CXR

Question 1

RIP in CXR is for image quality. What does RIP stand for

Answer 1

R - rotation (are clavicles equal distance from the central spinous process)
I - inspiration (are 5-7 ribs visible anteriorly; the curved ribs)
P - penetration (is the spine visible thru the heart)

Question 2

ABCDE in CXR looks for?

What should you do BEFORE ABCDE and after RIP?

Answer 2

A - airway, lungs, pleura
B - bones (ribs, clavicles, humerus, spine)
C - circulation (heart & mediastinum)
D - diaphragm
E - extra features & review
Always COMMENT on the ELEPHANT in the room - the OBVIOUS complaint/deformity

Question 3

A - airway looks for?

Answer 3

Airway:
trachea - midline or deviated; direction of deviation
Lungs - zones (not lobes) upper, middle, lower; symmetrical? too black or too white? which is abnormal?
markings to entire lung edge
Pleura - should NOT be visible in healthy people.

Question 4

B - bones looks for?

Answer 4

Bones: ribs, clavicles, humerus, spine

look for #, metastatic deposits, arthritis, dislocation

Question 5

C - circulation looks for?

Answer 5

Circulation: heart & mediastinum
heart: size, shape & border
size - cardiothoracic ratio (< 50% PA)
L border = aortic knuckle, pulmonary outflow tract, LA appendage, LV
R border = SVC, RA, IVC
borders should be well-defined

Question 6

D - diaphragm looks for?

Answer 6

Diaphragm:
each side domed & sharply visible
R higher than L (b/c of liver)
Costophrenic angle (lateral)
Cardiophrenic angles (medially)
gastric bubble under L hemiD

Question 7

E - extra looks for?

Answer 7

Medical intervention lines & tubes (IVT, ETT, NGT, defib pad, CVC, PPM, ICD etc);
Lung apices;
Hilar regions (bronchi & pulm vessels); L higher than or = R, should be same in size & density;
look behind heart
check soft tissues
r/v UNDER diaphragm (air under)

Question 8

Before reviewing a CXR, what THREE things should you confirm?

Answer 8

Identity of the pt
Orientation of the xray (PA or AP)
Quality of image - RIP