Final Assessment

Summative Assessment 

100 CXRs with 70% abnormal. Normals to include variants. 

The report to be clear and concise using appropriate terminology as referenced in Fleischner Society:  Glossary of Terms for Thoracic Imaging . 

For the abnormal cases, report should include a tentative or differential diagnosis and where appropriate provide advice regarding the next step

Lung 

Variants

· Dextrocardia (with and without Situs inversus)

· Azygous lobe

· Right-sided arch

· Left superior vena cava

· Bifid ribs

Infection

· Tuberculosis including bronchopneumonia and military presentations

· Covid 19 pneumonitis

· Fungal infection including invasive pulmonary aspergillosis and aspergilloma

· Lobar pneumonia

· Atypical pneumonia

· Bronchopneumonia

· Aspiration pneumonia

· Septic emboli

· Opportunistic infection (eg pneumocystis jiroveci pneumonia)

· Abscess

Inflammation/autoimmune

· Vasculitis (granulomatosis with polyangitis), pulmonary eosinophilia, cryptogenic organising pneumonia, infarction from pulmonary embolism

Obstructive lung disease and airway abnormality

· Smoking-related emphysema, lower lobe emphysema (alpha 1 anti-trypsin deficiency)

· Cystic fibrosis

· Asthma and complications

· Bronchiectasis

· Bullae

· Unilateral lung hyperlucency (post-infectious obliterative bronchiolitis, bronchial atresia, aspirated foreign body)

Diffuse and interstitial lung disease

· Interstitial fibrosis

· Cystic lung disease (eg lymphangioleiomyomatosis and pulmonary Langerhans cell histiocytosis)

· Pneumoconiosis and progressive massive fibrosis, asbestos-related lung disease

· Sarcoidosis including examples of intrathoracic adenopathy, parenchymal disease with nodules and/or lung fibrosis

· Hypersensitivity pneumonitis

· Vaping-related lung disease

· Diffuse alveolar damage

Cardiac and vascular

· Heart failure (subtle septal thickening to gross pulmonary oedema)

· Interstitial pulmonary oedema, alveolar pulmonary oedema, upper lobe blood diversion

· Cardiac chamber enlargement (eg left atrial dilatation)

· Pericardium; effusion, calcification, pneumopericardium

· Aortic dilatation and aortic aneurysm

· Cardiac shunt (eg atrial septal defect)

· Calcified left ventricular aneurysm

· Calcification of the mitral annulus

· Arterio-venous malformation

Devices and lines

· Vascular line placement-tip position and complications

· Cardiac devices – position and complications (acute as well as chronic complications such as lead migration and fracture):

o Pacemakers, implantable cardioverter-defibrillators; according to local institutional protocol may also be involved in CXR assessment prior to magnetic resonance imaging (MRI) (eg ensure no lead migration or fracture prior to MRI)

o Closure devices – atrial septal defect/patent foramen ovale, left atrial appendage occlusion device

o Mechanical prosthetic valves including transcatheter aortic valve implantation

· Nasogastric tube correct and misplaced (never event)13

· Chest drains correct and misplaced

· Endotracheal tube

Hilar abnormality

· Dilatation of proximal pulmonary artery (differential diagnosis: hilar lymphadenopathy) to pick up pulmonary hypertension

· Bilateral adenopathy; sarcoidosis, tuberculosis, malignancy

· Unilateral adenopathy; malignancy

· Pulmonary arterial hypertension

Mediastinal abnormality

· Anterior, middle and posterior mass lesions

· Aortic aneurysm

Pleural abnormality

· Simple unilateral effusion on supine and erect X-ray

· Loculated/complex effusion

· Bilateral effusions

· Supine pleural effusion

· Subpulmonic effusion

· Smooth pleural thickening

· Nodular pleural thickening

· Asbestos-related pleural d

· Empyema

· Diffuse pleural calcification

· Pleural tumours

Trauma and emergency

· Pneumothorax; tension and non-tension

· Pneumothorax and pleural fluid on supine X-ray

· Pneumo-mediastinum, surgical emphysema

· Haemothorax

· Hydropneumothorax

· Diaphragmatic rupture

· Subphrenic gas

· Pneumopericardium

· Lung contusion

· Aspiration

· Aortic dissection/transection

· Oesophageal rupture

· Non-cardiogenic pulmonary oedema

· Musculoskeletal injury; ribs, spine, clavicles and shoulders

· Aspirated foreign body

· Acute respiratory distress syndrome

Lung malignancy and benign nodules

· Lung and lobar collapse

· Lung nodule/mass in a location commonly missed (eg behind heart, first rib, hilar region)

· Hilar, mediastinal adenopathy

· Adenocarcinoma presenting as consolidation

· Lymphangitis carcinomatosis

· Lung metastases

· Malignant pleural disease

· Benign lung nodules including hamartoma and calcified granuloma

Post-surgical or intervention

· Vats procedure

· Lobectomy – distinguish between lobar collapse and lobectomy

· Pneumonectomy

· Lung transplant

· Gastric pull-up (oesophagogastrectomy)

· Post-tuberculosis treatment (thoracoplasty, plombage)

· Radiotherapy

· Pleurodesis

Extrathoracic abnormalities

· Hiatus hernia

· Gastric obstruction

· Pectus excavatum

· Mastectomy

· Diaphragmatic eventration

· Diaphragmatic elevation

· Diaphragmatic hernia

Subphrenic abnormalities

· Obstructed or dilated bowel

· Pneumoperitoneum

MSK abnormalities

· Benign and malignant bone lesions; spine, ribs, shoulders, clavicles and humeri

· Bone injury (see trauma section)

· Scoliosis

· Osteoporosis

· Osteomalacia and vitamin D deficiency

· Renal bone disease

· Congenital bone anomalies