20. Intro to Chest X-Rays Flashcards

1
Q

Briefly describe how X-Rays work.

A

X-ray machine sends X-rays to chest, dense/hard tissue stops most x-rays, some light lands on photographic plate making a negative picture

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2
Q

What kinds of things make the different shades of grey A-E?

A

A: black - air

B: dark grey - fat

C: light grey - soft tissues/organs/muscles

D: white - bone/fluid

E: bright white - metal

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3
Q

What are the 8 things to look for during the ‘first look’ at an X-ray?

A

1. patient details (top/bottom of film)

2. date/time of x-ray

3. Orientation: PA or AP (PA most common, preferred, performed in radiology, AP = mediastinum larger, performed on wards/bedbound)

4. coverage - good = lung apices, costophrenic angles

5. rotation - spinous processes should be straight and lie mid-way between head of clavicles

6. inspiration - can count 7 anterior ribs

7. skill

8. penetration - vertebrae just visible behind heart

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4
Q

Determine whether A and B are PA or AP Xrays and why.

A

A: AP because scapula lies over lung fields and clavicles are horizontal, ribs more horizontal, heart shadow larger

B: PA because clavicle in lung field, ribs slanted, scapula outwards from lung field, heart shadow smaller

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5
Q

Label 1-10

A

1: trachea
2: hilum
3. lungs
4. diaphragm
5. heart
6. aortic knuckle
7. Ribs (P and A)
8. scapulae
9. breasts
10. stomach

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6
Q

How do you distinguish posterior and anterior ribs on an Xray?

A

Posterior = more horizontal and articulate with midline

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7
Q

Are these Xrays rotated?

A

A is, B isn’t

Spinous processes should be straight and lie mid-way between medial head of clavicles.

With A : clavicles asymmetrical, no clear spinous process in middle

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8
Q

How would you describe the following two Xrays?

A

A: underpenetrated

B: overpenetrated

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9
Q

What system is used for image interpretation?

A

Airways, Breathing, Circulation, Diaphragm, Everything else

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10
Q

Label A-E

What part of the X-ray examination is this?

A

A: R. main bronchus

B: trachea

C: aorta

D: L. main bronchus

E: carina

Airways

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11
Q

What has happened in this Xray?

List possible causes.

A

Pushed airway

Masses, tension pneumothorax

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12
Q

What has happened in this Xray?

List possible causes.

A

Pulled airways.

collapse of lobe, loss of lung volume, consolidation, fibrosis

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13
Q

Describe how you would assess the ‘breathing’ part of the Xray examination.

A

Divide lungs into zones (U/M/L), compare and look for asymmetry e.g. lung fields and hilar. Lungs must fill thoracic cavity and markings must extend to chest wall.

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14
Q

What 3 things must you look for in the ‘circulation’ part of the Xray examination?

A

1. mediastinum (aortic knuckle, not widened)

2. heart contours (if not clearly seen, may be due to pathology in adjacent lung)

3. cardiothoracic ratio (heart size compared to thoracic cavity) (>50% is considered abnormal - cardiomegaly)

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15
Q

What can you observe here?

A

Metal wires from cardiothoracic surgery (top arrow)

Valve replacement (bottom arrow)

In aorta- breakdown of epithelial cell wall, get pale lumen, aorta swollen with blood,

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16
Q

What is the usual appearance of the diaphram on an Xray?

Where must you look?

A

dome shape, R higher due to liver, +/- gastric bubble (air in fundus)

Look above - blunting of cardiophrenic and costophrenic angles? Look below - air under diaphragm?

17
Q

Label A, B and C

A

A: costophrenic recess

B: costophrenic angle

C: cardiophrenic angle

18
Q

What does this Xray show and what could have caused it?

A

Blunted costophrenic angle (L and R)

Can be caused by fluid in pleural cavity - pleural effusion

19
Q

What do you look for in the ‘everything else’ category of Xray examination?

A

Soft tissue - neck, shoulder, axilla, breasts

Foreign bodies

Tubes

Lines

Clavicle

Ribs

Vertebrae

20
Q

What is this line?

A

Visceral pleural edge