The Chest X-Ray Basics_How to read A CXR ?

Posted by e-Medical PPT Friday, April 19, 2013
5 steps to CXR interpretation
1- assess the lung expansion
2- assess the pleura
3- look for infiltrate
4- look at the mediastinum
5-Assess the abdomen

Techniques
Volume of PE and whether it’s mobile or loculated.
Sensitive method for detecting small quantity of PF(50-100ml).
Nondependent hemithorax to confirm a pneumothorax in a patient who  could not be examined erect .
if the layering fluid is 1 cm thick, indicates an effusion of greater than 200 mL that is amenable to thoracentesis
The patient should be in full inspiration .
Shows better intrapulmonary abnormalities
The diaphragm fount at about the level of the 8th -10th posterior ribs or 5th -6th anterior rib on good inspiration
On a good PA film , the thoracic spine disk spaces should be barely visible through the heart but bony details of the spine are  not usually be seen through the heart .
On the lateral view , proper penetration and inspiration is seen through the spine appears to darken as you move caudally . This is due to more air in lung in the lower lobes and less chest wall .
The patient must be flat against the cassette  , if there is rotation of the patient , the mediastinum may look very unusual .
Clavicular heads whether they are in equal distance from the spinous process of the thoracic vertebral bodies .

Recognizing  a technically adequate Chest x ray
Factors to evaluate :
1- Penetration
2- Inspiration
3- Rotation
4- Angulation

You should be able to just see the thoracic spine through the Heart .
About 10 posterior ribs visible is an excellent inspiration
In many Hospitalized patient 9 posterior ribs is an adequate Inspiration .
Posterior ribs are those that are most apparent on the chest x ray .they rum more or less horizontally.
Anterior ribs will be visible but are harder to see . They run more or less at a 45 degree angle downward to ward the feet ,

AP Versus PA the effect of magnification
In al PA film the heart is closer to the film and thus less magnified .
    - the standard chest X-ray is a PA film .
In a AP film , the heart is farther from the films and is more magnified .
     - Portable chest X-ray are almost always done AP.

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