Chest X RAY: Airway and Mediastinum

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Chest X RAY

1. Demographic
2. AP/PA
3. Date taken

Ex: This is a chest radiograph belongs to Mr, X, in supine AP position, taken on 01/01/11.

4. Penetration/ exposure ( should be just able to work out the spinous process.)
Ex: under exposure = too black
over exposure = too white

5. Field (adequate)
Ex : diaphragm ( x miss pneumo-peritoneum)
groin ( x miss hernia)

6. Rotation
Ex: medial clavicle ends equidistant from the spinous process

7. The most obvious abnormality is …….


8. Going through it systematically.

Airway and mediastinum


9. Trachea- central or slightly to the right lung as crosses aortic arch.
10. Thymus
11. Posterior ribs : 8-9th
12. Anterior ribs : 6th
13. Use only posterior ribs in the younger child
14. Hyperinflated lung

Breathing
15. Lung – UZ,MZ,LZ
16. Lung field outlines – abnormal(homogenous or heterogeneous) opacity/lucency, consolidation
17. Vessels and bronchi(air bronchogram?) in the lung field
18. Pleural –Pleural thickening

Circulation
19. Heart position – RA, RV, LA, LV (2/3 to left, 1/3 to right)
20. Heart size – Cardiothoracic ratio on AP film ( 0.6 )
21. Hilar shadows

Diaphragm
22. Hemidiaphragm level – right lung higher than left lung (liver)
23. Cardiophrenic and costophrenic angle – clear and sharp.
24. Gastric bubble/ colonic air
25. Subdiaphragmatic air – pneumoperitoneum
Soft tissues
26. Ribs, sternum, clavicles, spine – fractures, dislocated

27. Summarise

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