Chest X-ray Interpretation Lecture Notes

Introduction

• Presented by Olivia from Geeky Medics.
• Focus on interpreting chest x-rays using a structured approach.
• Clinical context is essential for effective x-ray interpretation.

Basic Principles of X-rays

• X-rays use high-energy electromagnetic radiation to create images of body structures.
• Density Differences:
  • Less dense structures (e.g., lungs) appear dark.
  • Dense structures (e.g., bones, dense tumors) appear white.
  • Soft tissues appear in shades of gray.

Initial Checks Before Interpretation

• Confirm patient details: name, date of birth, hospital number.
• Check date and time of the x-ray.
• Review previous imaging for comparison.
• Understand clinical context and associated symptoms.

Assessing Image Quality: RIPE Mnemonic

Rotation

• Ensure vertebral bodies and spinous processes are vertically aligned.
• Medial aspects of clavicles should be equidistant from the spinous processes.

Inspiration

• Check for visualization of 5-6 anterior ribs, lung apices, costophrenic angles, and lateral rib edges.

Projection

• Standard is the posterior-anterior (PA) projection.
• AP projection often used for unwell patients but can distort cardiac size.

Exposure

• Proper exposure should allow visualization of pulmonary vessels, lung fields, and bony anatomy.
• Overexposed films appear darker; underexposed films appear whiter.

Systematic Interpretation: ABCDE Approach

A - Airway

• Examine trachea, carina, bronchi, and hilar structures.
• Tracheal Deviation: Indicates issues like pleural effusion, pneumothorax, lobar collapse.

B - Breathing

• Inspect lungs and pleura.
• Divide lungs into upper, middle, and lower zones to check for abnormalities.
• Pathologies include pulmonary edema, consolidation, and pneumothorax.

C - Cardiac

• Assess cardiac size (cardiothoracic ratio <0.5 in PA film) and cardiac borders.
• Cardiac enlargement can indicate various heart diseases.

D - Diaphragm

• Inspect left and right hemidiaphragms and costophrenic angles.
• Pneumoperitoneum: Air under the diaphragm indicating potential bowel perforation.

E - Everything Else

• Review mediastinal contours, bones, soft tissues, and medical equipment.
• Check for aortic knuckle and aorto-pulmonary window.

Documentation

• Document patient details, x-ray timing, clinical indications, findings, impressions, and management plans.

Case Studies

Case 1: Pneumonia

• 71-year-old with fever and productive cough.
• X-ray: Bilateral opacification, slightly enlarged heart, likely pneumonia.
• Management: Assess with CURB-65 score.

Case 2: Tension Pneumothorax

• 18-year-old post-motorcycle accident.
• X-ray: Trachea deviated to the right, lung collapse, left pneumothorax.
• Immediate management: Needle decompression should be performed in clinical suspicion of tension pneumothorax.

Conclusion

• Practice using structured approaches to develop confidence in chest x-ray interpretation.
• Further resources available on the Geeky Medics website.