The popular mnemonics to remember is DRSABCD. This is quite simple to understand and interpret accordingly.
The steps on Chest Xray Interpretation is as under:
D – Details about the patient and the x-ray. Why it’s important? Well, a what’s can go wrong if we interpret another patient’s x-ray for some one else. We describe details under the following sub heading.
- Patient name, age / DOB, sex
- Type of film – PA or AP, erect or supine, correct L/R marker, inspiratory/expiratory series
- Date and time of study
R- Ripe it’s for assessing the technical quality of the image.
- Rotation – medial clavicle ends equidistant from spinous process
- Inspiration – 5-6 anterior ribs in MCL or 8-10 posterior ribs above diaphragm, poor inspiration?, hyperexpanded?
- Picture – straight vs oblique, entire lung fields, scapulae outside lung fields, angulation (ie ’tilt’ in vertical plane)
- Exposure (Penetration) – IV disc spaces, spinous processes to ~T4, L) hemidiaphragm visible through cardiac shadow.
S – Soft tissues and Bones –
- Ribs, sternum, spine, clavicles – symmetry, fractures, dislocations, lytic lesions, density
- Soft tissues – looking for symmetry, swelling, loss of tissue planes, subcutaneous air, masses
- Breast shadows
- Calcification – great vessels, carotids
A- Airway and Mediastinum
- Trachea – central or slightly to right lung as crosses aortic arch
- Paratracheal/mediastinal masses or adenopathy
- Carina & RMB/LMB
- Mediastinal width <8cm on PA film
- Aortic knob
- Hilum – T6-7 IV disc level, left hilum is usually higher (2cm) and squarer than the V-shaped right hilum.
- Check vessels, calcification.
B – Breathing
- Vascularity – to ~2cm of pleural surface (~3cm in apices), vessels in bases > apices
- Pneumothorax – don’t forget apices
- Lung field outlines – abnormal opacity/lucency, atelectasis, collapse, consolidation, bullae
- Horizontal fissure on Right Lung
- Pulmonary infiltrates – interstitial vs alveolar pattern
- Coin lesions
- Cavitary lesions
- Pleural reflections
- Pleural thickening
C – Circulation
- Heart position –⅔ to left, ⅓ to right
- Heart size – measure cardiothoracic ratio on PA film (normal <0.5)
- Heart borders – R) border is R) atrium, L) border is L) ventricle & atrium
- Heart shape
- Aortic stripe
- Hemidiaphragm levels – Right Lung higher than Left Lung (~2.5cm / 1 intercostal space)
- Diaphragm shape/contour
- Cardiophrenic and costophrenic angles – clear and sharp
- Gastric bubble / colonic air
- Subdiaphragmatic air (pneumoperitoneum)
E – Extras
- ETT, CVP line, NG tube, PA catheters, ECG electrodes, PICC line, chest tube
- PPM, AIDC, metalwork
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