BRS Phase 1B: Interpreting X-rays
Summary
Explore this session 'Interpreting X-Rays' lead by Vaishaanth Nagaraj, where you will learn how to interpret several components of radiological images such as the trachea, bronchi, diaphragm, cardiac area, and more using the ABCDE approach. This course includes engaging, real-life case studies including an 80-year-old man with breathlessness and reduced air entry on the left and a 50-year-old woman with increasing breathlessness on exertion, both designed to help improve your diagnostic skills. You'll also learn to identify and differentiate between normal and pathological conditions. Ideal for medical professionals looking to hone their X-Ray interpretation skills and enhance patient care.
Learning objectives
- The learners will be able to accurately examine and analyze X-rays by following the ABCDE approach: Airways, Breathing, Cardiac, Diaphragm, and Everything else.
- The learners will gain proficiency in identifying relevant features in the X-ray such as tracheal deviation, pleural effusions, lung field zones, and other abnormalities.
- The learners will be trained in associating X-ray findings with physical symptoms and pathologies, like the correlation between a globular heart shape and pericardial effusion in a chest X-ray.
- The learners will gain knowledge about differentiating between AP and PA views and how to interpret the structures accordingly.
- The learners will have enhanced competency in determining abnormal structures in the X-ray, like abnormalities in the hilar structures, costophrenic angles, fractures in the bones, or presence of medical devices like tubes and pacemakers.
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INTERPRETING X-RAYS VAISHAANTH NAGARAJX-RAYSRIPE Rotation Inspiration Projection ExposureABCDE APPROACH Breathing Cardiac Diaphragm Everything Airway ElseAIRWAY 1 Trachea 2 Carina & Bronchi 3 Hilar StructuresAIRWAY TRACHEA True Tracheal Deviation Pushing the trachea Pulling the trachea Pleural Effusion Lobar collapse Tension pneumothorax Apparent Tracheal Deviation Rotation of the patient, inspect the clavicles to rule this outAIRWAY Carina & Bronchi Carina NG tube should bisect the carina Bronchi Right main bronchus is wider, shorter and more vertical than the left Common place for inhaled foreign objectsAIRWAY Hilar Structures Normal Left hilum slightly higher Hilar are usually same size Pathology Hilar enlargement Abnormal hilar position Pushed: enlarging soft Bilateral symmetrical enlargement: sarcoidosis tissue mass Unilateral/asymmetrical enlargement: malignancy Pulled: lobar collapseBREATHING BREATHINGBREATHING Right & Left lung: 3 zones Zones are different to lobesCARDIAC PA CXR Heart should occupy no more than 50% of the thoracic widthDIAPHRAGM PneumoperitoneumDIAPHRAGM Costophrenic Angles Loss of this acute angle: fluid consolidationEVERYTHING ELSE Bones Soft tissues Tubes, valves & pacemakerNORMAL CXRCASE 1 A 80 year old man presents with gradually increasing breathlessness. On examination, he has oxygen saturations of 86% on room air, an increased respiratory rate and reduced air entry on the left with a dull percussion note.CASE 1 A 80 year old man presents with gradually increasing breathlessness. On examination, he has oxygen saturations of 86% on room air, an increased respiratoryrate and reduced air entry on the left with a dull percussion note. Left sided pleural effusion CASE 2 A 50 year old female presents to hospital with increasing breathlessness on exertion and chest pain. Examination reveals slightly muffled heart sounds, a raised jugular venous pulse and a clear chest. You request a chest X-ray. CASE 2 A 50 year old female presents to hospital with increasing breathlessness on exertion and chest pain. Examination reveals slightly muffled heart sounds, a raised jugular venous pulse and a clear chest. You request a chest X-ray. large globular shaped heart, in keeping with a pericardial effusionSUMMARY • What view are you are looking at? AP vs PA • Airways – is trachea deviated? If so is it true? What’s causing the deviation: push or pull? • Breathing – are the lung fields clear? If not which zone? • Cardiac – Can you comment on the heart size? If so what is the ratio? • Diaphragm – is the costophrenic angle sharp? Is there anything below the diaphragm? • Everything else – Can you see any fractures on the bones? Any tubes? Any pacemakers? Any soft tissue abnormality?Thank you! vn321@ic.ac.uk