Chest Radiography

Question 1

Posterioranterior (PA)

Answer 1

Less magnification of the heart

This requires pts. to be able to stand

Question 2

Left Lateral

Answer 2

• Determines location
• Confirms presence of disease
• Demonstrates disease not visible on the frontal image

Question 3

Lateral decubitus

Answer 3

Assess pleural effusions

Look for layering of fluid

Question 4

Penetration

Answer 4

• On a PA film, thoracic spine structures should be visible through the heart
• You should be able to see bronchovascular structures through the heart
• On lateral film, the spines appears to darken as you move caudally

Question 5

Overpenetration

Answer 5

makes the picture too dark and may look like emphysema or a pneumo

Question 6

Rotation

Answer 6

Medial heads of clavicles should be centered on either side of the thoracic spine

Question 7

Air

Answer 7

Absorbs least amount of xray

“Blackest” on images

Question 8

Fat

Answer 8

Gray – darker than soft tissue

Question 9

Fluid or soft tissue

Answer 9

Light gray

Question 10

Calcium (bones)

Answer 10

White

Question 11

Metal/Contrast

Answer 11

whiter than bone

Question 12

Pneumonia

Answer 12

• More opaque than surrounding lung
• Margins may be fluffy, except where they abut a pleural surface
• Homogeneous in density
• Air bronchograms
• Atelectasis in affected portion of segmental pneumonias

Question 13

Lobar Pneumonia

Answer 13

• Silhouette sign
• airbronchograms centrally
• typical cause is S. pneumoniae

Question 14

Segmental Pneumonia

Answer 14

• Tends to be multifocal, does not have air bronchograms, and can be associated with volume loss because the bronchi are also filled with inflammatory exudate
• Most common cause is Staphylococcus aureus
• Margins tend to be fluffy and indistinct

Question 15

Interstitial Pneumonia

Answer 15

• Most common cause is viral pneumonia, mycoplasma pneumoniae, pneumocystis pneumonia in pts w/ AIDs
• Tend to take on a fine, reticular pattern early on
• May mimic pulmonary edema

Question 16

Cavitary

Answer 16

• lucent cavities produced by lung necrosis as its hallmark
• Affects the apical or posterior segments of the upper lobes or the superior segments of the lower lobes.
• Bilateral upper lobe disease is very common.

Question 17

Aspiration Pneumonia

Answer 17

• Aspiration almost always occurs in the most dependent portion of the lung
• When a person is recumbent, aspiration usually occurs into the superior segments of the lower lobes or the posterior segments of the upper lobes.
• The right side is more often affected than the left because of the straighter and wider nature of the right main bronchus.

Question 18

Different types of atelectasis

Answer 18

• subsegmental
• compressive/passive
• obstructive

Question 19

Pleural effusion fluid collection

Answer 19

-75cc blunts costophrenic angle on lateral xray

250-300cc blunts angle on frontal view

2L will opacify entire hemithorax

Question 20

Pleural Effusion-how to recognize

Answer 20

Shift of mobile structures away from side of effusion with a large effusion
Effusions act as a mass pushing structures away

Effusions will flow freely with position change (lateral decub view)