1. Spokane Community College
Film critique

2. Overview CXR Anatomy -Lungs - Heart -Cervical & Thoracic Spines - Ribs
- Upright PA
-Upright Lateral
Anatomy
-Lungs
- Heart
-Cervical & Thoracic Spines
- Ribs
- Shoulder girdle
- Sternum

3. UPRIGHT PA Chest

4. PA Upright Chest

5. Upright Why Upright?
Supine
Blunting of Costophrenic Angle
Normal Costophrenic Angle

6. 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

7. #5 #1
PA Chest #2 #2 #3 #3 #4 #6 #7

8. 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.

9. Common problems 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!!)

10. Left Lateral Chest

11. Lateral Chest Left lateral 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

12. Upright Left
Lateral
Chest

13. Common problems Rotation Breathing Arms out of lung field
Leaning into or away from wall bucky

14. Left lateral Chest
Rotation

15. Left Lateral Peds ChestM
Left Lateral Peds Chest
Motion

16. How to read a CXR 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

17. Supine Chest

18. PA Chest

19. Upright Chest

20. Upright PA Peds Chest
Upright Left lateral Peds Chest

21. Left Lateral Chest

22. Motion
Left Lateral Chest

23. Left Lateral Chest ?

24. The heart is on what side?
Upright PA Chest

25. AP Upright Chest

26. Is this the left side?

27. Air/fluid levels
***Remember the CR needs to be horizontal or parallel to the floor to show air-fluid levels

28. PA Upright
Chest
Clavicles

29. Please just sit the patient up more!!!
No tube angle! How can we see air fluid levels!!!