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How to Read a CXR – A CXR Checklist

January 18, 2023

Written by Amanda Mathews

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Here is a consistent, systematic, and comprehensive approach to interpreting chest x-rays and a checklist to prevent common errors. We modified the checklist to make it easier to remember.

Why does this matter?
Chest X-ray is the most commonly performed imaging study in medicine. On a single shift, an ED provider can order and interpret dozens of images. However, there are multiple errors that can occur in interpretation, leading to missed findings and diagnoses.

A Chest X-ray Checklist
First, to optimize image interpretation, the authors recommend the following:

  1. Optimize viewing conditions and quality of image.
  2. Pay special attention to blind spots.
  3. Recognize the importance of a lateral radiograph (85% of lungs are visible on PA films).
  4. Avoid “satisfaction of search” and “inattentional blindness.”
  5. Compare to prior CT and CXR studies.
  6. Review pertinent clinical history.

They also present a practical visual scheme for interpreting a chest x-ray with an associated checklist specifically used to avoid common areas by anatomical region. They recommend specific attention be given to blind spots on the PA and lateral views where pathology can be missed on a quick review.

This article recommends one specific visual scheme for chest x-ray interpretation. You may already have a method of interpreting a CXR that works. Review this proposed scheme and find what works for you. Whether it’s mnemonic based or anatomy based, you need a comprehensive, systematic way to review the images.

Adapted from cited article

Editor’s note: I like LAMP BULB: Lungs, Airways, Mediastinum/hila, Pleura, Bones, Upper abdomen, Lines/tubes, Bodies (foreign that is). This article has example images you should check out. ~Clay Smith

Reducing Errors Due to Commonly Missed CXR Findings. Chest. 2022 Dec 10:S0012-3692(22)04227-1. doi: 10.1016/j.chest.2022.12.003. Epub ahead of print.

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