Radiology: Reporting a Chest Radiograph (CXR)

There are many different ways to present a CXR, but the most important thing is that your method is systematic. A clear system means you will not forget, or miss, anything crucial. It will also ensure that you come across as fluent and able. Here is an example –

State the type of image, the projection, the name of the patient (if available), and the date on which the film was taken.

"This is a PA chest radiograph of Mr. John Smith, which was taken on 1st January 2015."

Comment on the technical adequacy of the film.

"This chest radiograph is technically adequate. It is correctly penetrated, not overly rotated, there is good inspiration and it is fully exposed."

Now, you can either state the most striking feature/abnormality (if you’re feeling brave!)…

"The most striking feature of this CXR is a left sided pneumothorax, which is causing mediastinal shift. This is a medical emergency and needs to be treated with immediate decompression by inserting a large bore cannula in the left 2nd intercostal space, in the mid-clavicular line."

Or you can mention each part of the CXR in turn (probably better for medical school OSCEs!)…

"The heart is a normal size and the mediastinum is not displaced. The trachea is central. The apices and hilar regions look normal. Both lung fields are clear and I am able to see both costophrenic angles and both cardiophrenic angles. There is no air under the diaphragm and I can see the gastric bubble on the left. There is no bony or soft tissue abnormality. In summary, this is a normal CXR."

By observing and commenting on all the regions of the CXR marked in bold, you are unlikely to miss something. Even if you have stated the most striking feature you can see, you should still review all areas of the CXR to ensure you haven't missed anything else. Always comment on any lines or objects visible, for example, an endotracheal tube in the trachea, a central line or PICC line, oxygen tubing, a permanent pacemaker, or cardiac monitoring wires. Finally, summarise your main findings at the end of your presentation.

Look at some examples of presentations of classic CXR pathology in 'CXR examples'.

written by: clare_price, first posted on: 07/02/15, 17:26

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