1) The posterior-anterior (PA) view is the standard and most reliable technique for a chest x-ray. It allows detection of air under the diaphragm. 2) A lateral view helps localize infiltrates and evaluate the cardiomediastinal silhouette, effusions, and left atrial dilation. 3) An anterior-posterior (AP) view is used when a patient is too ill to be transported, but image quality is poorer and structures may appear enlarged compared to a PA view.

1. CXR Interpretation Sherry L. Knowles, RN, CCRN, CRNI In CCU

2. Posterior-Anterior (PA): Standard view & most reliable technique Erect films detect air under the diaphragm Lateral view: Done at the same time as the PA film Helps localize infiltrates Also helps with CM, effusions & LAD Anterior-posterior (AP): Portable- patient is too ill to go to X-ray, usually patient is sitting upright in bed Poor quality but may be the best you can do Remember- AP films may cause the mediastinum & heart to appear larger than they are CXR Views

3. Basic Rules Make sure you have the right patient Look for symmetry Have a system Look for the marker (R/L) Check Exposure Check for inspiration (need 8-9 ribs) Check for Rotation Search the pattern

4. Have a System Inspect the bony framework Inspect the soft tissues that overlies the thoracic cage Examine the lung fields Examine the diaphragm and pleural surfaces Examine the heart and mediastinum

5. Rules Read the label on the chest film Assess the quality of the film Check the Structures Look at the heart and major vessels Assess the boundaries Assess the Airways Assess the Lung Tissues Look for Line & Tube Placement

8. Normal Thoracic Anatomy

9. Normal CXR

10. Normal CXR

16. Right Upper Lobe Pneumonia

17. Right Middle Lobe Pneumonia

18. Left Lower Lobe Pneumonia

19. Enlarged Heart

20. Pulmonary Edema

21. CHF

22. CHF

23. CHF

24. Pleural Effusion

25. Pneumothorax

26. Pneumothorax

27. Pneumothorax

28. Spontaneous Pneumothorax

29. Dissecting Aneurysm

30. ARDS

31. Honeycombing

32. Honeycombing

33. Honeycombing

34. Pulmonary Fibrosis

35. Subcutaneous Air

36. Tuberculosis

37. Lung Cancer

38. PA Catheter

39. Lines & Tubes on CXR