Chest X-Ray Flashcards
What is represented by black on an x-ray?
Air
What is represented by dark grey on an x-ray?
Fat
What is represented by light grey on an x-ray?
Soft tissue
What is represented by white on an x-ray?
Bone/fluid
What is represented by bright white on an x-ray?
Metal
Describe how you assess an x-ray for quality
> Check patient orientation: PA or AP
Check coverage: should show the lung apices and the costophrenic angles
Check to see if the patient is straight or rotated (rotated is indicated by rotated clavicles)
Check that there is a full inspiratory effort (should be able to count 6 ribs)
Check the penetration: you should be able to see the vertebra just behind the heart
How do you know which orientation the x-ray is in?
PA is conducted when standing, and AP is conducted in bed;
In AP the heart appears larger and it can’t be commented on in this angle
What is the mnemonic for x-ray image interpretation?
Airways Breathing Circulation Diaphragm Everything else
How do you assess the airways in a chest x-ray?
Is the trachea deviated?
Do the main bronchi have a clear lumen?
How do you assess breathing in a chest x-ray?
> Should be white lungs markings to the edges of the lungs
Visible hilar
Clear lung fields
Is there consolidation (diffuse whiteness due to fluid?)
How does consolidation appear on x-ray and what may this indicate?
Where the small airways appear to fill with dense, white material (fluid).
This can occur in:
- Pneumonia (fluid and sometimes pus)
- Haemorrhage (blood)
- Pulmonary oedema (fluid)
- Cancer (cells cause white density)
How may a pneumothorax present on chest x-ray?
There will be an asymmetric chest x-ray with lack of lung markings to the edge of the affected lung field
How may a pleural effusion appear on x-ray?
There is white homogenous region with a meniscus on x-ray in the affected lung (there is fluid in the pleural space)
What is a pleural effusion?
When there is fluid in the pleural space
How do you assess circulation on chest x-ray?
> Is there cardiomegaly?
Is there a widened aortic knuckle?
Are there visible heart contours? (if not may be due to pathology in adjacent lung tissue)
How do you assess the diaphragm on chest x-ray?
> Is it dome shaped?
Is it higher on the right (due to liver)?
Is there a gastric bubble in the stomach?
Is there any blunting of the cardiophrenic and/or costophrenic angles?
Is there air beneath the diaphragm? (MEDICAL EMERGENCY)
How do you assess ‘everything else’ in a chest x-ray?
> Are there any fractures in the bones?
Are there any soft tissue swellings?
Are there any lines? (pacemaker, ECG etc.)
How may COPD appear on a chest x-ray?
> Hyperinflation of the lungs (more than 6 anterior its or 8 posterior ribs are visible)
Flattening of the hemidiaphragm
What are the classic signs of congestive heart failure on chest x-ray?
A - alveolar oedema B - kerley B lines C - cardiomegaly D - upper lobe divisions E - bilateral effusions
