Chest X-Ray Flashcards
What is a chest x-ray and what are the 2 main views?
Black and white film of the thorax
Posterior anterior view
Anterior posterior view
How can you tell if the x-ray was taken in a AP view or PA view?
Look at the scapluae
If the scapluae overlie the lung fields then film is AP
Check L and R labels
What x-ray view will be in the exam?
Posterior anterior view
What basic checks should you always do when looking at a chest x-ray?
Name and DOB
Date
R or L
PA or AP
Exposure
Patient position
Inspiration or expiration
Any previous x-rays to compare
Common for a patient who is very sick to have a normal chest x-ray
What is the sequence to assess a chest x-ray?
A - Alignment
B - Bones
C - Cardio
D - Diaphragm
E - Expansion
F - Lung Fields
G - Gadgets
Soft tissue
How do you check A for a chest x-ray?
Are the spinous processes in the middle of the trachea
Put both thumbs on the end of the clavicles - is the spinous processes in the middle
How do you check B for a chest x-ray?
Find the scapula - may mistake this for pathology when looking at the lung fields
Count down all the ribs - check for fractures
See how well the lungs are expanded - 6th rib mid clavicular line
Remember - Patient is asked to take a deep breath in when taking the x-ray
How do you check C for a chest x-ray?
Does the heart take a 1/2 of the distance of the diaphragm
See heart borders either side of the spine
1/3 of the heart R of the midline and 2/3 of the heart L of the midline
Clear angles between the heart and the diaphragm and clear heart border
How do you check D for a chest x-ray?
How well expanded each lung - see if the lungs come down to at least the 6th rib mid clavicular line
R side higher due to liver
Gastric air bubble L side due to stomach
Distinct costophrenic angle = bases are well expanded
How do you check F for a chest x-ray?
Look through the lung fields to see if there is any pathology
Lung marking = blood vessels
If blood vessels are throughout the lung fields to the periphery, then you know the lungs are occupying the entire thorax = no air or fluid in the pleural space (pneumothorax/pleural effusion)
Harder to see blood vessels in the top part of the lung as the lung is stretched more open = blacker
Identify the hilum
How do you check G for a chest x-ray?
Endotracheal tube - radio opaque stripe
Oxygen tubing
Pace maker
Central line
Staples
Wiring after a sternotomy
ECG dots
Chest drains
If the chest x-ray is not aligned what do you need to be aware of?
This will affect the position of the heart and the lung fields
How do you check for soft tissue on a chest x-ray?
Check outline of the body
Surgical emphysema - see air in the soft tissue
See a lot of tissue if the patient is obese
Breast tissue in females
Name the anatomical structures
Spinous process*
Trachea*
Clavicle*
1st rib*
Anterior rib*
Posterior rib*
Scapulae*
Breast tissue
Diaphragm*
Gastric air bubble*
Liver*
Aortic knob*
Right atrium*
Hilum markings
Bronchial bifurcation*
Left bronchus*
Descending aorta*
What may horizontal ribs indicate?
Ribs become horizontal when patient takes a deep breath in
What does a clear heart border indicate?
Lung tissue next to the heart is not atelectatic
How do you check E for a chest x-ray?
Count ribs to see if ribs have normal expansion
6th rib mid clavicular line
8th rib mid axillary line
T10
What does pneumonia look like on a chest x-ray?
More patchy and fuzzy compared to pleural effusion
Does not pull the heart towards it (like atelectasis) as the lung is just filled with exudate
Combine x-ray with subjective and objective assessment
What does pleural effusion look like on a chest x-ray?
Lipping effect (sucks fluid up) due to negative pressure in the pleural space
Significant opacity (Solid white)
What does atelectasis look like on a chest x-ray?
More patchy and fuzzy compared to pleural effusion
Pulls the heart and trachea towards it due to the lung shutting down
What does a pneumothorax look like on a chest x-ray?
Absence of lung markings (vessles)
Heart gets pushed away
What does emphysema look like on a chest x-ray?
Long thin heart
Low set diaphragm
Very black looking lungs, hard to see lung markings = as lung is stretched open and there is more air
Lungs are hyperinflated
What does pulmonary oedema look like on a chest x-ray?
Throughout lung looks fluffy - lung markings flared up
Note boot shaped heart
What does pulmonary fibrosis look like on a chest x-ray?
Similar hazy presentation to pulmonary oedema
In patches not throught lung
