Tuesday, November 11, 2008

How do you evaluate a chest film?

1o things to do after doing your x-ray:

1. Check that you have use appropriate size film relative to the patient body size
2. Check that the ID and markers are present and correct in the appropriate area of the film. It should not cover the lung field or bony thorax.
3. Check the limits of anatomy seen on the chest film: superiorly the skin margins of the apices, inferiorly the costophrenic angles, laterally the ribcage. No parts of these anatomy should be cut off from the film.
4. Check that there is no rotation: the medial ends of the clavicle should be equidistant from the spine. The patient should be well-position and asked to stay still until told to do otherwise.
5. Check that the patient is well centred: the image should be centered in the midline at the level of T6/7.
6. Check that the medial ends of the clavicles should be projected at the level of T4/5.
7. Check that the scapulae should be clear of the lung fields. Otherwise, it may obscure or mimic pathology.
8. Check that there should be sufficient inspiration to demonstrate 10 posterior ribs or 6 ½ anterior rib above the diaphragm.
9. Check the penetration: Only the first 4 vertebral outlines should be visible in the mediastinum. The lower thoracic vertebrae should be vaguely seen.
10. Check the density: the average density of the lung fields should be approximately 1.

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