Chest x-ray

• Anterior-posterior (AP) direction


  • Taken from in front of the patient
  • Patient often in lying – scapular shadows within lung fields
  • Often taken on ward/inpatient setting
  • Cardiac size appears larger
  • Diaphragm sits higher –positional/compressive forces
• Posterior-anterior (PA) direction


  • Taken from behind the patient
  • Patient in standing with hands behind head – scapular shadows out of lung fields
  • Often taken in Outpatient setting
  • Cardiac size appears smaller
  • Mediastinum wider
  • Pulmonary vessels are same size in upper and lower lung fields
• Quality check


  • RIP
  • Rotation
  • Inspiration
  • Penetration
• Rotation


  • If rotated the lung will not appear the same on both sides
  • Check the medial ends of the clavicle are both the same distance from the spinal column
• Inspiration


  • Can you see the 10th rib posteriorly and 6th rib anteriorly?
  • Can you count too many ribs? Hyperinflation
  • Can you count too few? Poor inspiration
• Penetration


  • Can you see spinous processes above the heart?
  • Can you see gaps between vertebrae below the cardiac shadow- if not visible its under penetrated,
  • If very penetrated its been over penetrated
• Interpreting X-ray


  • Airways
  • Bones
  • Cardiac silhouette
  • Diaphragm
  • Edges
  • Fields
  • Gas
  • Hilum
  • Instrumentation
• Trachea


  Midline to clavicle
• Mediastinum


  Right side should be 2/3mm from etches edge and left 1/2cm
• Hilia


  Left should be 2.5cm higher than right, compare shape and density
• Border of heart


  • Clear edge, maximum diameter should be less than 1/2 the transthoracic diameter
  • Dextracardia is where the heart sits on the right side
• Diaphragm


  • Should be dome, clear borders
  • Displacement= collapsed lung
• Soft tissues


  Enlargement (breast cancer)
• Classification of abnormalities


  • White (Collapse, Consolidation, Plural effusion, foreign bodies)
  • Black (Hyperinflation, pneumothorax, bullae)
  • Enlarged heart and mediastinum
• Collapse


  • Upper lobe- trachea deviated
  • Left lower lobe- triangle density behind heart, no medial diaphragmatic border
  • Right lower lobe- horizontal fissure displaced downwards, loss of right border
• Consolidation


  • Alveoli and small airways are full of dense material
  • Obscures the same borders as in collapse
  • Opacity is not defined and is patchy
• Pulmonary oedema


  • Upper lobe diversion
  • Increased heart size
  • Kerley B lines
  • Bat wing
• Plural effusion


  • Fluid building up from the base
  • Meniscus shape shadow
• Foreign bodies


  • Tumours
  • Abscess
  • Inhaled object
• Hyperinflation


  • Know horizontal diaphragm
  • More than 10 ribs visible
• Pneumothorax


  • Unilateral black lung
  • Lung edge
• Bullae


  Permanent air-filled space
• Enlarged heart


  Over 1/3 of chest
• Widened mediastinum


  Wide shadow
• There are two main types of fissures: oblique (horizontal) and vertical (diaphragmatic).
• The lungs are divided into lobes by fissures, which are lines that separate them from one another.
• Increased density on an X-ray can indicate fluid accumulation, such as pleural effusion or pulmonary edema.
• The left lung has three lobes separated by horizontal fissures.