"This is a <PA/AP> chest X-ray of a <age> year old which was taken on the <date>. It is normally rotated/slightly rotated to the right <rotation> and is normally orientated <orientation>. There is an adequate degree of penetrance/it is underexposed/overexposed <penetrance/exposure>, and there is adequate/inadequate degree of inspiration <inspiration>"
(Note: PA/AP is decided by looking at whether the scapula is more in front (AP) or behind the chest wall (PA).
Degree of rotation is decided by comparing the sternal ends of the clavicle.
Orientation is noted by looking at whether the 'L' sticker is pasted on the correct side. If heart is facing opposite side, look for gastric bubble under the left diaphragm but to be 100% sure it is dextrocardia/situs inversus and not a mistake a history and physical examination needs to be done.
Penetrance is adequate if vertebra can just be made out through the cardiac shadow
Degree of inspiration is adequate if 5-7 anterior ribs and 10 posterior ribs can be counted)
"The most significant abnormality is a…"
1) Homogenous/patchy/reticular/nodular opacity/lucency/White-out in R/L/bilaterally upper/mid/lower zones
Air bronchograms/peri-bronchiolar cuffing?
Kerley 'B' lines?
Then finish off by checking off 'LAHMBDA' - Lungs, Airways, Heart, Mediastinum, Bones, Diaphragm, Air outside lungs)
"Otherwise, there are no signs of..."
2) Airways - tracheal deviation? (Mass in thorax or tension pneumothorax). Foreign bodies?
3) Heart - >50% of thoracic diameter in PA films? (cardiomegaly) Abnormal heart shape, calcification, valves?
4) Mediastinum - Widened mediastinum? May mean aortic dissection. In children a mediastinal mass is most likely thymus
5) Bones - Mets, fractures, osteoporosis? soft tissue - subcutaneous emphysema, edema?
6) Diaphragm - costophrenic angles clear? (pleural effusion)
7) Air outside lungs - collapsed lung (pneumothorax), under diaphragm (air in peritoneal space)
(Note: PA/AP is decided by looking at whether the scapula is more in front (AP) or behind the chest wall (PA).
Degree of rotation is decided by comparing the sternal ends of the clavicle.
Orientation is noted by looking at whether the 'L' sticker is pasted on the correct side. If heart is facing opposite side, look for gastric bubble under the left diaphragm but to be 100% sure it is dextrocardia/situs inversus and not a mistake a history and physical examination needs to be done.
Penetrance is adequate if vertebra can just be made out through the cardiac shadow
Degree of inspiration is adequate if 5-7 anterior ribs and 10 posterior ribs can be counted)
"The most significant abnormality is a…"
1) Homogenous/patchy/reticular/nodular opacity/lucency/White-out in R/L/bilaterally upper/mid/lower zones
Air bronchograms/peri-bronchiolar cuffing?
Kerley 'B' lines?
Then finish off by checking off 'LAHMBDA' - Lungs, Airways, Heart, Mediastinum, Bones, Diaphragm, Air outside lungs)
"Otherwise, there are no signs of..."
2) Airways - tracheal deviation? (Mass in thorax or tension pneumothorax). Foreign bodies?
3) Heart - >50% of thoracic diameter in PA films? (cardiomegaly) Abnormal heart shape, calcification, valves?
4) Mediastinum - Widened mediastinum? May mean aortic dissection. In children a mediastinal mass is most likely thymus
5) Bones - Mets, fractures, osteoporosis? soft tissue - subcutaneous emphysema, edema?
6) Diaphragm - costophrenic angles clear? (pleural effusion)
7) Air outside lungs - collapsed lung (pneumothorax), under diaphragm (air in peritoneal space)