As critical care transport practitioners, a valuable skill to have in ones bag of clinical tricks is the ability to confidently analyse and interpret chest radiographs. With each health center in hospital now capable of digital imagery, there is tremendous benefit to being able to like your clinical assessment to the objective data found in the radiographic image.
Take a look at these videos in order to develop a solid and systematic approach to interpreting the data found in the image. Have fun.
Systematic Analysis 5 + 1
There are many different systems employed in the assessment of a chest radiograph. Despite the differences, each has a stepped approach so as to glean all of the important information contained in the image.
Here Are the Five + One Points to Add to Your References
1) Properly orient the image so the image is correctly displayed on the screen:
a) check exposure (spinus processes of first four vertabrae only seen)
b) patient position (medial ends of clavicles equi-distant from spine)
2) Divide the chest into three distinct lung zones and compare each side for:
a) lung tissue on each side of equal radiolucence
b) examine the apices's for symmetry and aeration
c) phrenic margins for crispness sharp definition
d) diaphragm for proper proportion (R diaphragm 1-1.5 cm higher than L)
e) inspect the hilar vessels (L higher than R)
f) identify the trachea and assess for deviation
3) Cardiac silhouette
a) measure cardiothoracic ratio (L + R cardiac border= <1/2> )
4) Inspect the bones
a) study each side of chest for bone symmetry and attachment
c) visualize each joint for proper positioning
5) Inspect the soft tissue
a) presence of swelling
b) symmetry between sides of chest
Plus 1) Assess for tubes and lines
a) what type of tube or line
b) right place, position and use
Remember that radiography is all about perspective and like a fine piece of art on the wall, it must be viewed from various distances and angles to be best appreciated.
Now Lets See Some Examples
Dr A. J. Chandrasheker, specialist of internal medicine in Louisiana, will guide us through progressively more pathological radiographic images and break down what is seen and not seen.
By applying a consistant approach to reading radiography films, and reading every one you can get your hands/eyes on, will help you link your assessments into the broad diagnostic picture. Again, all of the health facilities across the Yukon will be digital by October 2010, allowing for better diagnosis and consult for every patient.
