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CXR Tutorial

CXR Tutorial . Images courtesy of Andy Luks, MD. An Object’s Density Affects Its Appearance on CXR. Maximum X-Ray Penetration (least dense structure). Maximum X-Ray Absorption (most dense structure). Initial Steps for Reading CXRs. Verify patient name, date/time Assess technique

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CXR Tutorial

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  1. CXR Tutorial Images courtesy of Andy Luks, MD

  2. An Object’s Density Affects Its Appearance on CXR Maximum X-Ray Penetration (least dense structure) Maximum X-Ray Absorption (most dense structure)

  3. Initial Steps for Reading CXRs • Verify patient name, date/time • Assess technique • PA or AP (portable)? • Supine or upright? • Adequate inspiration? • Rotated? • Adequate penetration?

  4. PA vs AP (portable)

  5. Supine vs Upright

  6. Adequacy of Inspiration

  7. Patient Rotation

  8. Adequacy of Penetration

  9. Basic Method of Reading CXRs • Do the ABCDEF • A = airway • B = bones • C = cardiac (heart and aorta) • D = diaphragm • E = everything else (lines & tubes, air that shouldn’t be there, lymph nodes, etc) • F = finally, lungs!

  10. A = Airway • Trachea position (midline or toward one side) • Size of trachea (i.e. narrowing)

  11. B = Bones • Number of ribs • Rib fractures

  12. C = Cardiac (Heart) • Cardiac silhouette

  13. C = Cardiac • Silhouette sign = obscured cardiac borders

  14. C = Cardiac (Aorta) • Aorta size

  15. D = Diaphragms • Roundness • Costophrenic angles

  16. D = Diaphragms

  17. E = Everything Else • Lines and tubes

  18. E = Everything Else

  19. E = Everything Else

  20. E = Everything Else • Air that shouldn’t be there

  21. E = Everything Else • Lymphadenopathy

  22. F = Finally, Lungs! • Opacities

  23. F = Finally, Lungs! • Lung collapse

  24. F = Finally, Lungs! • Masses

  25. Summary • Check patient name, date/time • Assess technique • PA or AP (portable)? • Supine or upright? • Adequate inspiration? • Rotated? • Adequate penetration? • Do ABCDEF • Seriously, leave lungs for last!

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