The First Secret of Chest Radiograph (CXR) Interpretation
This rule of chest radiograph interpretation (CXR) is to really look at the radiograph. It should take two minutes to evaluate a chest radiograph. Any time you order a chest radiograph, you need to devote two minutes to thoroughly review the radiograph. I have found many times in my career where I did indeed miss a clinically important finding, whether it was an infiltrate, pneumothorax or fractured ribs. It was not that I could not see them, it was because I did not take my time and was going too fast. So, I have to stress that if you are going to be a speedster when it comes to looking at chest radiographs, you are going to miss something. This takes discipline. It is classic for me to see a patient with an acute coronary syndrome, and order a CXR. Especially if it’s an acute myocardial infarction where time critical, I have felt the draw to brush over the CXR, and not do a detailed evaluation. That can be a lethal mistake. This takes a disciplined approach.
It is not a matter of if you are going to miss something, it is a matter of when and how big of a miss is it going to be. So, I cannot stress enough to take your time and take the two-minute. So, if you order five chest radiographs in a shift, 10 minutes out of your shift should be specifically directed toward CRX radiographs.
February 27, 2012 | Share: