Wednesday, February 18, 2009

How do you evaluate a chest Image?

You have done a PA chest x-ray. How do you evaluate the image?

1. You have use the appropriate film size relative to the patient's body. For a small size patient, you may use film size 14x14 or 15x12 inches.
2. ID and markers must be present and correct.
3. Limits of anatomy, superiorly the skin margins of the apices, inferiorly the
costaphrenic angles, laterally the ribcage.
Remember that thyroid is very radio-sensitive. Make sure the upper limit of the radiation beam doesn't include the thyroid gland.
4. Check that there is no rotation. The medial ends of the clavicle should be equidistant from the spine.
5. Centering, the image should be centered in the midline at the level of T6/7
The medial ends of the clavicles should be projected at the level of T4/5.
6. The scapulae should be clear of the lung fields.
7. There should be sufficient inspiration to demonstrate 9+ posterior intercoastal spaces
or minimal 6 anterior rib above the diaphragm.
8. Penetration: the vertebral outlines should be visible in the mediastinum.
9. Density: the average density of the lungfields should be approximately 1

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