A chest radiograph with the angle parts of the ribs and some other landmarks labeled.
There are many methods of structuring chest x-ray (CXR) interpretation from formal to mnemonics. The daily routine CXR in ICU is changing to a rationale approached intervention to prevent unnecessary exposure.
Some approaches:
DRSABCDE
Details, Rotation/Inspiration/Picture/Exposure, Soft tissue and bones, Airway and mediastinum, Breathing, Circulation, Diaphragm, Extras (lines, drains, ETT)
Key Learning Points (no matter which approach you take):
Difference between posterioranterior (PA) vs anteriorposterior (AP) view
Basic anatomy seen on the CXR
Inspiration
Signs of COAD
Develop a consistent approach (one that will stand up during night shift at 04:30 on a Sunday morning!)
1. AP View
AP views are commonly performed for critically ill patient using portable x ray machines.
AP- the beam passes through the chest from front to back
Posterior ribs are most apparent (closer to the film). Anterior ribs should still be seen on a quality film
2. Anatomy
AP view may provide an enlarged image of the heart and mediastinum
Heart size should be less than 50% of the thoracic cavity
Supine position causes different fluid shifts compared to normal upright position
3. Inspiration
Review image (1. PA View) above and count the number of ribs above the diaphragm. On inspiration there should be 10 posterior ribs and may be possible to see 6 anterior ribs.
Look for current or old fractures (try 'invert' setting on reviewing your x-ray)
4. Signs of Chronic Obstructive Airways Disease (COAD)
Widened intercostal spaces occur in COAD due to increase in lung volume and hyperinflation.
Caution: Pneumothorax and pleural effusion may also be causative factors.
5. X-Ray Interpretation as part of daily practice and try different methods until one sticks.
Costal cartilages animation
References
Siela, D. (2008). Chest radiograph evaluation and interpretation. AACN Advanced Critical Care, 19(4), 444-473. http://bmhlibrary.info/18981746.pdf