Chest X-Ray Interpretation 2

Introduction to Chest X-ray Interpretation

• Focus of the video: systematic approach and normal chest X-ray anatomy.

• Learning objectives:

  • Familiarity with systematic approach for interpreting chest X-rays.

  • Understanding the correlation between anatomy and normal shadows on an X-ray.

Importance of a Systematic Approach

• Especially crucial for less experienced clinicians.

  • Reduces chance of missing important findings.

• All aspects of interpretation must be included.

• Sequence of examination should be logical and easy to remember.

• No single best system, but all should start with assessing film quality.

ABCDEF System for Chest X-ray Interpretation

• Informally referred to in teaching as the ABCDEF system.

• Commonly used in the US, though not perfect.

• Breakdown of the system:

  • A: Airways - trachea in midline, right & left main bronchus.

  • B: Bones and Soft Tissue - assessment of visible bones.

  • C: Cardiac Silhouette and Mediastinum - various structures of the heart.

  • D: Diaphragm - includes gastric air bubble.

  • E: Effusions - assessment of the pleura.

  • F: Fields - examination of the lung fields.

• Additional consideration: assessing lines, tubes, devices, and prior surgeries.

• Lungs evaluated near the end to avoid distraction from significant abnormalities.

Airway Structures (A)

• Key anatomical structures visible on normal X-ray:

  • Trachea - located midline.

  • Right Main Bronchus - more vertical angle.

  • Left Main Bronchus - more horizontal angle.

• Implications:

  • Increased likelihood of foreign body aspiration into right lung.

  • Risk of endotracheal tube misplacement into right bronchus.

Bones and Soft Tissue (B)

• Identifiable bones on PA/lateral X-ray:

  • Ribs: posterior and anterior components.

  • Clavicles: right and left visible.

  • Sternum: may be obscured on lateral view.

  • Vertebral Bodies: usually visible on PA when quality is adequate.

Cardiac Silhouette and Mediastinum (C)

• Components to evaluate:

  • Shapes and sizes forming the cardiac silhouette.

  • Notable structures include the aortopulmonary window (location for recurrent laryngeal nerve and lymph nodes).

• Visualization techniques:

  • Use drawings for anatomy understanding.

Diaphragm and Pleura (D)

• Diaphragm characteristics:

  • Right hemidiaphragm generally higher due to liver.

  • Curvature represents 3D structure; assess both views.

• Pleura:

  • Surrounds lungs, usually invisible due to thinness.

• Costophrenic angles:

  • Right and left angles assess pleural spaces.

  • Posterior costophrenic angle visible on lateral.

• Gastric air bubble under left hemidiaphragm indicates stomach position.

Lung Fields and Fissures (F)

• Structures to examine in lungs:

  • Fissures:

    • One horizontal fissure visible on right, not usually visible in left lung.

    • Two oblique fissures on right, and one on left.

  • Lobes:

    • Right lung: divided into three lobes (upper, middle, lower).

    • Left lung: divided into two lobes (upper, lower).

• Fissure visibility aids in localization of lung abnormalities.

Conclusion

• Recap of systematic approach and normal chest X-ray anatomy.

• Encouragement to like/share the video and notes.

• Next video will cover assessing technical quality of chest films.