Chest Radiography for the PA student

Question 1

what are the 6 CXR basics?

Answer 1

1 AP/PA
2 upright, erect, supine
3 rotation
4 inspiration/expiration
5 penetration
6 landmarks present

Question 2

what are the RIPs of CXRs? (first three things to assess)

Answer 2

rotation
inspiration
penetration

Question 3

how can you tell if a CXR is rotated?

Answer 3

clavicles should be equal distant from midline

Question 4

what is full inspiration for a CXR?

Answer 4

can count 10 ribs or greater

Question 5

How far away is a standard PA view?

Answer 5

6 ft away

Question 6

what does correct penetration look like?

Answer 6

can barely see vertebral discs though heart

Question 7

Over pentration causes you to?

Answer 7

under-interpret-too dark (and clear visibility of vertebrae)

Question 8

Under penetration causes you to ?

Answer 8

over interpret -too light

Question 9

what constitutes a diagnostic xray?

Answer 9

• at least 2 views with one at least 90 degrees to the other
  
  • PA and lateral

Question 10

what are the 8 steps of systematic approach to examining a CXR?

Answer 10

• *1. RIP
  2. extra thoracic structures**
• Ryan’s P D heart hangs low*
  3. ribs
  4. pleura
  5. diaphragms (Rt and Lt)
  6. heart
  7. hila
  8. lung parenchyma

Question 11

which extra thoracic structures are important to note when examining a CXR?

Answer 11

• sternum
• ribs
• spine→ foramina, vertebral bodies, intervertebral spaces
• diaphragm
• heart
• supracardiac space
• infracardiac space

Question 12

what are 2 ways to determine orientation of a patient in a CXR?

Answer 12

• gastric bubble → air rises in standing patient
• beads→ bead at Bottom of bubble is patient is standing

Question 13

where is the position of the heart in infants and younger children?

Answer 13

more central than older children and adults (more on the left side in older infants and above)

Question 14

which view should be taken for a CXR intending to demonstrate the margins of the heart, ( what view shows how big the heart really is)?/why?

Answer 14

PA for least magnification from back to front where heart is

Question 15

What is the normal cardiac diameter in males vs females?

Answer 15

• Males
  
  • Less than 15.5cm
• Females
  
  • Less than 14.5 cm
• A change in diameter greater than 1.5cm is significant

Question 16

Describe the cardio-thoracic ratio?

Answer 16

determines if the heart is enlarged

Question 17

Heart greater than x% of chest is considered an abnormal heart in adults?

This could be due to?

Answer 17

• Heart >50% of chest is
considered abnormal in an
adult.

• Possible causes of a ratio
greater than 50% include:
- cardiac failure
- pericardial effusion
- left or right ventricular
hypertrophy

Question 18

What soft tissue shadow do you most commonly see in a female chest x-ray?

Answer 18

breast tissue

Question 19

On an clavicle placement should be? if not it means it could be?

Answer 19

Clavicle placement should be at 2-3 intercostal space (if not, may be rotated)

Question 20

which 2 sharp diaphragmatic angles should you see?

Answer 20

costophrenic & costocardiac

Question 21

What should the diaphragm look like on a normal chest x-ray?

Answer 21

• Rounded with sharp pointed costophrenic and costocardiac angles
  
  • menisus sign-blunted
• right diaphragm is usually 1-2 cm higher because of liver

Question 22

The trachaea in a noral x-ray should be ?

Answer 22

trachea should be midline over the thoracic vertebrae and air filled

Question 23

The lung parenchyma in a normal xray should be ? If not then it may indicate?

Answer 23

Lung parenchyma becomes lighter as you go down the lung. If not, it may indicate a lower lobe ?or pleural effusion

Question 24

what is radiopacity and radiolucency?

Answer 24

radiopacity: whiteness (↑ density)
radiolucency: blackness (↓ density)

Question 25

what is infiltrate vs effusion?

Answer 25

collection of something (usually fluid in a space) infiltrate: collection of something within **tissue** or space (usually lung parynchyma) effusion: collection of fluid outside a tissue or within a **potential space (outside lung tissue)**

Question 26

What lung lobe is most posterior? How many lobes does R & L lung have? What lung has the lingula? Is it posterior or anterior?

Answer 26

* Left lower lobe is most posterior * Right lung=3 lobes so left has 2 * left lung has lingula (located anteriorly)

Question 27

what is mass vs lesion?

Answer 27

mass: well marginated solid that doesn't belong there lesion: poorly marginated, doesn't belong

Question 28

what are the three patterns of radiopacity for infiltrates?

Answer 28

* alveolar: fluffy, soft, poorly differentiated * interstitial: lacey branching lines toward periphery * vascular: pulmonary arteries ↓ or ↑ in size

Question 29

What are the possible causes of ... 1. Alveolar pattern? 2. Interstitial pattern? 3. Vascular pattern?

Answer 29

1. Pulmonary edema 2. Interstitial pneumonitis 3. 1. Pulmonary hypertension -if there is an increase in size of the pulmonary arteries as the extend out into lung 2. Embolus-if there is a decrease in size, truncation, or obilteration of a pulmonary artery 3. Pneumonthorax-Lack of vascular marking in periphery

Question 30

alveolar pattern chest xray

Answer 30

clouds (bilateral diffuse batwing alveolar infiltrates with air bronchograms)

Question 31

Vascular pattern

Answer 31

**see vessels more at base rather then apex due to gravity**

Question 32

1. what is lobar consolidation? 2. what would you look for in chest x-ray radiologically? 3. What lung infection can cause lobar consolidation?

Answer 32

1. alveolar space filled with inflammatory exudate 2. -Lingular infiltrate that is obscuring heart border, density to corresponding to segment or lobe, air bronchogram, **no significant loss of lung volume** 3. **Pneumonia**

Question 33

what is obstructive atelectasis?

Answer 33

no ventilation to the lobe beyond obstruction → causes corresponding lung segment to deflate

Question 34

what are the 3 signs of atelectasis on xray?

Answer 34

1. ) density of one shrunken lobe 2. ) loss of volume 3. ) compensatory hyperinflation of unaffected lung

Question 35

what happens to the air distal to the blockage in atelectasis?

Answer 35

absorbed by pulmonary circulation

Question 36

what are 2 features of CHF in CXR?

Answer 36

* *1.) ↑ heart size (cardiomegaly)** 2. ) large hila with indistinct markings 3. ) fluid in interlobar fissures * *4.) pleural effusions, alveolar (bat wings) & interstitial edema (Kerley B lines)** 5. ) dilated prominent upper lobe vessels

Question 37

what does a tension pneumothoraxic look like?

Answer 37

* one lung condensed with just air around it * **tracheal deviation** * air in the pleural cavity caused by a puncture of the lung or chest wall

Question 38

what does the polkadot sign in xray represent?

Answer 38

metastatic lung cancer