Chest X-ray

Question 1

Begin chest X-ray interpretation by checking.….. (4)

Answer 1

Patient details

Date and time the film was taken

Type of film

Previous imaging

Question 2

Why need to check Previous?

Answer 2

useful for comparison

Question 3

To Assess image quality (4)

Answer 3

RIPE

Projection

Rotation

Degree of inspiration

Exposure

Question 4

Projection

Answer 4

Is the image AP or PA

Question 5

The image is PA when (2)

Answer 5

there is no label

the scapulae are not projected within the chest

Question 6

To check for rotation see (2)

Answer 6

The medial aspect of each clavicle should be equidistant from the spinous processes

Spinous processes should also be vertically orientated against the vertebral bodies

Question 7

Degree of Inspiration
The depth is

Answer 7

The 5 - 6 anterior ribs or 9 -10 posterior ribs

Question 8

Degree of Inspiration

Field

Answer 8

Lung apices,
both costophrenic angles,
and the lateral rib edges

should be visible

Question 9

Exposure (Penetration)

Answer 9

Left hemidiaphragm should be visible to the spine and the vertebrae should be visible behind the heart

Question 10

ABCDE Approach

Answer 10

Airway: trachea, carina, bronchi and hilar structures

Breathing: lungs and pleura

Circulation: Heart position, Heart size, Heart borders, Heart shape, Aortic stripe

Diaphragm: including assessment of costophrenic angles

Everything else: mediastinal contours, bones, soft tissues, tubes, valves, pacemakers, and review areas

Question 11

Trachea is normally located

Answer 11

centrally or deviating very slightly to the right

Question 12

Carina is

Answer 12

A cartilage situated at the
tracheal bifurcation

Question 13

Rt main bronchus is .….. than the Lt.

Answer 13

wider, shorter & more vertical

Question 14

Hila are

Answer 14

usually the same size

Question 15

Lt hilum is .….. Than the Rt

Answer 15

often slightly higher

Question 16

Hilar lymph nodes are

Answer 16

Not usually visible

Question 17

Bilateral/ symmetrical enlargement (4)

Answer 17

sarcoidosis, Lymphoma, metastatic disease & tuberculosis

Question 18

Unilateral/asymmetrical enlargement of hilar (2)

Answer 18

Breast cancer, metastatic disease

Question 19

Abnormal hilar position

Being pushed

Answer 19

enlarging soft tissue mass

Question 20

Abnormal hilar position

Being Pulled (2)

Answer 20

lobar collapse or fibrosis

Question 21

Breathing check for

Answer 21

lungs and pleura

Question 22

pleura is

Answer 22

Normally not visible

Question 23

Heart position

Answer 23

2⁄3 to left, 1⁄3 to right

Question 24

Heart Size

Answer 24

occupies no more than 50% of chest width

Question 25

Heart’s borders

Answer 25

Right atrium makes up most of the right heart border &Left ventricle makes up most of the left heart border.

Question 26

Abnormal Heart shapes (3)

Answer 26

Global Boot Egg

Question 27

Aortic stripe are

Answer 27

bands that result from air outlining thicker intervening mediastinal structures

Question 28

Aortic stripe (3)

Answer 28

Rt &Lt paraspinal stripes Aortopulmonary stripe Rt &Lt paratracheal stripes

Question 29

right hemidiaphragm is ……. than the left

Answer 29

higher

Question 30

Stomach underlies the

Answer 30

left hemidiaphragm

Question 31

Diaphragm is indistinguishable from the underlying

Answer 31

Liver

Question 32

Costophrenic angles are

Answer 32

formed from the dome of each hemidiaphragm and the lateral chest wall.

Question 33

Loss of this acute angle called

Answer 33

blunting

Question 34

Loss of this acute angle can be due to (2)

Answer 34

Effusion Hyperinflation

Question 35

Mediastinum contains (4)

Answer 35

heart, great vessels, lymphoid tissue & several potential spaces

Question 36

Aortic knuckle

Answer 36

can occur in the context of an aneurysm

Question 37

Aortopulmonary window is lost as a result of

Answer 37

mediastinal lymphadenopathy eg: malignancy

Question 38

Ribs, sternum, spine, clavicles Look for (5)

Answer 38

symmetry, fractures, dislocations, lytic lesions, density

Question 39

Soft tissues Look for (5)

Answer 39

symmetry, swelling, loss of tissue planes, subcutaneous air, masses

Question 40

great vessels, carotids Look for

Answer 40

Calcification

Question 41

After checking Soft tissues check

Answer 41

Breast shadows