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A-B-C-D-E-F-G

Two Types of X-Rays

  • Anterior-Posterior (“AP”)
    • Classic “portable” xray
      • The beam shoots from in front of the patient (anterior)
      • TO
      • The plate sitting behind the patient (posterior)
  • Posterior-Anterior (“PA”)
    • Requires trip to radiology
    • Results in a better picture
      • The beam shoots from behind the patient (posterior)
      • TO
      • The plate sitting in front of the patient (anterior)

Three Indicators of a High Quality Chest X-Ray

  • Well inflated lungs
  • Visualize spine through cardiac silhouette
  • Medial aspect of both clavicles lined up
    • Evaluates for rotation

Chest X-Ray Interpretation Mnemonic

  • A-B-C-D-E-F-G
  • A = Airway
    • Trachea midline (rule out tension pneumothorax)
  • B = Bones
    • Rib/Clavicle/Shoulder fractures
  • C = Cardiac silhouette
    • Should be no bigger than 50% of distance from chest wall to chest wall
      • Larger than this may represent cardiomyopathy
  • D = Diaphragm
    • Costophrenic angles should be sharp
      • Blunted in pleural effusion
  • E = Equipment
    • Central lines
    • Endotracheal tubes
    • Chest tubes
  • F = Lung Fields
    • The most important step
    • Look at lung markings/tissue to evaluate for…
      • Pneumothorax
      • Consolidation
      • Nodules
      • Pulmonary Edema
  • G = Great vessels
    • Look for mediastinal widening (> 8cm)
      • Can be a sign of aortic injury
      • Looks falsely widened on AP/portable chest x-ray

Additional Reading