CXR

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Be consistent and systematic in whatever approach chosen for reading chest films. The ABCDEFG method of interpreting chest films is an example of an easily remembered, systematic approach. Also see ACDEFGHI method from Radiopedia.

Recommended Reading

Resources

  • Radiopaedia is a free online reference source for all types of imaging findings.
  • Radiology Assistant is a free resource to learn and test your radiology skills.
  • Learning Radiology is the free companion website to Herring's text mentioned above.

ABCDEFG Method

A: Assessment

  1. Verify correct patient
  2. Verify the positioning and view.
    1. Verify L and R sides.
    2. PA is most common
    3. AP is used when the patient cannot stand upright
    4. Lateral is useful structures obscured on PA
    5. Decubitus is useful for detecting free fluid
    6. Lordotic is used to visualize the lung apices
  3. Assess rotation, inspiration, exposure.
    1. Rotation- distance from medial head of clavicle to vertebrate should be similar.
    2. Inspiration- 10 to 11 pairs of ribs should be visible with good inspiratory effort.
    3. Exposure- should have have sufficient detail of lungs and spinal column
  4. Check lines, tubes, drains, and wires.

A: Airway

  1. Trachea- patent and midline?
  2. Hilum- mainstem bronchi clear and not occluded? Left hilum should be higher than the right.
  3. Mediastinum- without widening or masses? Widening is classic in aortic dissection or anthrax. Can also occur in esophageal rupture.

B: Bones

  1. Check for presence (or absence), fractures, displacements, lytic lesions, bone density, alignment of the vertebrae.

C: Cardiac

  1. Heart width- less than half the thorax? (note: the heart may appear enlarged in the AP view)
  2. Heart borders- well defined? If blurred, think atelectasis or consolidation in corresponding lung lobe.
  3. Aortic knob- prominence may indicate aneurysm. Calcification common in atherosclerotic disease or advanced age.

D: Diaphragm

  1. Hemidiaphragm- right should be 2-3 cm higher than the left.
  2. Shape –a flattened diaphragm suggests increased lung volume.
  3. Costophrenic angles– any blunting suggestive of effusions?
  4. Air below the diaphragm indicates bowel perforation.

E/F: Equal Lung Fields

  1. Is there pneumothorax?
  2. Are both lungs equally lucent and air-filled?
  3. Check for infiltrates, atelectasis, or consolidation.
  4. Observe the pattern of opacification: interstitial, alveolar, diffuse, lobar. Are there air bronchograms?
  5. Vascular markings- increased markings can be seen in pulmonary hypertension.
  6. Check for any masses or nodules.

G: Gastric

  1. Identify the gastric air bubble beneath the left hemidraphgram.
  2. Check for hiatal hernia.