior (PA) film?

xray beam passes from back to front; standard for ambulatory pts

XR beam is posterior (pt’s back)

XR film is anterior (pt’s chest)

What kind of film should you always assume if there is no label?

PA film

What is portable film?

often AP, used for bedridden pts

What is lateral film?

side view, often used to complement PA/AP views

what does it mean to check for correct exposure?

check for adequate penetration (spine visible behind the heart) and proper contrast

What is the standard position for PA and lateral films?

upright

What position is common in critically ill or bedridden patients?

supine

What position is used to detect pleural effusions?

decubitus (lying on their side)

How should the diaphragm be positioned?

below 7th rib anteriorly for good inspiratory effort (poor inspiratory effort can mimic pathology)

How wide does that heart gave to be to be considered cardiomegaly?

more than half the thoracic width

How should cardiac borders normally be?

distinct w/ normal contours

What can tracheal deviation indicate?

tension pneumothorax or mass effect

when checking mediastinal contours, what are you looking for?

widening or abnormal contours; be sure to identify key structures (SVC, RA, IVC, aortic arch, L pulm trunk, LA, LV, L cardiophrenic angle)

What does mediastinal shift indicate?

volume loss or mass effect; (ensure hila are in correct position when checking)

What does blunting of costophrenic angle indicate?

fluid accumulation / pleural effusion

Where should endotracheal tube be placed?

at least 1 cm above carina

Where should nasogastric tube be positioned?

past the gastro-esophageal junction

What are you looking for in lung infiltrates, masses, and nodules?

areas of increased opacity

Where would you see a gastric bubble?

hemidiaphragms; check for elevation or abnormal positioning

What things are you looking at when reading a CXR?

age/sex/history:

film type:

position:

inspiratory effort:

structures:

What are common high miss areas / blind spots?

behind the heart and hemidiaphragms, lung apices, costophrenic angles, lytic rib lesions, and shoulders

What are the routine CXRs?

PA and lateral view with pt upright

What films can make the heart appear enlarged and lungs hypo inflated?

AP and supine film

What films are used to view the apices of the lungs?

lordotic films

What films are useful for identifying pleural effusions?

lateral decubitus films

What view is helpful for detecting pneumothorax?

expiratory view

What type of film is positioned like this?
scapula in the periphery, clavicles project over lung fields, posterior ribs are distinct

PA

what type of film is positioned like this?
scapula over lung field, clavicles above the apex of the lung, anterior ribs are distinct

AP

What indicates adequate inspiratory effort?

visualization of more than 7 ribs

What is the normal size of the heart?

less than half the width of the thoracic

What should you compare your xrays to?

old films- detect new diseases and evaluate changes in preexisting conditions

When do you decide on a differential diagnosis?

after a systematic review; decide on abnormalities, correlate w/ clinical information, and determine further evaluation steps

Where are you looking for bone abnormalities?

ribs, clavicles, and spine- looking for fractures, lesions, or deformities

What should you be able to see in normal exposure?

visualization of the vessels to at least the peripheral 2/3 of the lung