Wednesday, July 20, 2011

Simple Way to Interpreting CXR in Emergency Department


This morning during round, one medical student ask me how to simply read the radiograph in emergency department. Mmmm...i just smile to him, there is no simple way to interpret CXR in ED. I know they are waiting for my mnemonic to share with them. Maybe this mnemonics will help, i found this in the net. RIP ABCDEFG

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.

Click here for basic interpretation of the CXR

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