chest x-rays Flashcards

wk 2

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1
Q

1st line eval for

A

-respiratory
-cardiovascular
-GI
-musculoskeletal

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2
Q

pros of 2D

A

-cheap
-fast
-no absolute contraindications
-no prep
-can be used for screening and pre/post-op eval

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3
Q

cons of 2D

A

-ionizing radiation(~0.05 mSv)
-shadowgram- requires skill for proper interpretation
-requires 2 views to visualize location
-only detects structural abnormalities -> cannot assess function
-interpretation requires clinical correlation **
-compare with prior imaging

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4
Q

different types of CXR

A

-AP vs PA
-Upright vs Supine
-Lateral vs. Lateral Decubitus
-What does your patient need?
-What are the disadvantages of each film?

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5
Q

PA vs AP? Left lateral vs Right lateral?

A

-Upright PA view of the chest best represents all aspects of a chest x-ray
-It’s all because of the heart!
-PA and left lateral: heart closest to film reduces magnification
-It’s all about position! -> standing for fluid, pneumothorax
-PA: best inspiratory effort, easiest to position patient to reduce rotation
-scapula out of the way
-Clavicles project up
-Keep patient and clinical indication in mind!!
-left is better to view the heart -> closer*

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6
Q

lateral film

A

-Indications:
-Help determine the location of disease identified on frontal view
Fluid between fissures
-Confirms presence of disease when unsure on frontal view alone:
-Mass
-Pneumonia
-Demonstrate disease not visible on frontal image

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7
Q

steps to interpret x-ray

A

1) Assessment:
-Identification of pt
-Type: PA vs AP, upright vs portable
-Adequate: Centered, Inspiration, no rotation, and Exposure**
2) ABCs:
-Patience

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8
Q

assessment

A

-Patient name, MRN, and time/date of film
-AP vs. PA, upright vs. portable vs. lateral…
-Adequate:
-Centered: Must have view of lung apices, costophrenic angles, and ribs.
-Inspiration: See at least 8 posterior or 6 anterior ribs.
-Rotation: Clavicle heads equal distant from cervical spine.
-Exposure: Thoracic spine visible through cardiac shadow

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9
Q

Centered

A

-Centered: Must have view of lung apices, costophrenic angles, and ribs.

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10
Q

Inspiration

A

-Inspiration: See at least 8 posterior or 6 anterior ribs.
- in expiration: less of thorax visible, can miss seeing important diseases

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11
Q

Rotation

A

-Rotation: Clavicle heads equal distant from cervical spine.
-medial ends of spinous process should be equal distance from the clavicles

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12
Q

Exposure

A

vertebral bodies visible through the cardiac shadow

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13
Q

silhouette sign

A

-When two objects of the same density touch each other, the edge between them disappears.
-It’s the loss of distinct borders normally present that represent a silhouette sign
-An intrathoracic water density, when in contact with the border of the heart or diaphragm, will obscure that border, helping to localize the density

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14
Q

ABCs

A

-Airway: Centered, deviated, cleared, obstructed, intubated
-Bone: Fractured, decreased density, lytic lesion
-Cardiac: Borders visible, size, location, shape
-Diaphragm: Position, blunting, hyperinflated, air below
-Equal lung Fields: Radiolucency, consolidation, bat wing sign, Kerley A/B/C, air bronchogram, fissure, absent lung marking
-Gastric Bubble: Present, absent, over insufflated
-Hilum: Enlargement, abnormal positioning
-Instruments: ET tube, EKG leads, chest tube, NG tube, defibrillator/pacemaker

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