Chest Radiography

Question 1

name the 4 main types of densities

Answer 1

1. bone 2. fat 3. soft tissue 4. air

Question 2

what are the 3 technical aspects to look for on an xray

Answer 2

1. inspiration 2. rotation 3. penetration

Question 3

name the right side cardiac borders

Answer 3

R hemidiaphragm –> RA –> ascending aorta –> SVC –> brachiocephalic

Question 4

name the left side cardiac borders

Answer 4

L hemi–>LV –> descending aorta –> AP window–>aortic arch –> L brachiocephalic

Question 5

which fissures can you see on which type of xray

Answer 5

PA: may be able to see the horizontal
Lateral: able to see both

Question 6

*the left major fissure is anterior to the right

Answer 6

false - the left is POSTERIOR

Question 7

what are some of the skeletal things to look at

Answer 7

acromion, clavicle, posterior ribs, anterior ribs, spinous process, scapula, humeral head, glenoid fossa

Question 8

what is the paratracheal stripe

Answer 8

trachea with a little bit of CT tissue surrounding the cartilage - btwn the right lateral wall of trachea and RUL

Question 9

which ventricle is most anterior

Answer 9

right

Question 10

which heart structure is most posterior

Answer 10

LA –> RA

Question 11

what vascular structures should you be able to find on a lateral xray

Answer 11

aortic arch, left pulmonary artery, right hilar vascular opacity, AP window

Question 12

how can you tell the difference btwn the right and left hemidiaphragms on lateral xray

Answer 12

• left - obscured by the heart anteriorly, contacts the L ribs posteriorly
• right - not obscured by the heart and contacts the R ribs (magnified) posteriorly

Question 13

lateral chest XR cardiovascular borders

Answer 13

LA is most posterior with the LV just inferior to it and the IVC inferior to that

Question 14

What are the clear spaces seen on the lateral chest xr

Answer 14

1. retrosernal 2. retrotracheal 3. retrocardiac

Question 15

What are the 5 T’s and where are they commonly found

Answer 15

1. Found in the retrosternal area

- terrible lymphoma, thymoma, teratoma, thoracic aortic aneurysm

Question 16

What common diseases are found in the retrotracheal area?

Answer 16

1. vascular abnormalities
2. esophageal disease
3. lung cancer

Question 17

What common diseases are found in the retrocardiac area?

Answer 17

1. hiatal hernia 2. esophageal disease 3. LV enlargement, 4. PNA

Question 18

What are the 3 mediastinal compartments? And what are the structures in each?

Answer 18

1. anterior: thymus, ln, fat, internal mammary vessels
2. middle:
   - ht/percardium,
   - vessels: ascending aorta, arch, SVC, IVC, pulm vessels, brachiocephalic vessels,
   - nerves: phrenic nerves, left recurrent laryngeal nerve
   - airway: trachea, main bronchi
   - other: ln, AP window
3. posterior: esophagus
   - vessels: descend aorta, azygous vein, hemi-azygous vein
   - lymph: ln, thoracic duct
   - nerves

Question 19

what is the cardiothoracic ratio and what is a normal value?

Answer 19

• max trans diameter of the ht vs. diameter of the chest

- normal = 0.5 or less

Question 20

Which hilum is typically higher?

Answer 20

left higher than the right (opposite is pathological)

Question 21

which hemidiaphragm is typically higher?

Answer 21

right slightly higher than the left

Question 22

Please list the 9 general steps of how to approach an xr

Answer 22

1. adminstrative
2. technical quality
3. basic overview: body shape, size, symmetry, M vs. F, FB
4. lines and tubes
5. ST: neck,shoulder, cw, abd
6. skeletal structures: shoulder–>clavicle–>ribs–>spine
7. mediastinum: ht, essels, AP window
8. pleural spaces: costophrenic angles, air, fluid
9. lungs: lung size, vascular pattern, parenchyma