Basics to read a CXR

Question 1

What acronym is used to read a CXR?

Answer 1

DRS ABCDE

Question 2

What does “D” stand for in DRSABCDE to reading a CXR? and what does this include?

Answer 2

Detail:
Correct patient, 
Date and time, 
Type of film, 
AP/ PA,
Erect or Supine, 
Left/ right markers

Question 3

What does “A” stand for in DRSABCDE to reading a CXR? and what does this include?

Answer 3

Airway
Look at:
-Trachea,
-Paratracheal/ mediastinal masses
-Mediastinal width (<8cm on PA film)
-Hilum

Question 4

What does “R” stand for in DRSABCDE to reading a CXR? and what does this include?

Answer 4

RIPE
Another accronym to look at:
-R- rotation- medial ends of clavicle should be equidistant to thoracic vertebrae
-I- inspiration- should see 5-6 anterior ribs and 8-10 posterior ribs
-P- picture- is it of good quality
-E- exposure- Should see spinous process of T4 and hemidiaphragm through cardiac shadow.

Question 5

What does “S” stand for in DRSABCDE to reading a CXR? and what does this include?

Answer 5

Soft tissue and Bones

Check Bones for:

• Symmetry
• Fractures
• Dislocations
• Lytic lesions

Check soft tissue for subcutaneous air

Check breast shadows

Question 6

What does “B” stand for in DRSABCDE to reading a CXR? and what does this include?

Answer 6

Breathing

Check upper/ middle/ lower lobes 
Check Lung:
-Fields, 
-Vascularity
-Pneumothorax
-Infiltrates
-Collapse

Check Pleura:

• Thickenings
• Effusions

Question 7

What does “C” stand for in DRSABCDE to reading a CXR? and what does this include?

Answer 7

Circulation

Check:

• Heart position
• Heart size (can only see on PA)
• Heart shape

Question 8

What does “D” stand for in DRSABC”D”E to reading a CXR? and what does this include?

Answer 8

Diaphragm

Check:

• Levels of hemidiaphragm (right should be 1 rib space above the left)
• Costophrenic angles
• Gastric bubble
• Subdiaphragmatic gas (sign of perforation)

Question 9

What does “E” stand for in DRSABCDE to reading a CXR? and what does this include?

Answer 9

Extras

Check for:

• ETT
• CVD lines
• NG tube