Chest X-ray

Question 1

x-ray

Answer 1

-describe radiation which is part of spectrum which includes visible light, gamma rays and cosmic radiation

Question 2

tissue absorption of x rays

Answer 2

-bone and fluid- high absorption (white)
-tissue- somewhere in middle absorption (grey)
-air- low absorption (black)

Question 3

understand normal chest x ray

Answer 3

-costophrenic angle
-costophrenic angle
-hilum
-look at image on PP

Question 4

film view: PA vs AP

Answer 4

-PA- x rays penetrate through back of pt on to film
-AP- x rays penetrate through the front of pt on film (often distorted and only done in ER)

Question 5

it is adequate (quality)

Answer 5

-PIRA
-penetration - is film over or under penetrated -> you want to see cervical/thoracic vertebrae
-inspiration
-rotation- make sure collar bones and spine are centered
-angulation

Question 6

film quality: inspiration

Answer 6

-film is taken at full inspiration
-10 posterior ribs should be visible
-posterior ribs- most apparent and run more or less horizontally
-anterior ribs- visible but harder to see -> run more or less at 45 degree angle downward (hands in pockets)

Question 7

film quality- angulation

Answer 7

-beam is angled up
-clavicles moved up
-can show apices better -> to show mass
-x ray is angled toward head (usually bc pt is laying in bed and elevated)
-this is an apical lordotic view
-sharp angle of left hemidiaphragm - not visible
-makes heart look larger (and unusual shape)

Question 8

gastric bubble

Answer 8

-should be on left side

Question 9

x-ray: first step: look at diaphragm

Answer 9

-look for:
-free air: appears black near diaphragm
-margins should be sharp- costodiaphragmatic angles
-abnormal elevation
-flat line- likely fluid (effusion)

Question 10

x-ray 2nd step: check heart

Answer 10

-size and diameter- >1/2 thoracic diameter is enlarged heart
-shape
-silhouette margins should be sharp -> loss of silhouette is typically a pneumonia
-** AP views make heart appear larger

Question 11

water bottle heart

Answer 11

-abnormal shape and size
-pericardial effusion

Question 12

x-ray: step 3: check hilar region

Answer 12

-size and shape of aorta
-nodes
-enlarged vessels
-L and R pulmonary arteries -> enlarged -> pulmonary hypertension
-aortic knob

Question 13

hilar adenopathy

Answer 13

-hilar nodes
-often seen with sarcoidosis

Question 14

x-ray step 4: check lung fields

Answer 14

-infiltrates (slide 34) - loss of cardiac border
-increased vascularity- slide 35 -> white all around (ex. of heart failure)
-masses - slide 36
-increased interstitial markings - interstitial lung disease (slide 37) -> VERY DRY
-absence of normal margins
-air bronchograms

Question 15

air bronchogram

Answer 15

-something that fills the alveoli
-fluid or gunk in alveoli- white
-black line of air seen
-outlines the airway
-pulmonary edema often

Question 16

white

Answer 16

-fluid
-consolidations (bone)

Question 17

black

Answer 17

air
-pneumothorax
-giant bulla