1. Describing a chest x-ray
2. Cardiothoracic ratio (CTR)
3. Tips

Describing a chest x-ray

• Patient details [name, age, sex, date, place]
• Film details [contrast type, level, plane]

Then checklist ABCDEFGHI:

• Aorta
• Bubble [gastric]
• Cardiac shadow/ CTR
• Diaphragm: inflation, angles
• Esophagus (foreign body)/ Effusion
• Fields/ Fractures [rib]
• Gas (pneumothorax)
• Hila and bronchi
• Iatrogenic (subclavian line, pacemaker)

Alternatively:

• Airway: trachea, bronchi, hila, fields, effusion
• Bubble [gastric]
• CTR
• Diaphragm: inflation, costophrenic angles
• Esophagus (foreign body)
• Fractures [rib]
• Gas (pneumothorax)
• Heart: shadow, aorta
• Iatrogenic (subclavian line, pacemaker)

Cardiothoracic ratio (CTR)

• Measurement: widest part of heart divided by widest part of chest as measured inside the ribs.
• Normal value: <50%, except in:
  • Neonates, infants.
  • Skeletal problems: scoliosis, etc.
  • Athletes.

Tips

• Usual CXR is taken in PA direction during inspiration.
• Echocardiogram better for finding effusion, as CXR needs 250mL accumulation before visible.