This can only accurately be assessed on a PA view, with normal heart size being less than half of the thoracic cavity.Have accompanying pulmonary vasculature filled will blood (whitish-grey) fanning to right out to the lung edges.Have air all through the lung fields (black).Assess the breathing fields which should:.If your patient is intubated, assess that the position of the endotracheal tube is located approximately 5 cm +/- 2 cm above the carina (the point where the right and left bronchus burficate) and below the clavicles.To ensure that all the important components on a CXR are identified, a systematic approach is required to ensure nothing gets missed: Airway If abnormal findings are consistent with lung disease or overlying of soft tissue or bone over the lung fields.If the heart is enlarged as a left rotation results in a larger looking heart and a right rotation results in a smaller looking heart.If the trachea is deviated to one side by the lung condition or the rotation.If the spine appears closer to one clavicle then the other, there is patient rotation present that may result in difficulty assessing:.There should be an equal distance between the spine and the clavicle ends.Assess for any patient rotation on the CXR.Due to the alveoli only remaining open due to the lower expiratory pressure, this can make the lung fields appear de-recruited.If the ribs are closer together = expiration.Due to the alveoli being open and filled with air with higher inspiratory pressure, this can make the lung fields appear well recruited.If the ribs are further apart = inspiration.Verify if the CXR has been taken on inspiration or expiration.The AP view can make a normal heart appear enlarged due to the short distance between the x-ray machine and the anterior position of the heart.If the patient is unable to stand, the AP view can be utilised which is when the x-ray machine is in front of the person with the board behind their back.Due to how a patient positions their hands during a PA view, their scapulae are usually retracted laterally and do not overlap the lung fields, giving a clearer image of the lungs.If the patient is able to stand, the PA view is preferable which is when the x-ray machine is behind the person with the board in front of their chest.Verify if the CXR is an anterior-posterior (AP) or posterior-anterior (PA) exposure.Once again, this seems like an obvious starting but you would be surprised….Determine that the left and the right side is correctly marked on the CXR.This seems like an obvious starting point, but I’ve seen medical staff “umm” and “ahh” about how the CXR doesn’t match how the patient’s clinical picture only to realise they were looking at the wrong patient.Identify that it is the correct patient.Prior to interpretation, the CXR should be assessed for technical adequacy with consideration of the following: Whitish-grey = medium absorption = fluid/tissue. There are three distinct things you should look for on a CXR : The bone, tissue, fluid and air within our bodies all have different densities which result in a monochrome display ranging between white to black. When a CXR is taken, light is absorbed according to the density of what it passes.
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