Chest X-Rays (CXR) Interpretation
DRSABCD is a familiar acronym for those who have undertaken First Aid/Basic Life Support courses. Now DRSABCDE can used as a simple, yet comprehensive, approach to CXR interpretation.
Patient name, age / DOB, sex
Type of film – PA or AP, erect or supine, correct L/R marker, inspiratory/expiratory series
R – RIPE (assessing the image quality)
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 (it is common to leave it until the end)
Ribs, sternum, spine, clavicles – symmetry, fractures, dislocations, lytic lesions, density
Soft tissues – looking for symmetry, swelling, loss of tissue planes, subcutaneous air, masses
Calcification – great vessels, carotids
Trachea – central or slightly to right lung as crosses aortic arch
Paratracheal/mediastinal masses or adenopathy
Mediastinal width <8cm on PA film
Hilum – T6-7 IV disc level, left hilum is usually higher (2cm) and squarer than the V-shaped right hilum.
Check vessels, calcification.
Pleura: reflections, thickenning
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
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
Hemidiaphragm levels – Right Lung higher than Left Lung (~2.5cm / 1 intercostal space)
Cardiophrenic and costophrenic angles – clear and sharp
Gastric bubble / colonic air
Subdiaphragmatic air (pneumoperitoneum)
CVP line, NG tube, PA catheters, ECG electrodes, etc
More medical content here!
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