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Imaging interpretation By Ronan Fitzgerald and Risma ResmudeenItinerary -CXR interpretation -AXR interpretation -MSK x-ray interpretationCXR interpretation - Patient details - Date of CXR - Type of CXR (AP/PA Erect/supine) - Adequacy: RIPE Mangoes - Interpret: ABCDE - Differential and how you would complete your summaryNormal CXR Adequacy of a CXR: RIPE Mangoes Rotation: equal distance between spinous processes and clavicles Inspiratory effort: if 7 anterior rib (down sloping) transects the diaphragm the film is adequate for resp effort Penetration: Not too white or too dark-should be just able to see the spinous processes Exposure: Can see all of the lung field both sides and the diaphragm as well (particularly the costophrenic angles). Markings: red mark-means radiographer has spotted an abnormalityInterpretation: ABCDE- A - Tracheal deviation: volume loss drawing for Airw ay trachea towards or volume gain pushing trachea away? - Hilar region: hilar consists of pulmonary vasculature and major bronchi. Also contains LNs. Left hilum is usually slightly higher than the right. The hilar are usually the same size so asymmetry indicates pathology. ABCDE: B for breathing Lung fields: compare in thirds and always trace around the lung marking to ensure no air/fluid in pleural space. Note any consolidation/ whitening/ opacification or lesions in lung fields Pleura: any pleural thickening (shown in next image)ABCDE: C for Circulation Heart size: only applies on PA films (<50% size)- remember AP films are crAP for this reason Heart position: displacement indicates volume change in thoracic cavity (volume loss (lung collapse)/ volume gain (mass)) Heart borders Aortic knob Mediastinal width (widening=aortic dissection!!!) Aortic knuckle:reduced definition can indicate aneurysm Mediastinum Aortopulmonarywindow: If the space is lostthen this can indicate mediastinal lymphadenopathyAbcde: d FOR DIAPHRAGM Flattening of diaphragm-hyperexpansion of lung (COPD background?) Any air under the diaphragm Costophrenic angles-blunting=pleural effusionPneumoperitoneum vs gastric bubble Key indicator is lookingwhether air is presentunderthe diaphragm bilaterally. Furthermorewill seegastric bubble onleft side of CXR,not right.ABCDE: E for everything else - Any medical apparatus in situ: chest drains, ECG leads, pacemakers e.t.c. - Bones: especially the ribs (any #s) - Soft tissue: subcutaneous emphysema or massesSubcutaneous emphysemaLooprecorder(recordsheart rhythmsforup to Permanent pacemaker: continuously ICD: Implantable cardiac defibrillator BIV-ICD: Biventricular ICD 3years):lookslike a USB stick same thickness to line thin strandwith denserline in the middle (the coil)AXR interpretation - Patient details - Type of AXR: standard AXR is an AP projection in supine position. Special projections include a PA prone, lateral decubitus, upright AP & lateral crosstable - Adequacy: RiPE Mangoes - Interpretation: BOB - Differential and how you would complete your summaryNormal AXRAdequacy of film Rotation: assess symmetry of pelvis/ check spinous process is central of vertebrae Penetration: Not too white/not too dark Exposure: should be able to see up to the diaphragms and also see the pelvic joints where the femur inserts Markings: red dot=abnormalityInterpretation: BOB the minion (he looks jaundice and bloated) B: Bowels O: Other organs B: BonesInterpretation: BOB- B for bowels Small bowel: central position + valvulae coniventes; should be <3cm in diameter Large bowel: peripheral and haustra; should be <6cm in diameter (caecum and sigmoid <9cm) **The 3,6,9 rule Look for any gas in the bowel wall-ischaemia Look for any bowel on bowel appearance-Rigler’s signInterpretation BOB- O for other organs Liver Spleen Kidneys Gallbladder Psoas shadow Pancreas ** most important one- calcification=chronic pancreatitisINTERPRETATION BOB- b FOR BONES Spine and pelvis -Paget disease -Mets (lytic/sclerotic) -Osteoarthritis (LOSS) -vertebral fracturesOSTEOARTHRITISSIGMOID VOLVULUS-COFFEEBEAN SIGN CAECALVOLVULUS-FETALAPPEARANCESIGN TOXIC MEGACOLON IBD or infectious colitis with colonic dilatation + systemic toxicitiy