Quick interpretation steps for Chest X ray.
- Chest x ray – Evaluation primarily done in PA [postero anterior] view.P-First letter in view stands for the position of X ray tube and second letter for placement of Xray film-A.
- AP view- ICU pt.commonly taken.
- Cardiac evaluation -As heart is placed anteriorly film kept anteriorly and x ray tube posteriorly-PA view always.
- In AP view 5-10 % magnification of heart occures so appears as cardiomegaly.
- Ideally x ray shoot done with-1.optimal penetration.2.breath hold deep inspiration.3-PA view.
- Different views-1.lateral.2-Rt.anterior oblique and lt.ant.oblique.
- Types1.plain x ray2.fluroscopy.3.contrast radiography.
- First check-centralisation of film.
- See for optimal penetration.
- Always start reading either from periphery to centre/centre to periphery.
- If starting from periphery then-1.survey of bony cage,extrathoracic space .2.comment on lung parenchyma-pulmonary vascularity,any opacity,pleural spaces-effusion,thickening.3.domes of diaphargm-Rt.is always higher than lt.Below Lt.diagpharm stomach gas bubble is seen.4.trachea -deviation/central5.cardiac contour-a].cardiomegaly. [b] shape of heart-boot shape,egg on string appearence [c] cardiac malpositions.[d]thoracic aorta and branches.[e] calcific shadow in great arteries,at valve site.
- Cardiothoracic ratio- 33-55% normally.
- Rt.cardiac border formed by-1.svc,2.Rt.atrium 3.small portion of ascending aorta 4.rarely inferior vena cava.
- Lt. cardiac border-1. Aortic Knuckle 2.Pulmonary bay 3. mall portion of lt.atrial appendage.4.Lt.ventricle.
- Lateral view-1.ascending aorta,2.pulmonary art.3.rt.ventricle,[normally 3-5 m retrosternal space]
- posterior border-1.pulmonary artery.2.-lt.atrium.3.lt.ventricle from above downwords.
Chest X Ray1: Structure to Identify
Chest X Ray2: Lateral View Markings