Sunday, October 28, 2007

Reading Chest Xrays

I was thinking the other day that it would be nice to be able to read a chest xray better than I currently can so I set off to find some information on looking at different xrays and what I'm looking at. Now let me clarify that I'm talking about reading just chest xrays as this is most revelant to the job of a Respiratory Therapist, we don't really need to know if a patient has a tib/fib fracture of his left leg, that doesn't really help me out much. Well doing some searches here on the old internet I ran across a couple really good sites in my opinion on reading chest xrays so instead of writing a whole article and teaching a class on reading them because I'm not a pro at this here are a couple of sites I recommend.

Now for the ABC's of the technique to read a chest xray:

A - Airway: are the trachea and mainstem bronchi patent; is the trachea midline?
B - Bones: are the clavicles, ribs, and sternum present and are there fractures?
C - Cardiac silhouette: is the diameter of the heart > ½ thoracic diameter enlarged)?
D - Diaphragm: are the costophrenic and costocardiac margins sharp? Is one hemidiaphragm enlarged over another? Is free air present beneath the diaphragm?
E - Effusion/empty space: is either present?
F - Fields (lungs): are there infiltrates, increased interstitial markings, masses, air
bronchograms, increased vascularity, or silhouette signs?
G - Gastric bubble: is it present and on the correct (left) side?
H - Hilar region: is there increased hilar lymphadenopathy?
I - Inspiration: did the patient inspire well enough for 10 ribs to be counted, or was the patient rotated?

Well I hope this bit of information has helped someone look at a xray and see it better, I know doing this has helped me and will help me in the future with my patients.

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This would be a good thing for us RTs to freshen up on. It's not essential, but it would sure be nice to "know" what we are seeing instead of always having to ask. Maybe we could even impress someone with our wisdom.

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