Spokane Community College

Film critique

Overview

• CXR- Upright PA

-Upright Lateral

Anatomy

-Lungs

- Heart

-Cervical & Thoracic Spines

- Ribs

- Shoulder girdle

- Sternum

UPRIGHT PA Chest

PA Upright Chest

Blunting of Costophrenic Angle

Supine

Normal Costophrenic Angle

Upright Why Upright?

7 points to a good chest x-rayEvaluation criteria

1. Both apices on the film

2. Check clavicles for rotation

3. Scapulas up and out of the way

4. Can you see the spine thru the heart

5. Can see 8-10 ribs above the diaphragm

6. Check diaphragm for motion

7. Both costophrenic angles on

#1

#2 #2

#3 #3

#4

#5

#6

#7

PA Chest

PA Chest Center to T-6 Check trachea, is it over the spine (rotation) One to two inches of lung apex should show

above the clavicles Same distance on both sides between ribs

and edge of film Same distance from spine to lateral border of

the ribs on both sides (rotation) A small amount of the heart should be seen

on the right side of the spine *** Remember CR needs to be horizontal or

parallel to the floor to show air-fluid levels.

Common problems• Artifacts

• Rotation

• Crosswise or lengthwise

• Leaning into the board or leaning

back from the board

• Deep breath in

• Scapulas out of lung field

• Tube angle (just say no!!)

Left Lateral Chest

Lateral Chest Left lateral

• CR to T-6• Ribs superimposed• Arms out of field• Sternum lateral• Costophrenic angles and apices on• Hilum in the center of the image• Thoracic intervertebral spaces should be

open• Exposure penetrate heart with overexposure

of lungs

Upright Left LateralChest

Common problems

• Rotation

• Breathing

• Arms out of lung field

• Leaning into or away from wall bucky

Rotation

Left lateral Chest

M

Left Lateral Peds Chest

Motion

How to read a CXR• 1. Check patient name, position, technical quality• 2. Soft tissue including breast, chest wall, companion shadow• 3. Review soft tissues and skeletal structures of shoulder girdles and chest wall• 4. Review abdomen for bowel gas, organs• 5. Review soft tissues and spine of neck• 6. review spine and rib cage: check alignment, disc space narrowing, lytic or blastic areas• 7. Review Mediastinum: -Overall size and shape -Trachea: position - Margins: SVC, ascending aorta, right atrium, left subclavian artery aortic arch, main pulmonary artery, left ventricle - Lines and stripes: paratracheal,paraspinal, paraesophageal paraaortic -Retrosternal clear space 8. Review hila: -Normal size -Normal relationships 9. Review lungs and pleura: -Compare lung size -Evaluate pulmonary vascular pattern: compare upper to lower

lobe, RT to LT, normal tapering to periphery -Pulmonary parenchyma - Pleural surfaces: fissures, major & minor (if seen) compare hemidiaphragms,follow pleura around rib cage

Supine Chest

PA Chest

Upright Chest

Upright PA Peds Chest Upright Left lateral Peds Chest

Left Lateral Chest

Left Lateral Chest

Motion

Left Lateral Chest

?

Upright PA Chest

The heart is on what side?

AP Upright Chest

Is this the left side?

Air/fluid levels

***Remember the CR needs to be horizontal or parallel to the floor to show air-fluid levels

Clavicles

PA Upright Chest

Please just sit the patient up more!!!

No tube angle! How can we see air fluid levels!!!