Chest Film Interpretation Flashcards
Describe the five radiographic opacities:
The more radio-dense an object is, the more white it will appear. (1) Air [black]; (2) fat; (3) soft tissue; (4) bone; (5) metal [white].
What are the two most frequently used chest views?
(1) PA [posterior-to-anterior]; and (2) lateral [90 degree].
What factors should be assessed when analyzing image quality?
(1) Whether it is a PA or AP view; (2) whether the patient is upright, erect, or supine; (3) whether or not the patient is at full inspiration; (4) if the image is over or under-exposed; (4) whether or not there is rotation; (5) if all landmarks are present.
What is the most important distinction between the PA and AP views?
The heart will appear 10% larger on an AP view.
What is the most important landmark on a lateral film?
The retro-cardiac space.
How should a chest radiograph be viewed?
The film should be hung as if the patient is standing in front of you.
How many views does a diagnostic x-ray consist of?
At least two views; one at a 90 degree view to the other.
What three components are used to assess for film quality?
(1) Rotation; (2) inspiration [should be full]; and (3) penetration/exposure.
How can you tell if the image has been rotated?
(1) Look at the sternoclavicular joint on each side; and (2) determine if the ends of each clavicle are equidistant from the mid-line.
Why is it bad if rotation has occurred?
The image can still be read, however, anatomical landmarks will be changed. Rotation may also cause shadow-summation effect.
How can you tell if a patient has taken a full inspiration?
A full inspiration is defined as being able to see ten or more ribs.
How can you tell if a film has proper penetration?
You should barely see the intervertebral discs through the heart; the spine can be faintly traced through the heart; the diaphragm and costophrenic angles should be clearly demarcated (and higher on the right side).
How can you tell if a film has been under-penetrated, and why is this bad?
With under-penetration, the intervertebral discs can not be seen at all, and the borders of the diaphragm and costophrenic angles get lost. Under-penetration leads to over-calling pathology.
How can you tell if a film has been over-penetrated, and why is this bad?
If the intervertebral discs can be seen very clearly, then the film has been over-penetrated; this leads to under-calling pathology.
What is the systematic approach to evaluating a PA chest x-ray?
Assess: (1) RIP (rotation/inspiration/penetration); (2) extrathoracic structures; (3) ribs; (4) pleura; (5) diaphragms; (6) heart; (7) hila; and (8) lung parenchyma (apices/middle/bases/lingula).
What is the systematic approach to evaluating a lateral chest x-ray?
Assess: (1) Extrathoracic structures; (2) sternum (manubrium/body/xiphoid); (3) ribs (posterior/lateral); (4) spine (foramina/intervertebral spaces/vertebral bodies); (5) diaphragm (double bubble); (6) heart; (7) supracardiac space; (8) posterior triangle.
Describe the normal position of the heart:
It is more central in infants and children; and more on the left side in older children and teens.
What is the cardiothoracic ratio?
(A+B)
What are some reasons that a cardiothoracic ratio would be greater than 50%?
Heart failure; pericardial effusion; left or right ventricular hypertrophy.
How do you assess the lungs on a chest x-ray?
(1) Start at the top and sweep back and forth; (2) ensure the trachea is mid-line over the thoracic vertebrae and filled with air; and (3) ensure that the parenchyma gets lighter as you go down (if not there may be a lower lobe or pleural effusion).
Whatvis the difference between infiltrate and effusion?
Infiltrate is fluid within the lung tissue; effusion is a collection of fluid between tissues.
How is the lung divided on the right side?
(1) Right upper lobe; (2) right middle lobe; and (3) right lower lobe.
How is the lung divided on the left side?
(1) Left upper lobe with lingula; (2) left lower lobe; and (3) lingula.
What does an alveolar pattern look like?
Fluffy, soft, and poorly demarcated.
What are possible causes of an alveolar pattern?
(1) Pulmonary edema; (2) viral pneumonia; (3) pneumocystis; (3) alveloar cell cancer.
What does an interstitial pattern look like?
Branching lines (lace-like) that branch toward the periphery of the lung.
What are possible causes of an interstitial pattern?
(1) Interstitial pneomonitis; (2) pulmonary fibrosis.
What does it mean if there is an increase in the size of the pulmonary arteries as they extend out into the lung?
Pulmonary hypertension.
What does it mean f there is a decrease in size, truncation, or obliteration of the pulmonary arteries?
Embolus.
What does it mean if there is a lack of vascular marking in the periphery?
Pneumothorax.
What does a “batwing” pattern of alveolar infiltrate often indicate?
This is a common finding with congestive heart failure.
What does pulmonary consolidation look like?
Presence of a density which corresponds to a segment or lobe; air bronchogram; no significant loss of lung volume.
What does atelectasis look like?
Presence of a density corresponding to a segment or lobe; significant loss of volume; hyperinflation of normal lungs.
What does congestive heart failure look like?
Large hila with indistinct markings; fluid in interlobar fissures; pleural effusions and alveolar edema (bat wings); kerly B-lines (collections of fluid where the fissures of the lung are); cardiomegaly; dilated upper lobe vessels.
