Chest Xray Interpretation : Easy Mnemonics

Chest X ray interpretationChest X-ray is one of the commonest OPD investigation we frequently encounter. All of us must know Chest Xray Interpretation and findings.  Chest Xray Interpretation, though looks simpler, often overlooked by us. Here is a simpler way to remember and read a chest x-ray easily.

The popular mnemonics to remember is DRSABCD. This is quite simple to understand and interpret accordingly.

The steps on Chest Xray Interpretation is as under:

– Details  about the patient and the x-ray. Why it’s important? Well, a what’s can go wrong if we interpret another patient’s x-ray for some one else. We describe details under the following sub heading.

  •        Patient name, age / DOB, sex
  •        Type of film – PA or AP, erect or supine, correct L/R marker, inspiratory/expiratory series
  •         Date and time of study

R- Ripe it’s for assessing the technical  quality of the image. 

  • Rotation – medial clavicle ends equidistant from spinous process
  • Inspiration – 5-6 anterior ribs in MCL or 8-10 posterior ribs above diaphragm, poor inspiration?, hyperexpanded?
  • Picture – straight vs oblique, entire lung fields, scapulae outside lung fields, angulation (ie ’tilt’ in vertical plane)
  • Exposure (Penetration) – IV disc spaces, spinous processes to ~T4, L) hemidiaphragm visible through cardiac shadow.

S – Soft tissues and Bones –

  • Ribs, sternum, spine, clavicles – symmetry, fractures, dislocations, lytic lesions, density
  • Soft tissues – looking for symmetry, swelling, loss of tissue planes, subcutaneous air, masses
  • Breast shadows
  • Calcification – great vessels, carotids

A- Airway and Mediastinum

  • Trachea – central or slightly to right lung as crosses aortic arch
  • Paratracheal/mediastinal masses or adenopathy
  • Carina & RMB/LMB
  • Mediastinal width <8cm on PA film
  • Aortic knob
  • Hilum – T6-7 IV disc level, left hilum is usually higher (2cm) and squarer than the V-shaped right hilum.
  • Check vessels, calcification.

B – Breathing

Lung fields

  • Vascularity – to ~2cm of pleural surface (~3cm in apices), vessels in bases > apices
  • Pneumothorax – don’t forget apices
  • Lung field outlines – abnormal opacity/lucency, atelectasis, collapse, consolidation, bullae
  • Horizontal fissure on Right Lung
  • Pulmonary infiltrates – interstitial vs alveolar pattern
  • Coin lesions
  • Cavitary lesions

Pleura

  • Pleural reflections
  • Pleural thickening

C – Circulation

  • Heart position –⅔ to left, ⅓ to right
  • Heart size – measure cardiothoracic ratio on PA film (normal <0.5)
  • Heart borders – R) border is R) atrium, L) border is L) ventricle & atrium
  • Heart shape
  • Aortic stripe

D- Diaphragm

  • Hemidiaphragm levels – Right Lung higher than Left Lung (~2.5cm / 1 intercostal space)
  • Diaphragm shape/contour
  • Cardiophrenic and costophrenic angles – clear and sharp
  • Gastric bubble / colonic air
  • Subdiaphragmatic air (pneumoperitoneum)

E – Extras

  • ETT, CVP line, NG tube, PA catheters, ECG electrodes, PICC line, chest tube
  • PPM, AIDC, metalwork

Tag: Chest Xray Interpretation

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