CXR

Question 1

Introduction

Answer 1

Patient demographics

Previous films for comparison

Question 2

Radiograph detail

Answer 2

Date
Type
Adequacy (RIPE)
Rotation: medial borders of clavicals should be equidistant from nearest spinous processes
Inspiration: at least 5-6 anterior ribs above diaphragm
Picture area: lung apices and costodiaphragmatic recesses should be visible; scapulae should be out of the way
Exposure: vertebral bodies should be visible through the lower part of the cardiac shadow

Question 3

Interpretation (ABCDE)

Answer 3

Airway - tracheal deviation
Breathing: lung fields, pleura, hilar region
Circulation: heart size, heart position, heart shape and borders, great vessels, mediastinal width (<8cm)
Diaphragm: position and shape, costophrenic angles, air below diaphragm
Extra things: bones, soft tissue

Question 4

To complete

Answer 4

‘To complete my analysis I would examine previous films and ascertain the clinical history’
Summarise and suggest differentials

Question 5

Describing the abnormality

Answer 5

Density - uniform or non-uniform
Left or right 
Zone - upper, mid, lower
Anatomical position 
Size
Borders

Question 6

Diagnosing the abnormality

Answer 6

Consolidation - non-uniform soft tissue density, ‘air bronchogram’
Collapse - uniform soft tissue density, affected lobe is smaller, other structures move towards the empty space
Effusion - uniform soft tissue density, meniscus sign, fluid at lung bases if erect or along posterior thorax if supine
Pneumothorax - normal lung lobes but partially deflated, uniform air density (usually at top if erect), seen better on an expiration film, look very carefully around pleura

Question 7

COPD

Answer 7

Hyperinflation (>8 anterior ribs)
Flat hemi-diaphragms 
Decreased lung markings
Black lesions (bullae)
Prominent hila

Question 8

Heart failure

Answer 8

Alveolar shadowing ('bats wings')
B-lines (interstitial oedema)
Cardiomegaly 
Diversion of blood to upper lobe
Effusion