XRAY INTERPRETATION 12 steps approach (by team Lambda1)

Initial
D
D
O
V
I
P

Mnemonics
Di
Di
On
Video
In
Penny's

R
T
M
D
P

Room
To
Meet
Doraemon
Punya

Friend

Description
Detail
Date
Old Film
View
Inspiration
Penetration

Description
Name, Ptt registration number, address, age
Date of procedure
Trace for history of ANY previous old case (prereading)
1) AntPost 2) LateralDecubitus
Adequacy of inspiration ( PostRib/horizontal ribs must have 9 ribs seen )
Visibly darken lung and part of the vertebral column in the abdomen
showed overpenetration (detail of lung can't be seen need to reorder)
Rotation
Trachea should be in the middle, clavicle equidistance from the midline
Tissue
Soft tissue & Bony , Fractures, calcification, deformations
Mediastinum
Hilar, Size, whether it is deviated or not
Diaphragm
<50% of rib cage is normal, look for diaphragmatic recesses
Pleural and Fissure Look for sign of hydro/pneumothorax,
Fissures on the lungRight 3 lobes, Left 2 lobes (limitation/border)
Field
Look for any abnormal signs.
( Lung Field)

Abnormal X ray signs

1) Silhouette Sign Loss of normal border between structures e.g. Intrathoracic radioopacity obscuring the border of
the heart or aorta due to a contiguous structure.
2) Air Bronchogram equivalent to "Increased Lung Pattern" In Russian literature
3) Direct Sign of Collapse (atelectasis ) a) Septa Displaced toward collapsed lung
b) Lung will be more radioopaque due to loss of air (whitish)
c) Bronchi appeared to be crowded together
Indirect Sign of Collapse

a) Hilum will be displaced more to the collapsed part

b) Ipsilateral elevation of hemidiaphragm
c) RibCage size will be increased
d)compensatory emphysemaradiolucent (blackish)

4) Pulmonary Nodular Bullseye appearance ( granuloma )<4cm

Popcorn appearance ( harmatoma ) <4cm * due to calcification

>6cm
5) Pleural Effusion
6) Kerleys Sign sign of pulmonary edema (refer to the X ray below)
1) Peripheral to hilar ( central anastomoses of periphery to central lymphatics ) Kerley A (white arrow)
2) Short peripheral lines ( parallel lines at the lower lobes )Kerley B (white arrowhead)
3) Reticular opacities at lung baseinterlobular space ( net like ) Kerley C (black arrowhead)