Chest Radiographs

Question 1

What is a PA view and where do the X-rays travel from?

Answer 1

Posteroanterior

Beam travels from posterior to anterior (back to front)

Question 2

What is a AP view and where do the X-rays travel from?

Answer 2

Anteroposterio

Beam travels from anterior to posterior (front to back)

Question 3

Where do the X-rays travel from in a lateral view?

Answer 3

From side to side

Question 4

What is the most common X-ray views?

Answer 4

PA

Lateral

Question 5

When would you do an AP view?

Answer 5

If pt isn’t stable enough to travel to X-ray room (done in room)

Question 6

Which view is greater, AP or PA and where is the heart when taking these images?

Answer 6

AP view is greater

AP: heart = futheraway from plate

PA: heart = closer to film plate

Question 7

What happens to the heart in an AP view?

Answer 7

Enlarges

**Don’t diagnose cardiomegaly from Ap view

Question 8

What determines how much of x-ray beam is absorbed?

Answer 8

Density of the object

Question 9

What happens to the x-rays as the density of the object increases?

Answer 9

Fewer X-rays pass through the object –> lightens (bone)

Question 10

What will Air look like on an X-ray?

Answer 10

Black

Question 11

What does Fat look like on an X-ray?

Answer 11

Black

Question 12

What does Water look like on an X-ray?

Answer 12

Gray

Question 13

What do Organs, Muscle, Soft Tissues look like on an X-ray?

Answer 13

Gray

Question 14

What does Metal and Bone look like on an X-ray?

Answer 14

White

Question 15

What is conventional radiography?

Answer 15

Image recorded on film has to be developed (not done anymore)

Question 16

What is computed/digital radiography?

Answer 16

Process of producing digital radiographic image

Question 17

What is the correct positioning on the view box to view an X-ray?

Answer 17

R displayed on the radiograph should ALWAYS be opposite to the viewers left side

Question 18

What is the correct way to view a chest radiograph?

Answer 18

Make sure to glance for obvious abnormalities @ all 4 corners of the image

Question 19

What are the routine views for the chest?

Answer 19

PA

Lateral view

Question 20

What is the equivalent radiation of a chest X-ray?

Answer 20

10 days exposure to environmental background radiation

Question 21

What is the equivalent radiation for a CT scan?

Answer 21

3 years exposure to environmental background radiation

Question 22

What are the important anatomical structures to be included in an X-ray view?

Answer 22

First Ribs

Costophrenic Angles

Lateral Edges of the Ribs

Question 23

What should you have your patient do as you’re taking an X-ray image?

Answer 23

Take in a full breath volume –> diaphragm should be down @ 5 - 7 rib (so you can see the whole lung)

Question 24

Describe the methodical approach to view a PA chest radiograph

Answer 24

Start @ the top

Follow trachea inferiorly (should be midline) –> cardiac shadow

Evaluate cardiac shape

Divide lungs into horizontal thirds and compare R/L lung fields for symmetry

Evaluate the sharply demarcated domed diaphragms

Determine location of gastric air bubble

Question 25

What does a deviation of the trachea imply on a radiograph?

Answer 25

Mass effect –> thyroid enlargement (usually)

Question 26

What is the cardiothoracic ratio in a PA view?

Answer 26

Transverse diameter of the cardiac shadow shouldn’t exceed 50% of the transverse diameter of thoracic cage (PA VIEW ONLY!)

Question 27

Which hemidiaphragm (1/2 of the diaphragm) should be higher on a radiograph?

Answer 27

Right side b/c of the liver

Question 28

What should the costodiaphragmatic angles look like?

Answer 28

Sharp

Form actue angle where diaphragm insert laterally into the walls

Question 29

Where should you find the gastric air bubble?

Answer 29

Immediately underneath the left hemidiaphragm on an upright image

Question 30

Which side is the patient usually facing when taking a lateral chest radiograph?

Answer 30

Left

Question 31

Describe the methodical approach to viewing the lateral chest radiograph

Answer 31

Casually view entire image looking for obvious abnormalities

Estimate the size/shape of the cardiac shadow

Observe sternum/retrosternal/retrocardiac spaces

Observe contours of the diaphragms and costodiaphragmatic angles

Question 32

Which disease can you usually get a good view on a lateral chest radiograph?

Answer 32

Pneumonia

Question 33

When would you do a anteroposterior lordotic chest radiograph?

Answer 33

Routine imaging shows equivocal/ill defined lesion w/in the upper lobes that need further characterization

Question 34

What is a lordotic radiograph?

Answer 34

Frontal AP image w/ pt leaning back

Question 35

What are you looking at in a lordotic radiograph?

Answer 35

Apices of the lung

Displaces clavicles above thoracic inlet –> better visual evaluation of the apices of lungs

Question 36

How do you get a decubitus chest radiograph?

Answer 36

Place pt on his/her side and take Ap image

Question 37

When would you take a decubitus chest radiograph?

Answer 37

When standard imaging suggest pleural effusion and needs to be confirmed and quantified

Question 38

Why should you take an X-ray when placing an NG tube?

Answer 38

Make sure you’ve got it in the stomach

Question 39

When would you do CT chromatography?

Answer 39

Recommended when you have abnormal findings on standard x-rays that need further investigation

Question 40

What is a CT scan?

Answer 40

Detailed 3D model of organs made from x-rays (+/-) dye