Ch. 10

Question 1

How was the chest radiograph is produced?

Answer 1

By controlled electrical activity in specially designed vacuum tubes. They make up the high-energy portion of a range of frequencies called the electromagnetic spectrum which includes lower-energy waves such as visible light, microwaves, and radio waves.

Question 2

What is radiolucent?

Answer 2

Low-density substances such as air-filled lung tissue that minimally absorbs x-rays and appear dark or black on the x-ray.

Question 3

What is radiopaque?

Answer 3

Dense substances such as bone which significantly absorb x-rays (allows less penetration) and appear light or white on the x-ray.

Question 4

How does the density and thickness of organs and tissues affect their radiographic appearance?

Answer 4

The denser the organ or tissue is the more of the x-ray it will absorb. The less dense it is, the less of the x-ray it will absorb.

Question 5

How does the spatial relationship among the x-ray source, the patient, and the x-ray film affect the magnification of images on the radiograph?

Answer 5

Film takes a while to use and sometimes the images may not be as high quality. Whereas x-rays since they are electronic can be enhanced and analyzed in numerous ways and can be stored and accessed almost instantly via EHR.

Question 6

What are the clinical indications for a chest radiograph?

Answer 6

• Detecting alterations of the lung caused by pathologic processes
• Determining appropriate therapy
• Evaluating the affectiveness of treatment
• Identifying the position of tubes and catheters
• Observing changes in lung tissue
• Assessing the patient after an invasive procedure

Question 7

What are the most radiographic views used for chest imaging?

Answer 7

Standard Views
1. Posterioranterior (PA)
2. Anteriorposterior (AP)
3. Lateral (left or right)

Special Views
1. Lateral decubitis
2. Apical lordotic
3. Oblique
4. Expiratory

Question 8

What are the fundamental criteria used in the evaluation of the diagnostic quality of a chest radiograph?

Answer 8

• Systematic approach
• Interpretation
• Silhouette sign
• Air bronchogram

Question 9

What is the significance of the silhouette sign?

Answer 9

The difference in density between 2 adjoining structures will sharply delineate their borders. This allows the person viewing to see the heart border.

Question 10

What is the significance of an Air bronchogram?

Answer 10

It is useful in determining whether an abnormality seen on the radiograph is located within lung tissue.

Question 11

Significance of deep sulcus sign?

Answer 11

It’s another sign suggestive of pneumothorax

Question 11

Significance of kerley b lines?

Answer 11

These lines are usually seen in the right base, are less than 1mm thick and approximately 1-2cm in length. They are horizontal and start at the periphery, extending into the lung approximately 1-2 cm. These lines are very subtle and very hard to see on an image.

Question 12

Significance of the coin lesions?

Answer 12

Any round-shaped lung masses or nodules.

Question 13

What are the limitations of the standard chest radiographic procedure?

Answer 13

• Tracheal intubation
• Central venous pressure line
• Pulmonary artery catheter placement
• Nasogastric feeding tubes
• Chest tubes

Question 14

What are the clinical and chest radiographic findings for atelectasis?

Answer 14

• Rapid shallow breathing
• Decreased to absent breath sounds
• Decreased or absent vocal fremitus
• Decreased renosance to percussion
• Cyanosis

Question 15

What are the clinical radiographic findings for pneumothorax?

Answer 15

• Chest wall: reduction in movement in the chest on the side where pneumothorax has occured.
• Auscultation of the lung: loss of breath sounds or distant breath sounds on the affected side.
• Percussion: increased resonance to percussion on the affected side.
• Heart: tachycardia and low blood pressure.
• Other: cyanosis, external wound, bruising on the affected side, absent whispered voice sounds, tactile fremitus.

Question 16

What are the clinical radiographic findings for hyperinflation?

Answer 16

• Large barrel chest, with increased AP diameter of the chest wall.
• Increased resonance to percussion
• Decreased breath sounds
• Limited motion of low set diaphragms
• Wheezing
• Prologned expiratory phase
• Rapid respiratory rate
• Use of accessory muscles to breath

Question 17

What are the clinical radiographic findings for congestive heart failure?

Answer 17

• Fine inspiratory crackles
• Rapid heart rate
• Third heart sound
• Jugular venous distension
• Enlarged liver
• Hepatojugular
• Ankle edema

Question 18

What are the clinical radiographic findings for pleural effusion?

Answer 18

• Blunting
• small meniscus sign
• complete or nearly complete whiteout of the involved side
• complete obscurring of the hemidiaphragm
• shift of the thoracic organs

Question 19

What are the physical findings of consolidation?

Answer 19

• reduced resonance to percussion over the involved area
• bronchophy and bronchial breath sounds
• fine crackles
• whispered voice sounds
• Tachypnea and fever

Question 20

Describe the correct position for the ET tube?

Answer 20

3-5cm above the carina

Question 21

What are the values and limitations of using radiographs to determine the location of the tubes and cathers?

Answer 21

It shows good placement of the tube for the purposes of draining pneumothorax.

Question 22

What is the technique and indication for performing nuclear medicine lung scans?

Answer 22

There obtained by measuring radiation emitted from the chest after radiopharmaceuticals are injected into the blood stream or inhaled into the lung

Question 23

What is the technique for pulmonary angiography?

Answer 23

It is done by threading an intravascular catheter up a vein to the right side of the heart, past the tricuspid valve and the pulmonary valves into the pulmonary artery and then injecting contrast medium into the the pulmonary artery or one of its branches.