Medliorate

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How to Read a CXR

Posted by medliorator on August 4, 2009

The first thing to always check is that the film is associated with the correct patient. After doing so, to read a PA view, I utilize a mnemonic called RIP ABCDEFGH. Here is how it works:

  • Rotation: Check to see that the patient is not rotated. You can look at the clavicles and make sure the vertebral processes line up nicely in between them.
  • Inspiration: Check to see that you can see about 9 ribs on each side. Less than 8? It is likely poor inspiration.
  • Penetration: You should be able to see lucencies in the middle of the film representing the intervertebral discs. If there are none, the film is over-penetrated; if they are too well-defined, the film is under-penetrated.
  • Airway: Trace the lucency from the neck down towards the carina. It should be midline and you should be able to see two bronchi splitting from it.
  • Bones: Look at the shoulder joint and trace out each rib contour to check for fractures or other abnormalities.
  • Cardiac Silhouette: Check the right and left heart borders.
  • Diaphragms: These should be well-defined with no obscuration of their margins.
  • Empty Space Fields: Look at the lung fields bilaterally and compare. Don’t forget the apices.
  • Gastric Bubble: Check for a lucency in the left upper abdominal quadrant.
  • Hardware: Make sure the placement of any lines or other hardware is appropriate.

How To Read A Chest X-Ray [The Radiology Blog]

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