Findings

• 13. The Lung Fields!

To help you determine abnormalities and
their location.
– compare lung sizes
– evaluate pulmonary vascular pattern
• compare upper to lower lobe,
right to left, normal tapering to
periphery
– pulmonary parenchyma
– pleural surfaces
• fissures - major and minor - if
seen
• compare hemidiaphragms
• follow pleura around rib cage
 How To Read CXR
DR.MUHAMMAD ISRAR UL HAQ
 The 13-Steps

}
• 1: Name
• 2: Date Pre-read
• 3: Position markers
• 4: What type of view's
• 5: Initial survey

}
• 6: Penetration
• 7: Inspiration
• 8: Rotation Quality Control
• 9: Angulation

}
• 10: Soft tissues / bony structures
• 11: Mediastinum
• 12: Diaphragms Findings
• 13: Lung Fields
Pre-Reading

• 1. Check the name

• 2. Read the date
• 3. Position markers

• 4. Which view’s do you have?

– PA / AP, lateral, decubitus, AP lordotic
5. Initial survey
1. General Body Size, Shape, and Symmetry
2. Sex
3. Age (cartilage/aortic arch
/ascending aorta/Pulmonary trunk)
• Infant/ child/ young adult/ elderly person
4. Foreign objects
• tubes, IV lines, ECG leads, surgical drains, prosthesis
• non-medical objects, bullets, shrapnel, glass, etc
Quality Control
• 6. Penetration

– Can see ribs through the

heart
– Barely see the spine
through the heart
– Can see pulmonary
vessels nearly to the
edges of the lungs
Overpenetrated
Film
• Lung fields darker than
normal—may obscure
subtle pathologies
• See spine well beyond the
diaphragms
• Inadequate lung detail
Underpenetrated
Film
• Hemidiaphragms are
obscured
• Pulmonary markings
more prominent than
they actually are
Quality Control

• 7. Inspiration 2
1

4
– Should be able to count
9-10 posterior ribs 5

– Heart shadow should 6

not be hidden by the 7

diaphragm 8

9
10
 Poor inspiration can
crowd lung markings
8 producing pseudo-
airspace disease
About 8 posterior ribs are showing

With better inspiration, the

“disease process” at the
lung bases has cleared
9

9-10 posterior ribs are showing

Quality Control

• 8. Rotation

– Medial ends of bilateral

clavicles are equidistant
from the midline or
vertebral bodies
 If spinous process appears closer to the right clavicle (red
arrow), the patient is rotated toward their own left side

If spinous process appears closer to the left clavicle (red arrow),

the patient is rotated toward their own right side
Quality Control
1
2
9. Angulation
3

• Clavicle should lay

over 3rd rib
Findings

• 10. Soft tissue and bony

structures
– Check for
• Symmetry
• Deformities
• Fractures
• Masses
• Calcifications
• Lytic lesions
Findings
• 11. Mediastinum
– Check for
• Overall size and shape
• Trachea & its bifurcation:
position
• Margins
• Retrosternal clear space
• Cardiomegaly
• Mediastinal and Hilar
contours for increase
densities or deformities
Findings

• 12. Diaphragms

– Check sharpness of
borders
– Right is normally higher
than left
– Check for free air, gastric
bubble, pleural effusions
 Findings
• 13. The Lung Fields!
– Compare lung sizes
– Evaluate pulmonary vascular
pattern: compare upper to lower
lobe, right to left, normal
tapering to periphery
– Pulmonary parenchyma
– Pleural surfaces
• fissures - major and minor - if
seen
• compare hemidiaphragms
• follow pleura around rib cage