CXR interpretation

Question 1

What’s the process for assessing the image quality?

Answer 1

RIPE
-ROTATION
–clavicular heads need to be the same distance from the spinous processes
-INSPIRATION
–5-6 anterior ribs visible, lung fields
-PROJECTION
–AP vs PA
–NB cannot comment on size of heart on AP films as may cause an appearance of cardiomegaly
-EXPOSURE
–Hemidiaphragm and vertebra behind heart

Question 2

What are the A and B steps in assessment of CXRs?

Answer 2

AIRWAY
-Trachea - central
-Carina visible
-Bronchi
-Hilar regions - symmetry, check for opacities
BREATHING
-Lung fields / zones
-Pleura

Question 3

What are the C+D steps in assessment?

Answer 3

CARDIAC + DIAPHRAGM
-Heart size and borders
-Air under diaphragm (bowel perforation, especially on RHS)
-Costophrenic angles

Question 3

What is the E step in assessment?

Answer 3

EVERYTHING ELSE
-Mediastinal contours
-Bones
-Soft tissues
-Foreign objects eg wires, pacemakers
-Review areas

Question 4

What signs does heart failure have on CXR?

Answer 4

1.Alveolar oedema
2. Kerley B lines
3. Cardiomegaly
4. Upper lobe diversion
5. Pleural effusion

Question 5

Why would someone have hyper inflated lungs?

Answer 5

-COPD
-More ribs visible