• Chest X-Ray: Basics

  • 2022/06/28
  • 再生時間： 11 分
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Chest X-Ray: Basics

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    • Indications: broad (respiratory or cardiac disease, tube positioning, trauma) 



    • Characteristics of a good chest x-ray (PIER): 
      • Projection (AP, PA, lateral, lateral decubitus): heart will appear bigger on AP,  but not by much, AP is better for intubated/sick patients, two views is KEY
      • Inspiration and ribs: do you see at least 8-9 posterior ribs (if too little inspiration, things can crowd and mimic abnormalities)
      • Exposure: can you see the spine through the heart (too much penetration makes things dark, too little makes things bright and fuzzy)
      • Rotation and clavicles: what is the relationship between the clavicles and thoracic spinous processes (patient rotated to their right will have their left clavicle appear closer to the spinous process)
      • Angle of patient: should be perpendicular, but x-ray beams may be angled upward (apical lordotic), which can make anterior structures look more superior (clavicles above first rib)



    • Approach
      • Start every time with verifying patient information and imaging quality (PIER)/information 
      • Then execute your systematic approach for consistency 
      • Common approach is the tubes + ABCDEFGHI approach
      • First looks at tubes, lines, drains
      • A = airway, B= bones, C = cardiac, D = diaphragm, E = effusions/extra-thoracic tissues, F = fields, fissures, foreign bodies, G = great vessels, gastric bubble, H = hilum and mediastinum, I = impression
      • A/airway = follow the trachea down, is it midline
      • B/bones = follow outline of bones to look for fractures
      • C/cardiac = heart should be around or less than 50% diameter of chest
      • D/diaphragm = right hemi is slightly higher due to liver, are they flattened
      • E/effusions and extra-thoracic tissues = check costophrenic angles, lateral films, look for swelling, subcutaneous air
      • F/fields, fissures, and foreign bodies = check lung fields for opacities, masses, pneumothorax, vessel markings, look at major and minor fissures, assess any foreign bodies (wires)
      • G/great vessels and gastric bubble = follow path of aorta, pulmonary arteries and veins, gastric bubble under left hemidiaphragm
      • H/hilum and mediastinum = look for prominence (sarcoid), lymphadenopathy, masses, check for mediastinal widening (thymus can be normal in kids)
      • I/impression = overall conclusion or what is going on considering your findings 



    References: Herring's Learning Radiology, Radiopaedia, Mandell's CORE Radiology 
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あらすじ・解説

  • Indications: broad (respiratory or cardiac disease, tube positioning, trauma) 



  • Characteristics of a good chest x-ray (PIER): 
    • Projection (AP, PA, lateral, lateral decubitus): heart will appear bigger on AP,  but not by much, AP is better for intubated/sick patients, two views is KEY
    • Inspiration and ribs: do you see at least 8-9 posterior ribs (if too little inspiration, things can crowd and mimic abnormalities)
    • Exposure: can you see the spine through the heart (too much penetration makes things dark, too little makes things bright and fuzzy)
    • Rotation and clavicles: what is the relationship between the clavicles and thoracic spinous processes (patient rotated to their right will have their left clavicle appear closer to the spinous process)
    • Angle of patient: should be perpendicular, but x-ray beams may be angled upward (apical lordotic), which can make anterior structures look more superior (clavicles above first rib)



  • Approach
    • Start every time with verifying patient information and imaging quality (PIER)/information 
    • Then execute your systematic approach for consistency 
    • Common approach is the tubes + ABCDEFGHI approach
    • First looks at tubes, lines, drains
    • A = airway, B= bones, C = cardiac, D = diaphragm, E = effusions/extra-thoracic tissues, F = fields, fissures, foreign bodies, G = great vessels, gastric bubble, H = hilum and mediastinum, I = impression
    • A/airway = follow the trachea down, is it midline
    • B/bones = follow outline of bones to look for fractures
    • C/cardiac = heart should be around or less than 50% diameter of chest
    • D/diaphragm = right hemi is slightly higher due to liver, are they flattened
    • E/effusions and extra-thoracic tissues = check costophrenic angles, lateral films, look for swelling, subcutaneous air
    • F/fields, fissures, and foreign bodies = check lung fields for opacities, masses, pneumothorax, vessel markings, look at major and minor fissures, assess any foreign bodies (wires)
    • G/great vessels and gastric bubble = follow path of aorta, pulmonary arteries and veins, gastric bubble under left hemidiaphragm
    • H/hilum and mediastinum = look for prominence (sarcoid), lymphadenopathy, masses, check for mediastinal widening (thymus can be normal in kids)
    • I/impression = overall conclusion or what is going on considering your findings 



References: Herring's Learning Radiology, Radiopaedia, Mandell's CORE Radiology 
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