2 CXRs

Question 1

Why does AP vs PA positioning matter for CXRs?

Answer 1

The heart, being an anterior structure, is magnified by an AP view

You should never consider the heart size to be enlarged if the projection is AP but you CAN say it’s normal sized

Question 2

Where are most abnormalities seen on CXR?

Answer 2

Chest wall

Pleural markings should extend all the way to the chest wall

Question 3

Vascular markings are more prominent ______ and ______ within the lung fields, but should __________.

Answer 3

Lower and centrally

Should extend all the way to the periphery of the rib cage

Question 4

How should costophrenic angles appear?

Answer 4

Should form acute angles which are sharp to a point

Helps Dx of PNA, pleural effusions

Question 5

The right hemidiaphragm lies _________ to the left

Answer 5

Slightly higher

Because the liver is located immediately inferior to the right hemidiaphragm

Question 6

Where can you see the stomach bubble?

Answer 6

Below the left hemidiaphragm

Can see normal lung markings through it if the CXR is clear

Question 7

The mediastinum contains…

Answer 7

The heart and great vessels and potential spaces in from of the heart, behind the heart, and above the heart

Question 8

What is a normal cardio:thoracic ratio?

Answer 8

CTR greater that 1:2 should be considered abnormal

Heart size should be evaluated on every chest xray

Question 9

The aortic knob represents…

Answer 9

The left lateral edge of the aorta as it arches backwards over the left main bronchus and pulmonary vessels

Question 10

What bones are visible on CXR?

Answer 10

Clavicles
Ribs
Scapulae
Part of spine
Proximal numeric

Only the clavicle is seen in its entirety

Can also see sternum in frontal view but overlies other midline structures and is obscured

Question 11

Bones are useful markers of …

Answer 11

Chest radiograph quality

Can assess patient rotation, adequacy of inspiration and x-ray penetration

Question 12

The spinous processes of the vertebrae should lie…

Answer 12

Midway between the medial ends of the clavicles

If not central, the patient is rotated (oblique to the xray beam)

Question 13

Ribs play a role in assessing the ….

Answer 13

The adequacy of inspiration taken by the patient

Question 14

The anterior end of approx _____ ribs should be visible above the diaphragm in the midclavicular line

Answer 14

5-7

Less indicates incomplete breath in

More than 7 ribs or flattening of the diaphragm suggests hyper-expansion

Question 15

What patient ID/image data should you always double check?

Answer 15

Right patient?
Right date?
Right study?
Right side?

Question 16

How to check image quality

Answer 16

Rotation: clavicles are equidistant from the spinous processes

Inspiration: Diaphragm below 8-10 ribs posteriorly and 5-7 ribs anteriorly

Penetration: Disk spaces are seen but bony details of spine cannot be seen

Question 17

Mnemonic for systemic check of CXR

Answer 17

ATMLL - Are there many lung lesions?

Abdomen
Thoracic wall (soft tissue and bones)
Mediastinum
Lung fields (individually)
Lung comparison

Question 18

A unilateral high diaphragm suggests…

Answer 18

Paralysis (from nerve damage, trauma, or an abscess), eventration, or loss of lung volume on that side (atelectasis or pneumothorax)

Question 19

Bilateral crescent lines showing free air in abdomen?

Answer 19

Bilateral pneumo peritoneum

Question 20

How does a pneumoperitoneum appear on CXR?

Answer 20

Thin crescent shape

Question 21

What is the “sail sign”

Answer 21

Normal thymus shadow

Question 22

What is the Spinnaker sign?

Answer 22

When the “sail” from the thymus shadow is bowed out by air (sign of pneumomediastinum in an infant) - ABNORMAL

Question 23

An abnormal aortic knob contour could indicate…

Answer 23

Aortic aneurysm

Question 24

How do you differentiate a pneumothorax from a tension pneumothorax?

Answer 24

The trachea will be midline with a simple pneumo