Normal X-ray Reading

Normal X-ray reading :

Fig-1: Normal chest with marking.

Fig-2: Normal chest with marking.

➡️Chest x-ray P/A view ( including neck, upper part of skull, abdomen) showing-

(প্রথমে normal finding then abnormal)

1.Trachea is centrally placed/ shifted to right / shifted to left
2.Soft tissue shadow is normal ( abnormal - subcutaneous emphysema)
3.Bony skeleton is normal ( bronchitis- ribs horizontal)
3.Cardiophrenic & Costophrenic angles are normal/ obliterated
4.Heart is normal/enlarged in transverse diameter
5.Dense homogeneous opacity involving right upper/lower zone of right/ left lung

So, my radiological diagnosis is normal chest x-ray/ right sided consolidation/ left sided pleural effusion ((according to findings))

According to the radiograph of the chest, the boundaries of the heart are formed:

• The right border of the heart is the superior vena cava, the right atrium. The anterior wall of the heart is the right ventricle.
• Left border of the heart – aortic arch, left pulmonary artery, left atrium, left ventricle
• The lower border of the heart is the left ventricle.

Fig: heart border in x-ray.

Fig: x-ray lateral view. 

Fig : anterior view heart projection.

• 
  
• The right border extends between the margin of the third right costal cartilage to the sixth right costal cartilage just to the right of the sternum.
• The left border extends between the fifth left intercostal space to the second left costal cartilage.
• The inferior border extends from the sixth right costal cartilage to the fifth left intercostal space at the midclavicular line.
• The superior border extends from the inferior margin of the second left costal cartilage to the superior margin of the third costal cartilage.

X-ray Position : PA & AP View

AP View Vs PA view :

Lateral position X-ray:

Interpretation:

1. The clear spaces

2.Retrosternal space

3. Retro-tracheal space

4. Retro cardiac

5. Vertebral translucency

6. Diaphragm outline

7. The fissures

8. The trachea

9. The sternum

Chest X-ray Left Lateral view

The Left lung field : Divided into upper and lower zones.

1. Upper zone is represented by-

2. Left Upper lobe (White area)

3. Lower zone is represented by-

4. Left Lower lobe (Light green

area)

Chest X-ray Right Lateral view:

The right lung field : Divided into

upper, middle and lower zones.

1.Upper zone is represented by-

2. Right Upper lobe (White area)

3. Middle zone is represented by

4. Middle lobe (Dark green area)

5. Lower zone is represented by-

6. Right Lower lobe (Light green

area)

Lateral Decubitus position

The lateral decubitus view of the chest is a specialized projection utilized to demonstrate small pleural

effusions, or for the investigation of pneumothorax and air trapping due to inhaled foreign bodies. The

patient faces towards the cassette while lying in decubitus position and X-ray tube is towards the

back.

Patient position

1. The patient is laying either left lateral or right lateral on a trolley on top of a radiolucent

sponge

( Note: when investigating pneumothorax the side of interest should be up; when

investigating pleural effusions the side of interest should be down)

2.  The detector is placed landscape posterior to the patient running parallel with the long axis of

the thorax

3.  Patient's hands should be raised to avoid superimposing on the region of interest, legs may

be flexed for balance

4. Rotation of shoulders or pelvis should be minimized

5.  Patients should be changed into a hospital gown, with radiopaque items (e.g. belts, zippers)

removed

6.  X-ray is taken in full inspiration

Interpretation

1. To assess small volume pleural fluid

2. Loculated pleural effusion or mobile

Dorsal decubitus view:

The dorsal decubitus view is a supplementary projection often replacing the lateral decubitus view in

the context of an unstable patient who is unable to roll nor stand. Used to identify free intraperitoneal

gas (pneumoperitoneum). It can be performed when the patient is unable to be transferred to, or

other imaging modalities (e.g. CT) are not available.

Patient position:

1. The patient is supine

2.The detector is placed landscape of at the patient's left-hand side running parallel to the long axis of the abdomen

3. Patient's hands should be raised to avoid superimposing on the region of interest; legs may

be flexed for balance

4. Patients should be changed into a hospital gown, with radiopaque items (e.g. belts, zippers)

removed

5. X-ray is taken in full inspiration

Interpretation

To demonstrating fluid levels from a lateral perspective

Cardio thoracic ratio x-ray(CT):

Normal : A+B/C < 0.5 

Cardiomegaly : 

Adult:  A+B/C > 0.5

Newborn:  A+B/C > 0.6

Checking Normal Abnormal Features:

ABCDE X-ray Interpretation:

Just remember the following:

A - Airway

B - Breathing

C - Circulation/Cardiovascular

D - Disability

E - Everything Else

1.A - Airway

As mentioned above, the ABCDE mnemonic is a great method for reading and interpreting chest x-rays.

It provides a systematic approach to ensure that you don’t forget to look at something.

You’ll first start with “A”, which stands for “Airway”.

This is when you will interpret the parts of the airway visible on the chest x-ray.

This typically includes the trachea, the right main bronchus, the left main bronchus, as well as any portions of the airway distal to that.

Look for signs of tracheal deviation, filling defects, mass effect, or a foreign body that may have been aspirated.

2.B - Breathing

After assessing the airway, proceed to “B”.

“B” stands for “Breathing”.

This is when you will interpret both lungs.

Begin by looking at the lung borders, making sure that there are lung markings visualized out to the chest wall.

You are looking for any signs of pneumothorax, also known as a collapsed lung, in which there is an abnormal collection of air between the visceral and parietal pleura.

The presence of a pleural line on chest x-ray could indicate a pneumothorax.

After assessing the lung borders, compare and contrast both lungs in a “zig-zag” approach for any abnormalities.

Example abnormalities may include signs of pleural effusion, mass, or an opacity that could suggest pneumonia to name a few.

Lastly, make sure to observe any portions of lung visible below the hemidiaphragm on chest x-ray.

3.C - Cardiovascular/Circulation

After assessing the airway and lungs (breathing), move on to “C”.

The “C” stands for “Circulation or Cardiovascular”.

This is when you will assess the cardiomediastinal silhouette.

First, look at the right and left mediastinal borders, assessing the width of the mediastinum.

A widened mediastinum could potentially suggest an aortic dissection.

You are also looking for signs of pneumomediastinum, the presence of air in the mediastinum secondary to air escaping the lungs, airways, or bowel.

Next, assess the rest of the heart border.

You are looking to see if any portion of the heart border is obscured by an opacity, which could suggest pneumonia or other causes.

Assess the overall size of the heart as well for any signs of cardiomegaly.

Lastly, observe the right and left hilar regions as masses can present there.

4.D - Disability

Next, proceed to “D” which stands for “Disability”.

This is when you will assess the bones for fractures, dislocations, or any other abnormalities.

First, assess the proximal portion of the humerus available on x-ray, as well as the glenohumeral joint and scapula bilaterally.

Next, assess the right and left clavicle.

Third, assess each rib starting at the posterior aspect, follow it along the lateral border, and then assess any anterior portions available.

Lastly, take a look at the vertebral bodies. You can potentially pick up compression fractures or other abnormalities.

5.E - Everything Else

Lastly, “E” stands for “Everything Else” to help pick up the other aspects of the x-ray that have not yet been observed.

There are a few components to interpret here.

First, assess below the diaphragm (as well as the diaphragm itself) for any signs of free air. Observe the gastric bubble as well.

Next, look for any signs of subcutaneous air or emphysema.

Lastly, check for any tubes or lines in place such as an endotracheal tube, a central line, a nasogastric tube, etc.