9/8 Reading Chest X-rays

Question 1

why would you get a CXR?

Answer 1

what am I looking for and how is it going to change the management?

Question 2

what is the hierarchy of coloring in an xray from black to white

Answer 2

Air ; Fat ; Water/soft tissue and infection ; Bone/metal(white)

Question 3

what is a PA x-ray

Answer 3

a posteroanterior view or a view from the back. The name describes the direction of the x-ray travel

Question 4

AP x-ray?

Answer 4

anteroposterior view that is from the front to the back – heart will look a little bigger

Question 5

how do PA and AP differ in an image – how to tell apart?

Answer 5

the vetebral colomn is sharper on the PA, the heart is a little bigger for the Ap, and the scapula is more recognizable on the edges for the AP, and the clavical will look a little different between them (clavical is going down on the PA)

Question 6

how is a person orientated for a AP/PA xray

Answer 6

AP they are laying down and PA they are standing up.

Question 7

if they are up and walking and you want the lung chest x-ray what do you order?

Answer 7

PA is better for seeing the lungs

Question 8

how do you chose a PA? (pro/con)

Answer 8

most commonly done in outpatient settins because they must stand; better view of the lungs, closer to the x-ray beam.

Question 9

what are pro/con of AP

Answer 9

patient doesn’t need to stand up, so good for hospitalized, can use to evaluate medical ineterventins (placements) quick. con can make the heart seem bigger than it is

Question 10

What are benefits of the lateral x-ray

Answer 10

see behind the heart, see the lower lung lobes very well.

Question 11

before you read xray:

Answer 11

check the name and DOB; check the postion (type of xray); enough inspiration (10-11 ribs visible). rotation of the patient?

Question 12

what do the first ribs look like on x-ray

Answer 12

the first one is a little loop at the top, the second is faint and above the clavical,

Question 13

how to check for rotation on x-rays

Answer 13

head of the clavical should look even on the two sides

Question 14

reading a CXR?!

Answer 14

ABCDEF (GHI) : Airways, Bones/Breast shadow/ Cardiac silhouette; Diaphramgms; Effusion; Fields;

Question 15

what to look for the Airway

Answer 15

Pimarily Trachea position, patency, is it even, is there something in it. Does the airway follow the spinus process right down the middle

Question 16

Bones? what to look for?

Answer 16

look at the ribs clavicles, humerus, shoulder joint and look for fractures, and density (younger patients should have more density).

Question 17

breast shadow

Answer 17

this can look almost like fluid

Question 18

cardiac silhouette

Answer 18

look for size/width normal is about 1/2 the width of the chest. if obscured on the right then disease int he medial segment of RML. if left obscured then disease in the lingula

Question 19

what to look for in a Diaphram?

Answer 19

make sure that the right diaphram is higher then on the left, and it has a nice smooth shape.

Question 20

what to look for in effusion

Answer 20

look for a sharp angle on the diaphram these are calle dthe costophrenic angles. (the sharp angles are not good!)

Question 21

what to look for in “Fields”

Answer 21

this is looking at the lungs: look for black lungs/ white is not good!

Question 22

what are the lobes of the lungs?

Answer 22

RUL; RML; RLL;; LUL; LLL

Question 23

where are the lobes on a latteral chest xray?

Answer 23

the lower lobe is in the back and at the bottom

Question 24

how can you identify a middle lobe pnumonia in the right lung

Answer 24

you can’t see the edge of the heart at all