Chest x-ray

Question 1

what are the two fissures of the lung?

Answer 1

• horizontal fissure
• oblique fissure

Question 2

when are fissures visible?

Answer 2

only visible on chest x-ray (CXR) in case of pathologies which increase fluid content in fissures eg heart failure

Question 3

what equipment is used during chest x-ray

Answer 3

• high output x-ray tube
• generator with broad focus
• image recording system (DR, CR)
• standing aids
• radiographic markers

Question 4

preparation for radiography of the chest

Answer 4

• ensure that the area under concern is free from any external artifacts such as necklaces, braces, buttons, ECG stickers etc
• patient is ERECT against wall BUCKY
• lead apron

Question 5

SID

Answer 5

180cm

Question 6

FSS

Answer 6

broad focus

Question 7

kVp

Answer 7

125

Question 8

mAs

Answer 8

1.25-2

Question 9

clinical indications for a chest radiography

Answer 9

• shortness of breath
• heamoptysis
• anaemia
• pleural effusion
• pneumothorax
• ongoing cough
• lung nodule

Question 10

most commonly used routine projections

Answer 10

• prosterior-anterior chest radiograph

Question 11

alternative chest routine projections

Answer 11

• anterior-prosterior chest radiograph (supine/erect)

Question 12

describe prosterior-anterior chest positioning

Answer 12

• patient stands facing the detector
• chin is raised
• hands are placed on hips, elbows flexed and brought forwards
• median sagittal plane perpendicular to detectors
• horizontal central ray in midline at level of T6 inferior border of scapulae
• expose on full arrested insipiration

Question 13

superiorly

Answer 13

lung apices

Question 14

inferiorly

Answer 14

costophrenic angles

Question 15

laterally

Answer 15

lateral chest wall

Question 16

what is a poor positioned image called

Answer 16

lordotic image

Question 17

how many ribs should be visible posteriorly vs anteriorly in an x-ray within the lung field?

Answer 17

posterior - 9-10
anterior - 6-7
insipiration adequate to review radiograph

Question 18

which hilum is higher

Answer 18

left hilum of lung is always higher than the right

Question 19

when will you see the splenic fissure

Answer 19

in case of pathology - if it is full and healthy it will not be visible in an x-ray

Question 20

when would you see fissures in a radiograph

Answer 20

only in the presence of infection

Question 21

what type of focus do we use for a chest radiograph

Answer 21

broad focus

Question 22

what is one way you can distinguish between an AP radiograph

Answer 22

look at the heart shadow

Question 23

when would you do a lateral radiograph?

Answer 23

• used for localisation of a pathology
• if a region is shadowed
• usually referred for CT

Question 24

FDD for lateral radiograph

Answer 24

180cm

Question 25

why would you do a left lateral side radiograph?

Answer 25

- heart is closer to left side - magnification is larger

Question 26

midline of lateral radiograph

Answer 26

horizontal central ray in midline at level of T6 and level of inferior border of scapula

Question 27

consolidation of a chest radiograph

Answer 27

- area of lung becomes dense and white

Question 28

what does consolidation indicate?

Answer 28

- filling of alveoli and bronchioles in lung with pus (pneumonia) and fluid (pulmonary oedema) or blood

Question 29

what is pleural effusion

Answer 29

fluid within the pleural cavity

Question 30

what is seen of erect CXR pleural effusion?

Answer 30

clear fluid level seen

Question 31

what is seen of supine CXR pleural effusion?

Answer 31

increased even density over lung

Question 32

two possible causes of pleural effusion

Answer 32

- altered intrapleural/ capillary pressure - impaired lymph drainage

Question 33

treatment of pleural effusion

Answer 33

- thoracentesis; aspiration of fluid from pleural space

Question 34

what is a pneumothorax?

Answer 34

- filling of pleural cavity with air either from outside or from alveoli

Question 35

symptoms of pneumothorax

Answer 35

- pleuritic pain - increased resp rate - chest asymmetry while breathing - decreased breath sounds - hypoxemia

Question 36

treatment of pneumothorax

Answer 36

- follow up x-rays - insertion of chest drain - needle aspiration - airtight covering

Question 37

what is tension pneumothorax

Answer 37

- one way valve forms in lung - air enters pleural space = trapped - pressure rises collapsing lung and pushes heart away from injured side - vena cava = kinked - blood cannot return to heart and cardiac output falls

Question 38

what are interstitial lung diseases

Answer 38

involvement of supporting tissues of lung parenchyma --> fine or coarse reticular opacities or small nodules

Question 39

what is atelectasis

Answer 39

partial collapse of lung due to decrease in amount of air in alveoli --> volume loss + increased density