CXR Interpretation

Question 1

How should the CXR be introduced?

Answer 1

Name of patient, date/time it was taken, anatomical area and projection

Question 2

How should the quality of the film be assessed?

Answer 2

Rotation- are the clavicles equidistant from the spinous processes?
Inspiration- are at least 5-7 anterior ribs visible?
Penetration- is the spine visible behind the heart?
Artefacts- oxygen tubing, NG tubes, central lines

Question 3

Why can the cardiothoracic ratio only be interpreted with a PA film?

Answer 3

AP film exaggerates the cardiac contour

Question 4

Systematic approach to CXR interpretation? ABCDE-R

Answer 4

Airways- trachea, bronchi, hilar structures

Breathing- lung zones and pleura

Cardiac- heart size and heart borders

Diaphragm- free gas, contour, costophrenic angle

Everything else- mediastinum, bone, soft tissue, gas anywhere other than the lungs

Review areas

Question 5

What are the review areas? (ABCDE)

Answer 5

Apices- check for small pneumothoraces
Bones
Cardiac shadow
Diaphragm
Edge of the image