Presenting X-rays

[whopper]

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Anyone have the down pat universal method of presenting X-rays?

I can't find anything on this in any of the books or google searches I've used.

 

[MustafaMond]

Its different for different people.
Depends on whether you are presenting a CXR or bone film.

I do cxr like this :
Name
Bony structures/rotation
lung fields
vasculature
extra lines/densities (pneumothorax/effusion)


http://home.earthlink.net/~rhpos/cxr_main.txt.html

http://www.google.com/search?hl=en&ie=UTF-8&q=chest+x+ray+interpretation&btnG=Google+Search

 

[southerndoc]

No matter how poorly you are at reading x-rays, you will always appear like a pro if you start off by describing the x-ray!

"This is a portable chest taken at 30 degrees..." or "this is an upright PA..."

From there, describe what you see in the order you were taught to read them. I learned from the Felson's way -- looking at the abdomen, the soft tissues, the heart and mediastinum, then the lung fields.

Always, always describe lines and tubes. It makes you look like a pro when you say "There is a left subclavian central line with the tip noted to be in the superior vena cava (or wherever it may be)."

 

[MidwestMD]

I definitely agree w/ starting off w/ a description of what type of xray you're looking at. After that, there's no real gold standard. Just be consistent and take your time. An easy way to remember the process is:

A_irway (trachea midline, straight, etc)
B_ones (clavicles, ribs, scapula- for fractures, expansion, etc)
C_ardiovascular (heart size, chamber enlargement, obscured borders, arteries)
D_iaphragm (costophrenic angles, tenting/flattening)
E_verything below the diaphragm (gastric bubble, free air, etc)
F_ields (finally, the lung fields themselves, remembering to also check the periphery for pneumo's)

-key is to check symmetry throughout
-If you mention lines (and if they're properly placed)...well, that's just icing on the cake🙂

 

[DrQuinn]

Agree with all of the above. You need to get your own system, but I would describe it as Southern Doc does. It all depends on your environment.

If I'm in the ED and presenting to an attending, I'll do pertinent positives/negatives... i.e. "No PTX" or "cephalization, kerley b's, he's fluid overloaded."

Now if I'm in Medicine Morning Report, its different.

If I'm in the MICU, I basically only care about the lung fields, ETT placement, lines, etc.

Basically I also follow Felson's, which is a great way. Dont' get sucked into the lung fields immediately!
Q

 

[Whisker Barrel Cortex]

My only addition to the above mentioned recommendations is to emphasize that you should make a comment on how good the film is. A poor inspiration, lordotic, supine, AP portable chest x-ray is nearly useless to make any meaningful diagnosis. A PA and lateral with good inspiration is the best film, but rarely obtained on inpatients.