Before you go on to focus on the specific details, it's good practice to take an overview. The major things that you might have skipped over may change the baseline normals you adopt as reference points. Beginning with this overview may also sensitize to look for particular things. Technicians often use what is called the ABCDE method: check the airway (A), bones (B), cardiac silhouette (C), diaphragm (D) and lung fields and everything else (E).  Check to see if the airway is patent and midline. For example, in a tension pneumothorax, the airway is deviated away from the affected side. Look for the carina, where the trachea bifurcates (divides) into the right and left main stem bronchi. Look for any fractures, lesions, or defects. Note the overall size, shape, and contour of each bone, density or mineralization (osteopenic bones look thin and less opaque), cortical thickness in comparison to medullary cavity, trabecular pattern, presence of any erosions, fractures, lytic or blastic areas. Look for lucent and sclerotic lesions.  A lucent bone lesion is an area of bone with a decreased density (appearing darker); it may appear punched out compared to surrounding bone.  A sclerotic bone lesion is an area of bone with an increased density (appearing whiter).  At joints, look for joint spaces narrowing, widening, calcification in the cartilages, air in the joint space, and abnormal fat pads. The silhouette sign is basically the elimination of the silhouette or loss of lung/soft tissue interface, that occurs after a mass or flood in the lung. Look at the size of the cardiac silhouette (white space representing the heart, situated between the lungs). A normal cardiac silhouette occupies less than half the chest width. Look for water-bottle-shaped heart on PA plain film, suggestive of pericardial effusion. Get an ultrasound or chest Computed Tomography (CT) to confirm. Look for a flat or raised diaphragm. A flattened diaphragm may indicate emphysema. A raised diaphragm may indicate area of airspace consolidation (as in pneumonia) making the lower lung field indistinguishable in tissue density compared to the abdomen.  The right diaphragm is normally higher than the left, due to the presence of the liver below the right diaphragm.  Also look at the costophrenic angle (which should be sharp) for any blunting, which may indicate effusion (as fluid settles down). Examine the edges of the heart; the silhouette margins should be sharp. Observe whether a radiopacity is obscuring the heart's border, in the right middle lobe and left lingula pneumonia, for example. Also, look at the external soft tissues for any abnormalities.  A heart with a diameter greater than half thoracic diameter is an enlarged heart. Note the lymph nodes, look for subcutaneous emphysema (air density below the skin), and other lesions. Start by checking symmetry and looking for any major areas of abnormal lucency or density. Try to train your eyes to peer through the heart and upper abdomen to the the lung posterior. You should also be examining for vascularity, and the presence of any mass or nodules.  Examine the lung fields for any infiltration, fluid, or air bronchograms. If fluid, blood, mucous, or tumor, etc. fills the air sacs, the lungs will appear radiodense (bright), with less visible interstitial markings. Look for nodes and masses in the hila of both lungs. On the frontal view, most of the hila shadows represent the left and right pulmonary arteries. The left pulmonary artery is always more superior than the right, making the left hilum higher. Look for calcified lymph nodes in the hilar, which may be caused by an old tuberculosis infection.
لنبدأ بنظرة عامة. تحقق من وجود أية أجهزة مثل الخراطيم، الأنابيب الوريدية، أسلكة تخطيط رسم القلب، جهاز تنظيم ضربات القلب، دبابيس الجراحة، أو أنابيب التصريف. التحقق من مجرى الهواء. فحص العظام. ابحث عن العلامة الظلية للقلب. فحص الحجاب الحاجز. فحص القلب. التحقق من مجال الرئة. فحص نقير الرئة.