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Spokane Community College

Spokane Community College. Film critique. Overview. CXR - PA -Lateral Anatomy - Lungs - Heart -Cervical & Thoracic Spines - Ribs - Shoulder girdle

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Spokane Community College

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  1. Spokane Community College Film critique

  2. Overview • CXR - PA -Lateral Anatomy -Lungs - Heart -Cervical & Thoracic Spines - Ribs - Shoulder girdle - Sternum

  3. 7 points to a good chest x-rayEvaluation criteria 1. Both apices on the film 2. Check clavicles for rotation 3. Scapulas up and out of the way 4. Can you see the spine thru the heart 5. Can see 8-10 ribs above the diaphragm 6. Check diaphragm for motion 7. Both costophrenic angles on

  4. PA Chest • Center to T-6 • Check trachea, is it over the spine • One to two inches of lung apex should show above the clavicles • Same distance on both sides between ribs and edge of film • Same distance from spine to lateral border of the ribs on both sides • A small amount of the heart should be seen on the right side of the spine • *** Remember CR needs to be horizontal or parallel to the floor to show air-fluid levels.

  5. Common problems • Artifacts • Rotation • Crosswise or lengthwise • Leaning into the board or leaning back from the board • Deep breath in • Scapulas out of long field • Tube angle

  6. Lateral Chest Left lateral • CR to T-6 • Ribs superimposed • Arms out of field • Sternum lateral • Costophrenic angles and apices on • Hilum in the center of the image • Thoracic intervertebral spaces should be open • Exposure penetrate heart with overexposure of lungs

  7. Common problems • Rotation • Breathing • Arms out of lung field • Leaning forward and backwards

  8. How to read a CXR • 1. check patient name, position, technical quality • 2. Soft tissue including breast, chest wall, companion shadow • 3. Review soft tissues and skeletal structures of shoulder girdles and chest wall • 4. Review abdomen for bowel gas, organs • 5. Review soft tissues and spine of neck • 6. review spine and rib cage: check alignment, disc space narrowing, lytic or blastic areas • 7. Review Mediastinum: -overall size and shape -Trachea: position - Margins: SVC, ascending aorta, right atrium, left subclavian artery aortic arch, main pulmonary artery, left ventricle - Lines and stripes: paratracheal,paraspinal, paraesophageal paraaortic -retrosternal clear space 8. Review hila: -Normal size -Normal relationships 9. Review lungs and pleura: -compare lung size -Evaluate pulmonary vascular pattern: compare upper to low- er lobe, RT to LT, normal tapering to periphery -Pulmonary parenchyma - pleural surfaces: fissures, major & minor (if seen) compare hemidiaphragms,follow pleura around rib cage

  9. Is this the left side?

  10. Air/fluid levels ***Remember the CR needs to be horizontal or parallel to the floor to show air-fluid levels

  11. Abdomen AP supine AP upright Left lateral decubitus Anatomy -Spine T/L -Pelvis -Intestinal gas -Kidneys -Psoas muscle

  12. Diaphragm dome Thoracic Vertebra Gas bubbles 11 kidney

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