Applying the Mnemonic to the Search Pattern |
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Fig. 2.1 The normal chest X-ray, PA (posterior to anterior) view
Applying the Mnemonic to the Search Pattern
Details to consider on each of the items:
Frontal view (also known as either the PA posterior-anterior, or AP)
¥Airway: Follow the trachea to the carina and main bronchi.
¥Aorta: Follow the aortic contour.
¥Breathing: Study the lungs, both up and down and side to side. Include lung volumes and symmetry of markings. Check the periphery of the lungs for pneumothorax and effusions.
¥Bones: Assess all ribs and visible spine.
¥Circulation: Look at both hila (pulmonary arteries for the most part) for enlargement and abnormal bulges.
¥Cardiac: Evaluate mediastinal contours, edges, and shape.
¥Diaphragm: Check both hemidiaphragms for blunting, shape, and position. Also check upper abdomen for free air and abnormal air collections.
¥Deformity: Again assess spine for any deformity such as scoliosis, pedicle asymmetry.
¥Soft tissues: Trace the periphery of the chest, outside the lungs and ribs (chest wall). Include visible portions of soft tissues of the neck.
¥Shoulder: Look at the shoulders speciÞcally, soft tissue and bones, especially on the frontal projection.
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2 Search Pattern, Interpretive Approach, Basic Anatomy and Fundamentals |
Fig. 2.2 The normal chest
X-ray, lateral view
Lateral view
¥Airway: Follow the trachea to the left main bronchus.
¥Aorta: Follow the aortic contour.
¥Breathing: Review lung volumes and overall appearance. Check the periphery (anterior and posterior) of the lungs for pneumothorax and effusions/ loculations.
¥Bones: Follow the spine downward for vertebral bodies and darkening. Also assess all ribs.
¥Circulation: Note the size and shape of pulmonary arteries.
¥Cardiac: Note the area posterior to the heart and the darkening one should see toward the diaphragm. Evaluate mediastinal contours, edges, and shape. Look upward for darkening of the anterior mediastinum to the neck.
¥Diaphragm: Judge the size and shape of the diaphragms. Check the upper abdomen for free air and abnormal air collections.
¥Deformity: Assess spine for any deformity such as increased or decreased kyphosis, wedge shapes (compression or pathological fractures).
¥Soft tissues: Trace the periphery of the chest, outside the lungs and ribs (chest wall). Include visible portions of soft tissues of the neck and abdomen.
¥Shoulder: Consider the boney and soft tissue shoulder effects on the lateral.