Spokane Community
College
Film critique
Overview
• CXR
- Upright PA
-Upright Lateral
Anatomy
-Lungs
- Heart
-Cervical & Thoracic Spines
- Ribs
- Shoulder girdle
- Sternum
UPRIGHT PA Chest
PA Upright Chest
Upright
Why Upright?
Blunting of Costophrenic Angle
Supine
Normal Costophrenic Angle
7 points to a good chest x-ray
Evaluation 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
#1
PA Chest
#2
#2
#3
#3
#5
#4
#6
#7
PA Chest
 Center to T-6
 Check trachea, is it over the spine (rotation)
 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 (rotation)
 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.
Common problems
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Artifacts
Rotation
Crosswise or lengthwise
Leaning into the board or leaning
back from the board
• Deep breath in
• Scapulas out of lung field
• Tube angle (just say no!!)
Left Lateral Chest
Lateral Chest
Left lateral
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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
Upright Left
Lateral
Chest
Common problems
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Rotation
Breathing
Arms out of lung field
Leaning into or away from wall
bucky
Left lateral Chest
Rotation
Left Lateral Peds Chest
Motion
M
How to read a CXR
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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 lower
lobe, RT to LT, normal tapering to periphery
-Pulmonary parenchyma
- Pleural surfaces: fissures, major & minor (if seen)
compare hemidiaphragms,follow pleura around rib cage
Supine Chest
PA Chest
Upright Chest
Upright PA Peds Chest
Upright Left lateral Peds Chest
Left Lateral Chest
Motion
Left Lateral Chest
Left Lateral Chest
?
The heart is on what side?
Upright PA Chest
AP Upright Chest
Is this the left
side?
Air/fluid levels
***Remember the CR needs to be
horizontal or parallel to the floor to
show air-fluid levels
PA Upright
Chest
Clavicles
Please just sit the patient up
more!!!
No tube angle! How can we see air fluid levels!!!