Tag Archives: PA’s

ABC’s of Interpreting Chest X-Rays!

I’m sure I wasn’t alone the first time someone showed me a chest x-ray and asked me to interpret.  I believe “FML” was the first thing to hit my brain.

So, let me help you not have the FML moment when it comes to looking at chest x-rays.  The picture below is quite detailed and can be overwhelming.  What I am going to review is much more simple; but, it doesn’t hurt to take a peak at the image below just so you have some orientation.

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ABC’s of Chest X-Rays

A: Airway/Assessment of Quality

I’ve seen both written for the letter “A”.

Airway: make sure the airway is patent and is not deviating to one side or the other which might indicate a tension pneumothorax.

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Obvious tracheal deviation.

Adequate Study: 

  • Position.  Make sure the study was not taken with the patient turned more to one side than the other.
  • Lung expansion.  10-11 ribs should be visible in each of the lung fields to be considered adequate.
  • Penetration (too dark/too light)  Can you see the spaces between vertebrae?  That means its a good study!
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Example of how to properly count ribs.  There are 8 visible.  Finding a study with 10 visible was proving difficult.

B: Bones

Don’t forget there are bones to look at in a CXR!  Although in most cases its secondary and in the background make sure there are no clavicle or rib fractures or shoulder dislocations.  You never know what you might find.  So take a quick glance at the bones.  Start from the top and work your way down to stay organized and on track.  There can be a lot going on in a CXR.

C: Cardiac

What does the patient’s cardiac silhouette look like? The size of the heart should be <50% of the PA film dimension.

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Outline of cardiac silhouette.

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D: Diaphragm

Look for position (right will always be slightly higher than the left due to liver), make sure there isn’t free air or maybe flattening due to emphysema. Make sure the costophrenic angles are both visible.

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Example of how the diaphragm should appear on each side of the lung fields with the right slightly higher.  Also visualized is the gastric air bubble (which is normal).

E: Effusions

Simple.  Presence or lack of pleural effusions.

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Obvious right pleural effusion with what looks like tracheal deviation to right likely due to the large effusion on right.

 

F: Fields & Fissures

I’m not going to pretend like I can appreciate a lung fissure on an x-ray.  I am definitely NO radiologist.  Fields stands for lung fields.  Basically what do you see in the lungs.  Take a look around for infiltrates, kerley B lines, pulmonary congestion, granulomas, pneumothorax, masses, etc.  Symmetry is your best friend in radiology–make sure both lung fields look roughly the same in vascular markings, etc.

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Potential findings when looking at the lung fields.

G: Great Vessels

The Aortic knob is probably the only thing I can really appreciate well on a chest x-ray.  Make sure the aorta in it’s entirety isn’t obviously out of proportion.

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H: Hila & Mediastinum

Look for widening of the mediastinum which is a pearl for Aortic Dissection or Hilar Lymphadenopathy as seen in Sarcoidosis. image

I: Instruments/Impression

Instruments stands for anything implanted in the patient such as pacemakers, etc.Summarize all of your findings as concisely as possible and to the best of your ability!

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ICD visualized on Chest X-Ray.

Women In Medicine?

I read an article recently regarding the sayings surrounding women, their lives and careers and what would happen/how ridiculous it would sound if we applied them to men. For instance “Men in Medicine” or “Men, how to have a career and family”.  May favorite were the beauty remarks regarding wrinkles and weight.  It sounds absolutely ridiculous when you apply it to men–so why do the majority not see it as ridiculous when the latter are applied to women? It is kind of appalling when you think of it, at least it was to me.

To me these statements suggest a lot of things. First, that women are not a majority in advanced positions in medicine–which is false and also that as women we need to push for some type of movement to raise awareness that women can be health care providers, too.  Don’t get me started on the career and family balance.  In our country it is always always assumed that the woman is not the bread winner and if a man and a woman both have great careers the woman should be the one to make the sacrifice.  False.  Some personal stats for myself.  For my first job I worked with a group of 5 male and 5 female physicians–2 of the women whom brought home the sole salary.  All 3 of the mid level providers were also women.  So, why do people continue to be shocked that I’m a PA? Or that the female physician who is seeing them is actually the doctor.

How about some numbers?

Medical schools are supposedly comprised of a majority (>50%) women, so I have been told.  However, the best supporting statistics I found for that were from the AAMC from 2013-2014 stating 47% of medical students were female and 46% of medical residents were women.

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As for PA’s, the tale tells it that the profession was dominated by men.  Now, per a qualitative study conducted by the NCBI greater than 60% of practicing PA’s are female.  The statistics they utilized for this study was the AAPA Census Survey and over 16,000 PA’s were a part of the study.  I also read numbers that suggested up to 72% of today’s practicing PA’s are female, although I cannot quote a direct source.  The NCCPA Statistical Profile of 2014 revealed of the total 101,963 practicing PA’s, 67,901 were female, 66.6% total.  It does reveal the trend that when the profession first emerged it was in fact male dominant (if we are assuming older PA’s have been practicing longer which is not always the case).

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I realize some people may think that I am just perpetuating the cycle by talking about the subject; but, there is a part of me that thinks there hasn’t been much attention to this concept.  I guess my whole point–or even question is by making statements such as “women in medicine” are were fighting the stereotype or enabling it? Honestly, I’m not really sure. I do think that when you apply phrases directed towards women and replace it to represent men it sounds pretty off to say the least.  Until later, I guess it’s just something to think about and I would love to hear feedback!