Chest x-ray Basics

Question 1

What is the 8-step approach to chest X-ray interpretation?

Answer 1

1. Patient and Image Verification, 2. Airways, 3. Bones and Soft Tissues, 4. Cardiac Silhouette and Mediastinum, 5. Diaphragm, 6. Effusions, 7. Lung Fields, 8. Lines and Tubes.

Question 2

What does the mnemonic ‘PA B-C-DE-L-T’ stand for?

Answer 2

P: Patient/Image Verification, A: Airways, B: Bones/Soft Tissues, C: Cardiac Silhouette, D: Diaphragm, E: Effusions, L: Lung Fields, T: Tubes and Lines.

Question 3

Why is it important to verify patient identity and image quality when reading a chest X-ray?

Answer 3

To confirm you are evaluating the correct patient and ensure the image is of sufficient quality for accurate interpretation.

Question 4

What are the key indicators of good image quality on a chest X-ray?

Answer 4

Good positioning, no rotation, full inspiration (8-10 posterior ribs), proper penetration (spine faintly visible through heart), and exposure.

Question 5

What are you assessing when checking the airways on a chest X-ray?

Answer 5

Tracheal position, bronchial markings, and evidence of obstruction.

Question 6

What could cause tracheal deviation on a chest X-ray?

Answer 6

Tracheal deviation can be caused by tension pneumothorax, atelectasis, or a large mass.

Question 7

What bones should be evaluated on a chest X-ray?

Answer 7

Clavicles, ribs, scapulae, spine, and proximal humerus.

Question 8

What are common causes of rib fractures visible on a chest X-ray?

Answer 8

Trauma, osteoporosis, or metastatic lesions can cause rib fractures.

Question 9

What might soft tissue emphysema look like on a chest X-ray?

Answer 9

Soft tissue emphysema appears as streaky or bubbly black areas in the soft tissues.

Question 10

What is the normal size of the heart silhouette on a PA chest X-ray?

Answer 10

The heart should be less than 50% of the thoracic diameter on a PA X-ray.

Question 11

What are possible causes of an enlarged cardiac silhouette?

Answer 11

Causes include cardiomegaly, pericardial effusion, or heart failure.

Question 12

What could a widened mediastinum indicate?

Answer 12

A widened mediastinum may indicate aortic dissection, lymphoma, or trauma.

Question 13

What should the hemidiaphragms look like on a normal chest X-ray?

Answer 13

The right hemidiaphragm is usually slightly higher than the left, and the borders should be smooth.

Question 14

What does free air under the diaphragm indicate?

Answer 14

Free air under the diaphragm indicates pneumoperitoneum (e.g., bowel perforation).

Question 15

How do pleural effusions appear on a chest X-ray?

Answer 15

Pleural effusions appear as fluid in the dependent areas (e.g., meniscus sign or blunting of costophrenic angles).

Question 16

What causes blunting of the costophrenic angles?

Answer 16

Blunting of the costophrenic angles is caused by pleural effusion or thickening.

Question 17

What are the key zones to assess in the lung fields?

Answer 17

Upper, middle, and lower zones of both lungs.

Question 18

What causes focal opacities in the lung fields?

Answer 18

Focal opacities can be caused by pneumonia, tumors, or pulmonary edema.

Question 19

What is the difference between interstitial and alveolar opacities?

Answer 19

Interstitial opacities are thin, reticular markings; alveolar opacities appear dense and fluffy.

Question 20

What are common causes of cavitation in the lungs?

Answer 20

Common causes include tuberculosis, abscess, or necrotizing pneumonia.

Question 21

What is the correct position for an endotracheal (ET) tube on a chest X-ray?

Answer 21

The ET tube tip should be 2-5 cm above the carina.

Question 22

Where should a nasogastric tube (NGT) tip be located on a chest X-ray?

Answer 22

The nasogastric tube tip should be located in the stomach, below the diaphragm.

Question 23

How should a chest tube appear on a chest X-ray?

Answer 23

A chest tube should be in the pleural space, without kinking or malposition.

Question 24

What are signs of a malpositioned central venous catheter on a chest X-ray?

Answer 24

Signs include catheter coiling, misplacement, or tip outside the superior vena cava.

Question 25

How do pacemaker leads appear on a chest X-ray?

Answer 25

Pacemaker leads appear as thin, radiopaque wires leading to the heart chambers.

Question 26

What does a ‘white’ appearance on a chest X-ray typically indicate?

Answer 26

A white appearance indicates fluid, soft tissue, bone, or metal.

Question 27

What does a ‘black’ appearance on a chest X-ray represent?

Answer 27

A black appearance represents air (gas) in the lungs or pleural space.

Question 28

What material causes a ‘metallic white’ appearance on a chest X-ray?

Answer 28

Surgical implants, pacemakers, or bullets can cause a metallic white appearance.

Question 29

What are examples of pathological causes of increased lung opacity?

Answer 29

Pathological causes include pneumonia, pulmonary edema, tumors, or atelectasis.

Question 30

What might cause a hyperlucent (extra black) area on a chest X-ray?

Answer 30

Hyperlucent areas can be caused by pneumothorax, emphysema, or over-inflation.

Question 31

What abnormalities would you look for in the lung apices on a chest X-ray?

Answer 31

Lung apices are checked for Pancoast tumors, pneumothorax, or cavitary lesions.

Question 32

What should you check in the retrocardiac area on a lateral chest X-ray?

Answer 32

The retrocardiac area is checked for consolidation, masses, or hernias.

Question 33

How would a pneumothorax appear on a chest X-ray?

Answer 33

A pneumothorax appears as a sharp pleural line with no lung markings beyond it.

Question 34

What are the radiological findings of a tension pneumothorax?

Answer 34

A tension pneumothorax shows tracheal deviation, mediastinal shift, and collapsed lung.

Question 35

What does a consolidation look like on a chest X-ray, and what causes it?

Answer 35

Consolidation appears as a dense, white area with air bronchograms; causes include pneumonia, pulmonary hemorrhage, or ARDS.