Chest X-ray is one of the commonest OPD investigation we frequently encounter. All of us must know how to read it and interpret. Reading a chest x-ray, though looks simpler, often overlooked by us. Here is a simpler way to remember and read a chest x-ray easily. The popular mnemonics to remember is DRSABCD. This is quite simple to understand and interpret accordingly. 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 Lung fields 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 Pleura 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 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 ETT, CVP line, NG tube, PA catheters, ECG electrodes, PICC line, chest tube PPM, AIDC, metalwork Source
Hold the film A Side front and follow the heart like an arrow. If it points down to the right it's PA, otherwise its AP.
