Reading Plain Xrays:

Part I Chest Radiographs

Tuesday March 1st 2016

Peter Santos
Radiologist and Nuclear Medicine Specialist

Aims
Structure : Anatomy
Systematic Approach to Reading a CXR=Search Pattern
Lines and tubes
Emergency and common pathologies : consolidation,
pleural effusion, pneumothorax, fluid overload, mass,
asthma
PACS Tips and Tricks

Questions
What are the lobes of the lungs?

How is a CXR performed?

What is the difference between collapse and
consolidation?
How do you tell that there is fluid overload?
Do you order or request an imaging study?

How Chest Xrays are done PA and AP

How Chest Xrays are done lateral

How Chest Xrays are done supine

Widened mediastinum and

heart
Prominent pulmonary
vessels

Anatomy

Anatomy

Disclosures

Search Pattern

ETT
Tip 5 cm above carina
Just above the aortic
knuckle
2cm of movement
Neck flexion/extension

Hunter T B et al. Radiographics 2004;24:1725-1746

Pleural tubes
Thoracostomy, chest, tubes or
intercostal catheters
10-40Fr

Position
Pneumothorax
Anterosuperior

Pleural fluid
Posteroinferior

Malpositioned
Ptx or effusion still present
Fissures
Lung
Proximal side hole
Kinked
Tip mediastinum
Hunter T B et al. Radiographics 2004;24:1725-1746

Nasogastric
Tip below diaphragm

Venous catheters
Inferior SVC
Cavoatrial junction
1 VB below carina
SVC crosses the right
main bronchus

L brachiocephalic vein
Avoid tips at junctions

Vascular- pulmonary artery catheter

Swan- Ganz
Tip at the hilum
Inferior/ basal
pulmonary artery

Hunter T B et al. Radiographics 2004;24:1725-1746

How to present
This is a frontal chest xray in a X year old man/woman
who presented with Y

Look at the film in your search pattern

Lines and tubes
Then salient findings
Then relevant negatives (consolidation, pleural effusion,
pneumothorax, free subphrenic gas, rib fractures)

Lets go

Warm Up

Warm Up

Warm Up - Tips

Warm Up - 2

Warm Up - 3

Warm Up - 3

Case 1

Trouble seeing lines and tubes?

Invert

Case 2

Case 3

Case 4

Case 5

Case 6

Case 7

Cases

Case 8

Case 9

Case 10

Case 11

Radiation

Definition: Energy in the form of particles or waves

Radiation around us = background

Why do we fear radiation?

Radiation Risks : Cancer

What is the probability that we will die of cancer?

Radiation Risks : Mutation

Deterministic and Stochastic Effects of Radiation?

Radiation Doses in Background Equivalent

Study

Dose (background
equivalent)

Chest X ray

2 days

Chest X ray with Lateral

10 days

Return Flight from

Melbourne to London

10 days

VQ scan

11 months,
if preg 4 months

sestaMIBI stress

1.3 years

Coronary CT

1.3 years

Bone Scan

1.8 years

CTPA

2 years

CT Brain

10 months

Coronary Angiogram

2 6.8 years

To Order or Request?

CONCLUSION
1) Reading chest radiographs is an important skill
2) Systematic approach
3) If in doubt, please contact radiology

References

ACKNOWLEDGEMENTS
Dr Phillip Tran (Radiologist)
Western Health Medical Imaging

THANK YOU
Email : peter.santos@wh.org.au