Chest x-ray+

Question 1

What does costophrenic angles mean?

Answer 1

Places where the diaphragm meets the ribs

Question 2

What are the indications for chest x-ray?

Answer 2

Shortness of breath
Persistent cough
Chest pain
Chest trauma (if it involves the lung)
Pulmonary embolus
Chest Infection
Pneumonia
Tuberculosis
Inhaled foreign body
Haemoptysis
Tumour / Cancer
COPD/COAD
Pre-drug therapy for some medications
Increased inflammatory markers
COVID

Question 3

Why do we prefer erect?

chest xray

Answer 3

Diaphragm lower, heart pulled down,

When supine, raised intrathoracic pressure increases diameter of vessels, (AP causes magnification too).

Question 4

Planes/Landmarks in relation to the IR or each other.

Gross positioning

Answer 4

Median Sagittal Plane should be perpendicular (at 90˚) to the Imaging Receptor (IR)
Medial (sterno clavicular joints) ends of the clavicles equidistant from the IR

Question 5

Fine positioning

Answer 5

Patient should flex arms and place the dorsal aspects of the hands over the hips

Shoulders and elbows should be rolled forwards in order to clear scapulae away from the lung fields

Question 6

Direction of Central Ray

Answer 6

Horizontal Central Ray

SID 180cm

Question 7

Centring Point

Answer 7

In the Midline, over the body of the 8th Thoracic Vertebrae.

Which is at the level of inferior angle of the scapula before we move the arms forwards.
The angle of the bottom of the shoulder blades.

Question 8

Collimation

Answer 8

Superiorly
Apices of the lungs

Inferiorly
Costophrenic angles (bases of the lungs)

Laterally
Soft tissue borders of the thorax
Thoracic Cage/Rib Cage

Question 9

Instructions During Exposure

Answer 9

Full, arrested inspiration
‘Take a deep breath in, and hold it’…
Expose
‘Breath away…’

Question 10

What does lordotic mean?

Answer 10

The patient is leading back

To prevent this the patient is right next to the IR

Question 11

Lateral erect CXR Projection

Answer 11

Patient standing erect with lateral aspect of affected side’s shoulder in contact with the image receptor
Coronal plane perpendicular to IR
Horizontal Central Ray 180cm
Arms elevated away from thorax.
Along Mid axilliary line (under armpit)
Level of Inferior angle of Scapulae

Question 12

Where is the cardiophrenic angle?

Answer 12

The cardiophrenic angle is the angle between the heart and the diaphragm

Question 13

Cardio thoracic ratio (CTR)

Answer 13

size of the heart to the end of the ribs

less than 1:2 ratio

Question 14

What does the bony thorax consist of

Answer 14

Consists of three parts
Sternum (anteriorly)
Ribs - 12 pairs (laterally)
Thoracic vertebrae 1 – 12 (posteriorly)

Question 15

The sternum gross anatomy

Answer 15

Anterior, in the midline of the thorax
A flat bone about 15cm long
Supports clavicles and provides attachment to first seven pairs of ribs.

Question 16

The sternum comprised of

Answer 16

Comprised of 3 bones:
Manubrium (superior portion)
Body (middle portion)
Xiphoid process (projects inferiorly

Question 17

Sternum bony landmarks

Answer 17

Bony landmarks

• Supra sternal notch – upper border of Sternal angle
• the manubrium
• Xiphi-sternum – lowest part

Question 18

12 Rib Pairs

Answer 18

True Ribs
First 7 pairs (1-7)
Attached to the Sternum anteriorly, & thoracic vertebrae posteriorly

False Ribs
Pairs 8-12
Do not attach to sternum directly (but connect via the costal cartilage of 7th rib. Attach to thoracic vertebrae posteriorly.

Floating Ribs
Last 2 pairs (11 & 12)
No anterior attachment, only posteriorly to the vertebrae

Question 19

Surface Landmarks of the Thorax

Can you feel these

Answer 19

Suprasternal notch
Sternal Angle
Xiphisternal Joint
Medial ends of the Clavicles 
Lateral ends of the Clavicles
Inferior Angles of the Scapula
Lower Costal Margin

Question 20

Last rib is when?

Answer 20

T12

Question 21

Patient demos date/time etc
Area of interest
RIPE
Rotation (medial of clavices are equipstaint to the spinal processes)
Inspiration (deep breath)
Projection (is it PA or AP)
Exposure (enough KA, can you see the hemidiaphragm)

Airway
Bronchites right is wider

Answer 21

Patient demos date/time etc
Area of interest
RIPE
Rotation (medial of clavices are equipstaint to the spinal processes)
Inspiration (deep breath)
Projection (is it PA or AP)
Exposure (enough KA, can you see the hemidiaphragm)

Airway
Bronchites right is wider