CXR interpretation

Confirm patient details

Assess image quality (RIPE)

No evidence of ​​​rotation (clavicles equidistant from spinous processes)

Adequate field of view (5-6 anterior ribs visible)

PA / AP projection

Well exposed (vertebrae visible behind heart)

ABCDE

Airway

Trachea central.

Carina normal.

No hilar abnormalities.

Tracheal deviation: away from large pleural effusion or tension pneumothorax, towards lobar collapse

(may also be due to rotation)

Hilar enlargement: bilateral: sarcoidosis; unilateral: malignancy​​​​​

Abnormal hilar position: away from enlarging soft tissue mass, towards lobar collapse

Breathing

Lungs

Lung markings present.

Airspace shadowing?(consolidation, mass)

Pleura

No pleural abnormalities

Absent lung markings: pneumothorax

Shadowing: consolidation, mass

Pleural thickening - mesothelioma

Pleural effusion: hydrothorax, haemothorax

Cardiac

Normal heart size (PA)

Cardiac borders visible

Cardiomegaly (Cardiothoracic ratio < 0.5 in PA) : CHF

Sillhouette sign: consolidation

Diaphragm

Right hemidiaphragm higher than left.

Right hemidiaphragm indisdinguishable from liver.

Well-defined costophrenic angles

Pneumoperitoneum

Costophrenic blunting - pleural effusion, consolidation, lung hyperinflation

Everything else

Mediastinal contours

Normal mediastinal contours.

Bones and soft tissue

No obvious fractures or haematomas

Devices

NG tube

Central line, ECG cables

Artificial heart valves

Pacemaker

Reduced definition of aortic knuckle - aortic aneurysm

Loss of aortopulmonary window - mediastinal lymphadenopathy

Review areas

Lung apices

Retrocardiac area

Behind diaphragm

Lung peripherues

Hilar regions