rightheart

Chest X-Rays (CXR) Interpretation

DRSABCD is a familiar acronym for those who have undertaken First Aid/Basic Life Support courses. Now DRSABCDE can used as a simple, yet comprehensive, approach to CXR interpretation.

Normal CXR 

D – Details: 

  • 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 (assessing the image quality)

  • 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 (it is common to leave it until the end)

  • 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 & 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

  • Lung fields
  • Pleura: reflections, thickenning
  • 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

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

D – Diaphragm

  • 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

  • CVP line, NG tube, PA catheters, ECG electrodes, etc

More medical content here!

Independence Day
5 Seconds of Summer
Independence Day

You’re telling me the same old story, that I need to change
If you’re not living my life for me, you make it feel that way

You know, you know we’re losing control
I gotta break away, or nothing’s gonna change
You’ve got to go, it’s the end of the road
No matter what you do or say
Baby, you’re not what I need

I’m over this, I’m over you
I’m not gonna waste my life away
This is my Independence Day
I’m moving on, there’s no excuse
And I can’t take away your pain
This is my Independence Day
This is my Independence Day

Suddenly my picture’s lookin’ perfect since you’re not in the frame
And deep down, I never meant to hurt you, but you’re the one to blame

You know, you know we’re losing control
Before it’s too late, I’m making my escape
Now that I’m gone, you’re on your own
No matter what you do or say
Baby, you’re not what I need

I’m over this, I’m over you
I’m not gonna waste my life away
This is my Independence Day
I’m moving on, there’s no excuse
And I can’t take away your pain
This is my Independence Day

Wouldn’t it be nice if it coulda worked right for us?
I know you fought for all we had
But it didn’t feel right
Hearts on our sleeves we lost tonight
And there’s no looking back

I’m over this, I’m over you
I’m not gonna waste my life away
This is my Independence Day
I’m moving on, there’s no excuse
And I can’t take away your pain
This is my Independence Day

And wouldn’t it be nice if it woulda worked out right for us?
There’s no looking back

This is my Independence Day
This is my Independence Day

Independence Day
5 Seconds of Summer
Independence Day

You’re telling me the same old story, that I need to change
If you’re not living my life for me, you make it feel that way

You know, you know we’re losing control
I gotta break away, or nothing’s gonna change
You’ve got to go, it’s the end of the road
No matter what you do or say
Baby, you’re not what I need

I’m over this, I’m over you
I’m not gonna waste my life away
This is my Independence Day
I’m moving on, there’s no excuse
And I can’t take away your pain
This is my Independence Day
This is my Independence Day

Suddenly my picture’s lookin’ perfect since you’re not in the frame
And deep down, I never meant to hurt you, but you’re the one to blame

You know, you know we’re losing control
Before it’s too late, I’m making my escape
Now that I’m gone, you’re on your own
No matter what you do or say
Baby, you’re not what I need

I’m over this, I’m over you
I’m not gonna waste my life away
This is my Independence Day
I’m moving on, there’s no excuse
And I can’t take away your pain
This is my Independence Day

Wouldn’t it be nice if it coulda worked right for us?
I know you fought for all we had
But it didn’t feel right
Hearts on our sleeves we lost tonight
And there’s no looking back

I’m over this, I’m over you
I’m not gonna waste my life away
This is my Independence Day
I’m moving on, there’s no excuse
And I can’t take away your pain
This is my Independence Day

And wouldn’t it be nice if it woulda worked out right for us?
There’s no looking back

This is my Independence Day
This is my Independence Day

Independence Day
5 Seconds of Summer
Independence Day

Independence Day

You’re telling’ me the same old story
That I need to change
If you’re not livin’ my life for me
Make you feel that way
You know you know, were losing control
I gotta break away, or nothing’s gonna change
You got to go, it’s the end of the road
No matter what you do or say
Baby you’re not what I need

I’m over this, I’m over you
I’m not gonna waste my life away
This is my independence day
I’m moving on, there’s no excuse
And I can’t take away your pain
This is my independence day
Whoo, oh, oh, oh, oh, oh
This is my independence day
Whoo, oh, oh, oh, oh, oh

Suddenly my picture’s looking perfect
Since you’re not in the frame
And deep down, I never meant to hurt you
But you’re the one to blame
You know you know, were losing control
Before it’s too late, I’m making my escape
Now that I’m gone, you’re on your own
No matter what you do or say
Baby you’re not what I need

I’m over this, I’m over you
I’m not gonna waste my life away
This is my independence day
I’m moving on, there’s no excuse
And I can’t take away your pain
This is my independence day

Wouldn’t it be nice
If it would’a worked out right for us
I know you fight for all we had
But it didn’t feel right
Hearts on our sleeves we lost tonight
And there’s no looking back

I’m over this, I’m over you
I’m not gonna waste my life away
This is my independence day
I’m moving on, there’s no excuse
And I can’t take away your pain
This is my independence day

Wouldn’t it be nice
If it would’a worked out right for us
(there’s no looking back)
Whoo, oh, oh, oh, oh, oh
This is my independence day
Whoo, oh, oh, oh, oh, oh
This is my independence day