1] Adequacy of Film
The adequacy of the film is vital to allow accurate interpretation of the image. There are a number of factors that need to be considered:
Patient Details
To check the adequacy of a film we should first check the patient’s:
- name
- age
- date of the study
Fields of View/ Inspiration
When looking at the Chest Xray itself we should ensure the apices (tops) of the lungs and bases (bottom) of the lungs are seen on the film. In a full inspiration we should see six anterior ribs
How to assess for Adequate inspiration
We have to ensure that the patient has taken an adequate breath in. To assess for adequate inspiration we should be able to count 6 anterior rib ends from the apex to the diaphragm. Can you see 6 anterior ribs?
Expiratory / Inspiratory
Rotation of Film
We need to assess for unwanted rotation. To do this we need to look for equal distances between the medial borders of the clavicles and the spinous process on both sides.
How to assess rotation
The interspinous clavicular distance should be equal bilaterally!
Penetration of Film
To ensure adequate penetration of Xrays through the patient we need to see the vertebral column behind the heart.
How to assess penetration
Can you see the spine behind the heart?
Side Markers on Film
The side markers are very important and should be present correctly on every film. In this instance it looks like the patient has dextrocardia with the heart on the right. However, the side marker has been incorrectly placed on the wrong side and therefore the film was reversed again allowing misinterpretation of the film.
Is this really Dextrocardia?
The side markers are very important and should be present correctly on every film. In this instance it looks like the patient has dextrocardia with the heart on the right. However, the side marker has been incorrectly placed on the wrong side and therefore the film was reversed again allowing misinterpretation of the film.
