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  • Normal CXRs

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    Anishil
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    This document provides an overview of how to read a chest x-ray (CXR). It discusses assessing patient details and normal CXR anatomy. It describes how to evaluate image quality by checking for proper rotation, inspiration, and penetration. It also outlines the systematic approach of analyzing CXRs, including orientation, lung zones, and features used to define adequate coverage.

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    This document provides an overview of how to read a chest x-ray (CXR). It discusses assessing patient details and normal CXR anatomy. It describes how to evaluate image quality by checking for proper rotation, inspiration, and penetration. It also outlines the systematic approach of analyzing CXRs, including orientation, lung zones, and features used to define adequate coverage.

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    18 views19 pages

    Normal CXRs

    Uploaded by

    Anishil
    This document provides an overview of how to read a chest x-ray (CXR). It discusses assessing patient details and normal CXR anatomy. It describes how to evaluate image quality by checking for proper rotation, inspiration, and penetration. It also outlines the systematic approach of analyzing CXRs, including orientation, lung zones, and features used to define adequate coverage.

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    © All Rights Reserved
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    of 19

    CHEST XRAY (CXR)

    Basics of Chest Radiography


    Basics of CXR reading

     Patient Details
    ❑ Name
    ❑ Date of birth
    ❑ Gender
    ❑ Hospital number
    ❑ Date of Xray
    ❑ Previous films
    Normal CXR Anatomy
    Normal CXR Anatomy

    1 Trachea
    2 Carina (division of trachea into R+L bronchi)
    3 1st Rib
    4 Right hemidiaphragm
    5 Left hemidiaphragm
    6 Posterior rib
    7 Anterior rib
    8 Aortic notch
    9 Descending aorta
    10 Left ventricle
    11 Costocardiac angle
    12 Costphrenic angle
    13 Right atrium
    14 Clavicle
    15 Hilum
    Level of carina??
    What do the different shades
    represent in an Xray?

     A – Black → Air
     B – Dark grey → Fat
     C – Light grey → Soft tissue
     D – White → Bone/fluid
     E - Bright white → Metal
    Lung Zones – not the same as lung lobes
    How does the diaphragm appear in X-ray?
    Cardio-thoracic ratio
    Systematic Approach – Image Quality

     Image quality should always be


    assessed because it may not be
    possible to answer the clinical
    question if the image is inadequate.
     The chest X-ray should be checked for
    rotation, inspiration, and penetration.
    Systematic Approach – Image Quality

    Image quality - Rest In Peace


     Mnemonic - RIP - Rest In Peace
     R - Rotation - Spinous processes at
    midpoint between medial ends
    of the clavicles?
     I - Inspiration - 5 to 7 anterior ribs
    intersecting the diaphragm in the
    mid-clavicular line?
     P - Penetration - Spine visible
    behind the heart?
    What is the basic orientation of most
    X-rays and why?

     PA = Preferred - most common


     Can accurately comment on size of
    heart

     AP = used for patients who are unwell,


    unable to stand.
     Problem is heart appears larger (thus
    unable to accurately determine
    cardio-thoracic ratio, scapula appear
    over lung field and clavicles appear
    horizontal
    What is the normal patient rotation in X-rays?

    Spinous processes of thoracic vertebrae


    should be:
     STRAIGHT and lie in the MIDLINE at
    back of chest

     equidistant from the medial heads of


    the 2 clavicles.
    If patient is rotated, these processes will
    lie more towards one clavicle vs the other
    Rotated CXR
    Why are X-rays done in inspiration?

     Chest X-rays are generally done in inspiration

     Lung density increased in expiration as less air (lungs


    appear consolidated) and diaphragm is also raised -
    leads to exaggeration of heart size and obscuration of
    lung bases.
    How do we assess inspiration from X-rays?

    SHOULD BE ABLE TO:

     Count to 10th rib posteriorly

     Count to 6th or 7th rib anteriorly


    What about Exposure/Penetration?
    What are the features assessed to define
    whether an X-ray is good/poor coverage?

     Good: MUST have apices of lungs AND


    costophrenic angles visible
     First ribs as well as lateral edges of ribs
    should also be visible - need to be
    able to see the entire thoracic cage
    Refer to the link below

     https://www.radiologymasterclass.co.uk/tutorials/chest/chest_system/chest_system_03
     https://www.radiologymasterclass.co.uk/gallery/chest/quality/normal-chest-x-ray-male

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