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Hi, everyone. Thank you so much for joining this evening. I know it's quite a busy time of year in December. So I appreciate it all the more that you are here this evening. Um It's seven o'clock now and I think it's probably best that we just crack on cos we've got quite a bit to get through in the next hour or so. So I'll just start off with a little introduction to the series. It's called Hello, it's the Fy one and it's being run by three of us. So there's me, Ramya on the left there, um As well as Manish and Viv. Um And we are the Fy one co leads for mind the bleep and we're also part of a wider team of deanery representatives. The series, as I said is called Hello. It's the Fy one. It's a national webinar series with the goal of just helping you guys through your on calls as an F one. We are aiming to run these talks on Tuesdays um as you will have obviously noticed it's a Monday today. So there are, there are some exceptions to that. Um But we do try and run them on Tuesday evenings, 7 to 8 p.m. aimed at F ones. And yes, so it's all to do with just helping you feel a bit more comfortable, um, with various different topics. Um, during, um, your uncle's step one. Um So just to run through a few little disclaimers, um, all of our minor bleak content is intended only to be viewed by healthcare professionals. We've anonymized all clinical cases. Um and any resemblance of a natural person is unintentional. Um We always try to make sure that the information provided in our content is as accurate as possible. Um That we do remind everyone that we um it's our responsibility as doctors to keep up to date with things ourselves. And we can't guarantee complete completeness um and usefulness or accuracy. And if you want to see our full disclaimers, you can head over to that website over there. And if you want any further resources after this talk, um I'll have a slide which has some useful sort of chest X ray resources for you guys. Um But for more general things, um we've got whatsapp groups for mind the bleep um for each deanery, um You can give us a follow on medal um to see all our upcoming sessions that's really useful as that will be the first place we put them. Um There's also the mind the bleep website and that's got all of our articles um and including a very good one on chest X ray interpretation. Um There's a little QR code up there um which you can scan if you want to be linked to all the mind the Bleep whatsapp groups. So without further ado, let's get on to some chest X ray interpretation. So as I said, my name is Ramya, I am one of the F one colleagues for mind the bleep. Um And I'm currently in F two in Newcastle upon Tyne. So, learning objectives for today's session. So we're gonna start with just recapping a very basic strategy to interpreting chest X rays in a really systematic way um based on an ABCD E approach that some of you guys might have encountered at medical school already. Um The reason we'll be doing that sort of recap of that basic strategy is sometimes when we're tired, it's the middle of the night. It sometimes it's just really helpful to have a framework that you can fall back on. We'll then move on to interpreting some chest X rays um through being guided through three clinical cases. Um I've taken these from a mixture of medical and surgical on call scenarios and the overall goal of the session is to build your confidence in chest X ray interpretation. Um For your on call shifts worth mentioning, it's not an exhaustive guide to every single pathology that you might see or X ray. This is just an example of a few things that you might encounter on an on call shift. A typical on call on medical or a surgical ward fab. So without further ado the ABCD E approach, um So this approach consists of, first of all looking at the quality of the film and then running through an approach to a chest X ray that first looks at the airways, then the breathing, then circulation or cardiac depending on which you prefer for that. Um Di for diaphragm. Oh, someone's just put in that the slide isn't moving. Is anyone else having this issue at all? Oh OK. Same for you guys. Mm Not too sure what's happening. Let me just have a little look and any luck there now. No, still nothing. Hm. What I'll try and do just stop presenting, still stuck on learning objectives. OK. Interesting. So if I move it on another slide, have we gone through to quality of film? Now, my camera's also frozen a little refresh. Yeah. Looks like it's frozen. Oh dear. Give me a second. Sorry guys, I'll try and fix this for you. Have we moved on at all? We should be able to see quality of film. Yup. Can see quality of film. Lovely fab. So now working. Yeah, I've got it fab. Thank you so much for bearing with me and to answer someone's question above um the session is recorded and it'll be put on medal as catch up content. Lovely. Thanks for bearing with me. So let's move on to quality of film. Um So the first thing to check is obviously the patient details are easy to just click on the wrong patient's chest X ray. So always just check, you've got the right patient and check you have the right time of the image taken again. A very easy thing to click on a chest X ray from yesterday or the week before, for example. So just make sure you've got the most recent one in front of you and then the pneumonic to help you remember how to check the quality of the chest X ray film is ripe ri pe um and starting with rotation. So that involves looking at the distance between the medial end of each clavicle and the spine. Um eye is for inspiration. So you want to be able to see 5 to 6 anterior ribs, but you also want to have sort of the lengthways well inspired films. So you want to be able to see the apices and also the costophrenic angles. It's important to look at whether you've got an AP or APA chest X ray. So anteroposterior or post anterior, those chest X rays will be done as APA film. Um but some will be done as AP films in certain patients and then finally exposure. So you want to be able to see the vertebrae um behind the heart fab. So you guys should be able to see two chest X rays in front of you now, just because we had some issues with slides moving. Can you guys confirm that you can see two chest X rays in front of you? Yeah. Brilliant, brilliant stuff. Um So this is just a little demonstration of how important rotation is. So on the left hand side, we have a chest X ray that is not rotated. It's a nice normal chest X ray. But you can see that the medial lens of the clavicles are equidistant from the spinus processes if we look on the right hand side, however, we've got quite a rotated film. And the difficulty with this is obviously it's still APA film, but you might misinterpret the heart size here. The heart looks a lot bigger on that right hand side film. I think we can all agree. So just a little demonstration of how important rotation is they look like completely different chest X rays, I think in those two, right? And then we've got two more chest X rays in front of us now. Um So which is the AP film and which is the pa film if you guys can pop in the chat, the right is P eight. Absolutely perfect. And