How to read chest X rays RIPEAI

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Homepage: EMNote.org ■ • 🚩Membership: https://tinyurl.com/joinemnote • 🚩ACLS Lecture: https://tinyurl.com/emnoteacls • • How to read chest X rays (RIPE-AI): • The mnemonic RIPE-AI provides a systematic approach to interpreting chest X-rays. • “RIPE” is a mnemonic used to assess image quality, where R: Rotation, I: Inspiration, P: Projection, and E: Exposure. • “AI” reminds one to use the A to I approach to carry out a structured interpretation of a chest X-ray, where A: Airway, B: Bones and Breasts, C: Cardiac and Mediastinum, D: Diaphragm, E: Effusions, F: Fields of lungs, G: Gastric bubble, H: Hila, and I: Instruments. • The “RIPE” mnemonic. • Rotation. • Note that, the medial aspect of each clavicle should be equidistant from the spinous processes. • Inspiration. • Note that, the 5th and 6th anterior ribs, lung apices, both costophrenic angles and the lateral rib edges should all be visible. • Projection. • Note if the film is antero-posterior (AP) view, or postero-anterior (PA) view. • If the scapulae are not projected within the chest, it’s PA view. • Exposure. • Note that, the left hemidiaphragm should be visible to the spine and the vertebrae should be visible behind the heart. • The “A.B.C.D.E.F.G.H.I” mnemonic. • Airway. • Trace down the trachea to the carina. • The trachea should be straight and midline. • Check for any tracheal narrowing. • Trace down both main bronchi • Note if the carina is wider than 90 degrees. • Check for any bronchial narrowing or cut-off. • Check for any inhaled foreign body. • Bones and breasts. • Trace along each rib on both sides of the chest. • Check the clavicles and shoulders. • Check the vertebral bodies. • Look for any bony fracture. • Examine the breasts and soft tissue external to the ribcage. • Check for any subcutaneous emphysema. • Note if there is an absent breast shadow. • Cardiac and mediastinum. • Trace the left and right heart border. • Trace the descending aorta. • The cardiac position should be 1/3 to the right and 2/3 to the left. • Assess cardiac size, the cardiothoracic ratio should be less than 50%. • Check the position and size of the aortic arch and pulmonary trunk. • Check the aortic knob. • The width of the upper mediastinum should be less than 8 cm in PA view. • Diaphragm. • The right diaphragm is usually higher than the left by one intercostal space. • Elevation of the diaphragm may indicate diaphragmatic paralysis or underlying pathology. • Flattening of the diaphragm may indicate lung hyperinflation. • Trace the lateral margins of the lung to the costophrenic angles • The costophrenic angles should be acute and sharp. • Trace the hemidiaphragms in to the vertebra.. • The whole of the hemidiaphragm should be visible. • Check for any free air under the diaphragms. • Effusions (Pleura): • The pleura are not usually visible in healthy individuals. • If the pleura are visible it indicates the presence of pleural thickening which is typically associated with mesothelioma. • The absence of lung markings is suggestive of pneumothorax. • Fluid or blood can accumulate in the pleural space, resulting in hydrothorax or hemothorax. • Fields of the Lungs. • Assess lung parenchyma for abnormalities such as consolidations, infiltrates, nodules, or masses. Both lungs should be well expanded. • One should able to count 10 posterior ribs bilaterally. • Lung vessels or lung markings should branch out progressively and uniformly. • Retrocardiac and retro-diaphragmatic lung vessels should be visible. • Don’t forget to assess the lung apices. • Gastric Bubble. • The gastric bubble indicates an upright position of the patient. • Note if there is a hiatal or diaphragmatic hernia. • Check for any abnormal air collections within the abdomen.. • Hila. • The hilar vessels should be visible clearly on both sides. • The left hilum is usually 2 cm higher than the right hilum. • The loss of hilar point may indicate the presence of lung tumor or enlarged lymph nodes. • Instruments. • Check for any lines, tubes, and instruments such as endotracheal tube, nasogastric tube, • central venous catheter, peripherally inserted central catheter (PICC), chest tube, pacemaker (PPM), Implantable Cardioverter Defibrillator (ICD), surgical clips, etc. • #emergency #usmle #medical #medstudent

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