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Chest x ray basics
- 1. Chest X-Ray: Basics Interpreting the CXR General format: Check the technical aspects -Name, date, projection, rotation, penetration, inspiration Cardiac shadow -Size, shape, calcification Mediastinum -Position, width, outline, density, tracheobronchial tree Hila -Position, size, density, concave Lungs -Size, transradiancy, fissures, focal or generalised pulmonary infiltration Pleural spaces -Effusions, soft tissue masses, calcification, pneumothorax Bones -Fractures, lytic or sclerotic lesions Soft tissues -Masses, calcification
- 2. Technical Aspects Check the side markers Have you got L and R the right way around?
- 3. Assessment of rotation Distance between medial ends of the clavicles and the spinous processes
- 4. Penetration • Intervertebral disc spaces just visible through mid-cardiac shadow • Pulmonary structures visible with clarity • Few vessels in outer third
- 5. Inspiration Full inspiration: • 6-7 anterior ribs • 10-11 posterior ribs
- 6. Cardiac shadow Heart Size • Cardiac Transverse Diameter (CTD) = a+b < 15.5cm (males) < 15.0cm (females) • Cardio-Thoracic Ratio (CTR) =a+b÷c+d < 0.5
- 7. Cardiac configuration • Dilated left ventricle: -Ischaemic/dilated cardiomyopathy -Aortic reflux -Mitral reflux -VSD, PDA -Anaemia, hyperthyroid, Paget’s, AVF • Failing left ventricle: -AS, HTN, Coarctation • Cardiomegaly (CTR > 0.5) • Large third “mogul” • Double density right heart border • Displaced descending aorta • Dilated left atrium: -Mitral stenosis or myxoma -Mitral reflux, VSD, PDA, -ASD (late)
- 8. The mediastinum • Mediastinal position • Ratio: - 1/3 to the Rt of midline - 2/3 to the Lt of midline
- 9. Left heart border • Aortic arch •Main (left) PA •Left atrial appendage •Left ventricle Right heart border •Brachiocephalic vein •SVC •Right atrium •IVC - blurred or obscured and 'indistinct' right heart border
- 10. Hila •Position of hilar point: -Right = 6th rib in mid- axillary line -Left = 0–2.5cm higher •Outline: - "V" shaped
- 11. Lungs •Size •Transradiancy •Fissures •Focal or generalised pulmonary infiltration
- 12. Horizontal fissure 6th rib in mid-axillary line
- 13. Azygos fissure 4-layers of pleura, containing azygos vein
- 14. Plural Spaces •Effusions •Soft tissue masses •Calcification •Pneumothorax
- 15. Bones •Fractures •Lytic or sclerotic lesions
- 16. Soft Tissues •Masses •Calcification