Comman/Abnormal Findings Chest Film

Question 1

What is done prior to reading a chest film, aka “Pre-read”?

Answer 1

• Image is from the correct patient
• Image is from the correct date
• Image is from the correct body part
• Image is the correct type
• Image has the number of views expected
• Check for any film comparison

Question 2

What technique is used for assessing technical adequacy?

Answer 2

• RIP Technique
• Rotation
• Inspiration
• Penetration

Question 3

What is involved in Rotation when assessing technical adequacy?

Answer 3

• Look at clavicles relative to vertebral column
• They should be equally spaced
• If not properly aligned, structures will change in appearance (may be abnormal)

Question 4

What is involved in Inspiration when assessing technical adequacy?

Answer 4

• Look at the ribs
• Should be able to count 9-10 ribs
• Posterior ribs are easier to see ( more horizontal and project from spine)

Question 5

What is involved in Penetration when assessing technical adequacy?

Answer 5

• Should see ribs through heart
• Should barely see spine through heart
• Should see pulmonary vessel near edge of lungs (Lungs should not be completely black)

Question 6

Signs of over-penetrated film regarding pulmonary vessel?

Answer 6

• Lungs fields almost completely black

- Suggest pneumothorax

Question 7

Signs of under-penetrated film regarding pulmonary vessel?

Answer 7

• Soft tissue structures obscured

- Image appears bright suggesting consolidation (pneumonia)

Question 8

What are the steps to reading a chest x-ray?

Answer 8

1) Do pre-read
2) Assess technical adequacy of film (RIP)
3) Conduct a systematic method (ABCDE)

Question 9

What are the steps to conducting a systematic method?

Answer 9

A - Airways/Airspace
B - Bones
C - Cardiac Shadow/Silhouette
D - Diaphragm
E - Everything else

Question 10

What are you looking for in Airways/Airspaces in a systematic method?

Answer 10

• Follow trachea down (midline/patent?)
• Look at Airspaces
  
  • Blood vessels all the way to the edge
  • Any patches of white suggesting infection, fluid, or foreign objects

Question 11

What are you looking for in Bones in a systematic method?

Answer 11

• Look at the clavicles, ribs, pectoral girdle, spine

- Check alignment, lack of symmetry, and fracture lines

Question 12

What are you looking for in Cardiac Shadow/Silhouette in a systematic method?

Answer 12

• Transverse diameter of the silhouette should NOT exceed 50% of the transverse diameter of the thoracic cage
• AP films magnify the heart
• Shallow inspiration makes the heart horizontal and larger
• Cardiac Borders

Question 13

What is the cardiothoracic ratio and what films does it apply to?

Answer 13

• The transverse diameter of the silhouette should NOT exceed 50% of the transverse diameter of the thoracic cage
• Only applies to PA film

Question 14

What are the cardiac borders(moguls)?

Answer 14

• Upper right border (Superior Vena Cava)
• Lower right border (Right atrium)
• Left border (from top: aortic arch, pulmonary arteries, left atrial appendage, left ventricle)

Question 15

What are you looking for in Diaphragm in a systematic method?

Answer 15

• Should be dome-shaped
• Right hemidiaphragm is always higher than, or on same level, as left
• Check costophrenic angles (sulcus) which should be dark and have sharp points (like upside down cat ears)

Question 16

What are you looking for in Everything else in a systematic method?

Answer 16

• Look for gastric bubble

- Check for EKG leads, lines, tubings, and other missed items (four corners of the film)

Question 17

How do you read a lateral chest film?

Answer 17

• Spine should appear brighter as it proceeds inferiorly (more lung)
• Area behind sternum(retrosternal space) should be clear (contain upper lungs)
• Area behind heart (retrocardiac space) should be clear (lower lungs)
• Middle lobe projects over cardiac silhouette
• Cardiac and diaphragmatic borders should be sharp