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How To Read A Chest X-Ray | A Simple Guide On Reading Chest X-Rays | Chest Radiography Lecture Notes

How To Read A Chest X-Ray | A Simple Guide On Reading Chest X-Rays | Chest Radiography Lecture Notes Check patient’s first name, middle name, last name, age and date of X-Ray scan ( This is a very very important point). Check which view is taken ( PA, AP, Erect, Supine, Prone ) and the orientation ( Left or Right ) Note inspiration or expiration: Visualization of 9 pairs of ribs posteriorly shows adequate inspiration Medial aspect of each clavicle should have equal distance from the spinous process of vertebra at the same level. This ensures that there is no rotation. ‎Vertical orientation of the spinous processes against the vertebra must be present. For AP or PA films, if the label is missing, then assume it is a PA view. In a PA view, the scapulae are not projected within the chest. Thoracic vertebrae should be visible posterior to the heart. Both costophrenic angles and lung apices should be properly identified. Always compare any normal or abnormal appearance on one side with the opposite side at the same level. Trachea must be centrally located. Very slight deviation to the right is normal Significant tracheal deviation may be a sign of paratracheal mass or lymphadenopathy. The carina and bronchi should be clearly visible. The right main bronchus is wider, shorter and steeper than the left main bronchus. Inhaled foreign bodies are more likely to lodge in the right main bronchus. Left hilum is slightly higher than right hilum Both left and right hilum usually have similar sizes. Any notable difference in sizes indicates pathology. Normal hilar lymph nodes are not visible. Divide each lung into 3 arbitrary zones. This does not correspond to lung lobes. Compare each lung zone. There should be no significant asymmetry. Increased shadowing (bright area) in a lung field indicates pathology. Normal pleura is not visible. Lung markings should extend all the way to the lung field edges. Absence of lung markings suggests pneumothorax. Fluid accumulation in pleural space appears as an increased opacity (bright area) In a PA view, The heart must occupy 50% of the chest width. Cardiothoracic ratio must be less than 0.5 Heart borders should be well-defined. Right Atrium forms majority of right heart border Left Ventricle forms majority of left heart border If right heart border is poorly defined, it is usually associated with right middle lobe consolidation (bright areas). If left heart border is poorly defined, it is usually associated with lingular consolidation. The right hemidiaphragm is higher than the left hemidiaphragm, due to the liver. Air under diaphragm may be a sign of pneumoperitoneum, appearing as a radiolucency (dark area) below diaphragm Costophrenic angles should be clearly visualized and must have acute angles. Loss of costophrenic acute angle may be due to fluid accumulation or consolidation. Aortic Knuckle (aortic knob) appears as a lateral bulge above the left main bronchus. Examine the visible bones for any fractures Tubes (NG Tube) and cables (ECG Cables) appear radiopaque (bright) Artificial heart valves are seen as radiopaque (bright) rings inside the heart. Gastric bubble is a radiolucent (dark) area below left hemidiaphragm, representing the fundus of the stomach.