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.
