How to Interpret a Chest X-Ray
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 11 December 2016
⏱️ 9 minutes
🧾️ Download transcript
Summary
A-B-C-D-E-F-G
Two Types of X-Rays
* Anterior-Posterior (“AP”)* Classic “portable” xray* The beam shoots from in front of the patient (anterior)* TO* The plate sitting behind the patient (posterior)* Posterior-Anterior (“PA”)* Requires trip to radiology* Results in a better picture* The beam shoots from behind the patient (posterior)* TO* The plate sitting in front of the patient (anterior)
Three Indicators of a High Quality Chest X-Ray
* Well inflated lungs* Visualize spine through cardiac silhouette* Medial aspect of both clavicles lined up* Evaluates for rotation
Chest X-Ray Interpretation Mnemonic
* A-B-C-D-E-F-G* A = Airway* Trachea midline (rule out tension pneumothorax)* B = Bones* Rib/Clavicle/Shoulder fractures* C = Cardiac silhouette* Should be no bigger than 50% of distance from chest wall to chest wall* Larger than this may represent cardiomyopathy* D = Diaphragm* Costophrenic angles should be sharp* Blunted in pleural effusion* E = Equipment* Central lines* Endotracheal tubes* Chest tubes* F = Lung Fields* The most important step* Look at lung markings/tissue to evaluate for…* Pneumothorax* Consolidation* Nodules* Pulmonary Edema* G = Great vessels* Look for mediastinal widening (> 8cm)* Can be a sign of aortic injury* Looks falsely widened on AP/portable chest x-ray
Additional Reading
* How to Read a Chest X-Ray (Medgeeks)* Learn to Read a Chest X-Ray in 5 Minutes (YouTube)
Transcript
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| 0:00.0 | Hello, med students. My name is Zach Olson and thank you for downloading this episode of the EM Clerkship Podcast. |
| 0:13.0 | I got an email a while back from a student and she wrote, Hey, Zach, sometimes I feel unprepared when it comes to looking at imaging. |
| 0:21.6 | I know it's difficult to summarize without visuals, but I was wondering if you could share some |
| 0:26.2 | tips that will help us look like rock stars. Also, love your podcast. I feel like I'm already |
| 0:32.8 | doing so much better on this rotation compared to the last one after listening, Alex. |
| 0:38.0 | Well, thanks for the email, Alex, and again, sorry too. |
| 0:41.2 | We were in this whole trauma series, so it's been a couple months since you wrote me this, |
| 0:44.9 | but I haven't forgotten about you. |
| 0:47.0 | You are not alone. |
| 0:48.8 | You're definitely not alone when it comes to having some difficulty understanding how to analyze images. |
| 0:56.1 | Looking at this stuff isn't easy. |
| 0:58.0 | It wasn't easy for me. |
| 0:59.1 | I don't think it's easy for anyone. |
| 1:00.2 | I think part of the reason is because at a lot of the places where we're training, |
| 1:03.7 | we have radiology residents and radiology fellows and radiology everybody. |
| 1:08.3 | And so we get reads on all of our images. |
| 1:12.1 | And we don't necessarily, we aren't forced to read them ourselves. |
| 1:14.9 | And I think that's part of the reason why people just in general having more difficulty with this now, |
| 1:20.5 | compared to our attendings way back in the day when they had to do all their own image interpretation. |
| 1:25.8 | But my advice for you is focus on learning how to interpret a chest x-ray, because by far, the chest x-ray is the most important image study that you're going to be expected to interpret as a student. |
| 1:41.0 | You might get asked about some other stuff. |
| 1:42.6 | Someone might show you a head CT or something, |
... |
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