What is a Chest Radiograph?

SHADOW
 Reading CXR’s
 Have a structured method!
 Be consistent with that method
 Don’t take short cuts
 LOOK AT ALL YOUR PATIENTS XRAYS
YOURSELF (and with your resident of
course!)
 PRACTICE…PRACTICE… PRACTICE
 Start at the beginning

Identification!
 Correct patient
 Correct date and time
 Correct examination
 Are old films available?
 DO THIS EVERYTIME – It buys you time and is
vitally important.
Projection
Portable (AP or Antero-
posterior)
FILM
PA (Postero-anterior)
FILM
 Approach to the CXR: Technical Aspects

 Projection – PA or AP
 Position – Upright or Supine (Supine folks are
sick)
 Inspiratory effort
 9-10 posterior ribs
 Penetration
 thoracic intervertebral disc space just visible
 Positioning/rotation
 medial clavicle heads equidistant to spinous process
 Projection

PA AP
Over Exposure Proper Exposure
9
Mental Break
???
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Position?
Postion??
RUL (Right Upper Lung)
RML (Right Middle Lung)
RLL (Right Lower Lung)
LUL (Left Upper Lung)
LLL (Left Lower Lung)
 What to Evaluate

 Lungs
 Pleural surfaces
 Cardiomediastinal contours
 Bones and soft tissues
 Abdomen
 Where to Look

 Apices
 Retrocardiac areas (left and right)
 Below diaphragm
Left Retrocardiac Opacity
Normal Anatomy: Frontal CXR

 Heart
 Aorta
 Pulmonary arteries
 Airways
 Diaphragm/costophrenic sulci
 COMMON CHEST PATHOLOGY
LUL Pneumonia
Well-Defined

Calcification

Ill-Defined Mass
 Indeterminate Cavities

• max wall thickness 5-15 mm

• mildly irregular inner lining
Malignant Cavities: Squamous Cell Ca
• max wall thickness 16 mm
• Irregular inner lining
Pleural Effusion
Hemopneumothorax
Crushed right chest
PNEMOTHORAX
PNEMOPERITONEUM
Mental Break
??
?
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?