![]() Normally, 8-10 ribs are expected to be seen on the chest X-Ray (Figure-9).įigure-9: Bone structures on the PA chest X-Ray. Because of this, overinflation will result in a greater number of ribs that can be visible on the chest X-Rays. Hyperinflated lungs are seen as the result of chronic obstructive pulmonary disease where the patient is unable to fully expel the air that is inhaled with every breath. Each rib should be followed across its length to look for fracture lines or step-offs that could indicate a fracture. Rib fractures, however, can sometimes be hard to see. Clavicular fractures are usually at the middle 3rd of the clavicle, which is easy to see in chest X-Rays. ![]() (Red Arrows: trachea, Green Arrow: carina, Pink Arrows: left and right main bronchus)Ī chest X-Ray provides a good view to look for ribs and clavicle fractures. The collapsed lung will push the trachea to the opposite side and resulting in a deviation that will show up on chest X-Ray.įigure-8: Airway structures on the chest X-Ray. Introduction of air into one side of the chest cavity will cause that side of the lung to collapse. Look for if there is any deviation of the trachea away from the midline. The trachea, carina and both main bronchi are called the upper airway and should all be visible on an AP view (Figure-8). Finally, you should check patient’s position such as supine, erect or semi-erect. You should also check the side marker, and the film position (PA or AP). For chest X-Rays, there is a classic schematic: “ ABCDEF.” You should first check the patient’s name and date of the film. The interpretation of a chest X-Ray should be approached systematically. You are able to see all vertebral bodies with obvious intervertebral spaces. If the film is overexposed, details of bone structures will be lost (Figure-7).įigure-6: Underexposed PA X-Ray film.You can not appreciate thoracic vertebras.įigure-7: Overexposed PA X-Ray film. If the film is underexposed, you will not be able to see them (Figure-6). Exposure should be adequate if you are able to see approximately T4 vertebra and spinal process. Exposure / Penetration: Ideally, you should be able to see the heart, the blood vessels, and the intervertebral spaces.Supine views are less useful and should be reserved for critical patients who cannot stand erect position.įigure-5: The AP X-Ray shows magnification of the heart and widening of the mediastinum. The size of the pulmonary vasculature is more homogeneous throughout the upper and the lower lobes. ![]() The pulmonary vasculature is altered when patients are examined in the supine position. Therefore, mediastinal structures are widened because of gravity. Some patients are at semi-erect or supine position. This view is taken mostly at the bedside as portable. The heart and mediastinal shadow are magnified because of anterior structures, mainly sternum. On the AP film, the chest has a different appearance. If the x-ray is a true lateral, the right ribs are larger due to magnification and usually projected posteriorly to the left ribs (Figure-3).įigure-3: The right ribs (red arrows) and left ribs (green arrows) on the lateral chest X-Ray. The normal lateral chest x-ray view is obtained with the left chest against the cassette. Position: PA, AP, or lateral view? The standard chest X-Rays consists of a PA and lateral chest X-Ray.Inspiration: On good inspiration, the diaphragm should be seen at the level of the 8th – 10th posterior rib or 5th – 6th anterior rib.įigure 2 – The chest x-ray shows adequate inspiration.If there is a rotation, mediastinum may look abnormal.įigure-1: The clavicular heads and spinous process alignment. The x-ray shows minimal rotation. The distance between the thoracic spinal process and clavicular heads should be equal (Figure-1). Rotation: The clavicles should appear symmetrical and be seen as equal length.The image quality is one of the most important things in image interpretation.Īssessing The Image Quality, “ RIPE” mnemonic is used Rotation, Inspiration, Position, Exposure(Penetration). Emergency physicians interpret many portable (bedside) anteroposterior chest x-rays with poor quality, without lateral views to make the diagnosis. Unfortunately, the majority of the patients may not fit the ideal situation because of their acute problems. Meanwhile, the X-ray tube should be 180 cm away. The ideal timing can be defined as the end of inspiration, and the patient should hold his breath at that time. This chapter will summarize the basics of chest x-ray interpretation and give some pathologic examples. Therefore, knowing the basics and pathologies in the ED setting is very important. Emergency physicians are particularly exposed to various chest x-rays during a regular shift. Chest X-ray interpretation is one of the fundamental skills of every doctor.
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