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Chest X-Ray Interpretation Guide

The document provides an outline for interpreting basic chest x-rays. It discusses assessing the quality of the x-ray film and patient-dependent factors. It then describes a systematic approach of analyzing the airways, bones/soft tissues, cardiac silhouette, diaphragm, effusions, and lung fields. Specific abnormalities that can be seen in each area are outlined, such as fractures in bones, cardiomegaly in the cardiac silhouette, and pneumothorax in effusions. A systematic approach is recommended to reduce missing important findings, though different systems can be used.

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Alex beharu
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135 views35 pages

Chest X-Ray Interpretation Guide

The document provides an outline for interpreting basic chest x-rays. It discusses assessing the quality of the x-ray film and patient-dependent factors. It then describes a systematic approach of analyzing the airways, bones/soft tissues, cardiac silhouette, diaphragm, effusions, and lung fields. Specific abnormalities that can be seen in each area are outlined, such as fractures in bones, cardiomegaly in the cardiac silhouette, and pneumothorax in effusions. A systematic approach is recommended to reduce missing important findings, though different systems can be used.

Uploaded by

Alex beharu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd

Basic Chest X-Ray Interpretation

(5minutes talk)
Dr.Alemayehu
(ECCM R1)
Outlines:
QUALITY ASSESSMENT
PATIENT-DEPENDENT FACTORS
THE SYSTEMATIC APPROCH
Airways
Bones and soft tissues
Cardiac silhouette
Diaphragm
Effusions(i.e. pleura)
Fields(i.e. lung fields)
QUALITY ASSESSMENT

• When interpreting CXR prior to checking for


pathology, pay attention to two radiographic
parameters namely the quality of the film and
patient-dependent factors.
QUALITY ASSESSMENT
Quality of the film? Patient-dependent
Is the film correctly factors
labelled?  Assessment of patient
rotation
Is the film
 Assessment of
penetrated enough?
adequacy of inspiratory
Is the film PA or AP effort

The effect of varied exposure on the quality of the final image

On a high quality radiograph, the vertebral bodies


should just be visible through the heart.
Is the film PA or AP

The cardiomediastinal contour is


On the PA film, taken only an hour
significantly magnified on this later, the mediastinum appears
AP film normal.
This patient is rotated to the left. Note the
A well centered x-ray. Medial ends of spinous process is close
clavicles are equidistant from to the right clavicle and the left lung is
the spinous process. ‘blacker’ than the right, due to
the rotation.
Assessment of
adequacy of
inspiratory effort  If six complete anterior
or ten posterior ribs are
visible then the patient
has taken an adequate
inspiratory effort.
If a poor inspiratory effort is
made or if the CXR is taken
in expiration, then several
potentially spurious findings
can result:
Apparent cardiomegaly
Apparent hilar abnormalities
Apparent mediastinal
contour abnormalities
The lung parenchyma tends
to appear of increased
density, i.e. ‘white lung’.
THE SYSTEMATIC APPROCH
The principles are:
Most important for clinicians least experienced
with reading chest x-ray, since it reduces the
chance that important findings will be missed.
All aspect of chest x-ray interpretation should be
included.
There is no ‘’one best” system, though all should
begin with the assessment of the technical quality
of the film
The ABCDEF system
The DRSABCDE system
• A=Airway • D= Details
• B= Bones and soft tissues • R= RIPE
• C= cardiac • S= Soft tissue and bones
• D= diaphram • A= Airway
• E= Effussions(i.e pleura) • B= Breathing
• F= fields (i.e. lung fields) • C= Circulation
• D= Diaphram
• E= Extras
The ABCDEF system
Airway
 On chest x-ray airway can
be

 Narrowed
 Deviated
 Contains foreign objects
Tracheal shift

Away from the


affected side
Pneumothorax
pleural effusion
large mass

Toward the affected


side
Atelectasis
Pneumonectomy
Pleural Fibrosis
Carinal angle
Foreign body aspiration
Bones and soft tissue
On CXR bones can be
Fractured ( Recent Vs Old)
Deformed
Sclerosed
Lytic
Osteopenic
Notched( Ribs)
Rib fracture
Rib Notching
Superior surface
osteogenesis imperfecta
CT disorder
local pressure
hyperparathyroidism

Inferior surface
Coarctation of Aorta
subclavian or SVC obstruction
Soft tissue
Subcutaneous emphysema Foreign body
Cardiac silhouette and mediastinum

Cardiac silhouette:
Outline of the heart as seen
on frontal and lateral chest
x-ray and forms part of
the cardiomediastinal
contour.
The size and shape of
the cardiac
silhouette provide useful
clues for underlying disease
Abnormality of the cardiac silhouette

 Cardiomegaly
 LAE
 RVE
 Pericardial effusion
 Dextrocardiacm
 Widened mediastinum (>8cm)
Cardiomegaly
LAE (Double density sign)
Dextrocardia Pericardial effusion(Water bottle sign)
Effusions(i.e pleura)

• Pneumothorax
• Pleural effusion
• Subpulmonic effusion
• Pleural plaque
• Pleural thickening
Pleural effusion
Subpulmonic effusion
Diaphragm
pneumoperitoneum Elevated hemidiaphragm
Hiatal Hernia
Lung fields
Reduced lung volumes
Hyperinflation
Diffuse lung opacity
Alveolar
Interstitial
Hyperinflation
Alveolar opacity
Reference
• A-Z of chest radiology
• https://www.youtube.com/user/drericstrong
• https://litfl.com/
THANKS!

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