Chest X-ray (Johns) - W1

Question 1

What is the standard view for a chest x-ray?

Answer 1

PA (posterior to anterior)

Question 2

What type of X-ray do you order if the patient is in the hospital?

Answer 2

• portable chest x-ray –> A-P x-ray
  
  • may see enlarged heart (cardiac shadow)

Question 3

What is checked for on initial evaluation of an x-ray?

Answer 3

• Quality
• correct film - did they do the right location
• Film markers
• Artifacts

Question 4

What is important for radiographic technique?

Answer 4

1. Consistency
2. Patient position
3. Posteroanterior/anteroposterior - which view was used
4. Inspiration/expiration - need to visualize enough ribs. Need deep breath.
5. Proper exposure - too much energy turns it black, not enough energy turns it white

Question 5

What are the features you should see on a good chest x-ray?

Answer 5

• Trachea midline
• Clavicles equidistant from midline
• Thoracic vertebrae just visible behind the heat.
• Lung detail not overexposed.
• Both costophrenic angles seen.
• Accurate rib detail.
• Scapula pulled off of chest

Question 6

ABC’s of chest x-ray interpretation:

Answer 6

• A = airway and adenopathy
• B = bones and breast shadows
• C = cardiac silhouettes
  
  • cardiac shadow should be less than 1/2 diameter of ribs
• D = diaphragm
  
  • right higher than left
  • see costophrenic angles
• E = everything around the lung fields
• F = Fields (lung fields) - look at last cuz you don’t wanna miss something else.

Question 7

What are the advantages of a lateral chest x-ray?

Answer 7

• Can see behind the heart
• Can look at chest wall space
  
  • may be enlarged w/emphysema

Question 8

What structures appear radiopaque and what structures appear radiolucent on a chest x-ray?

Answer 8

• Radiopaque (white)
  
  • Metal = white
  • bone
• Radiolucent (black)
  
  • Air - appears black
  • Fat
• Muscle is in the middle of the spectrum

Question 9

3 reasons why we do CT scans?

Answer 9

• Evaluate lung masses or nodules seen on CXR’s.
• Check for pulmonary emboli
• Help define unknown abnormalities on routine CXRs.

Question 10

When do we use or not use contrast w/CT’s.

Answer 10

• USE
  
  • vascular abnormalities - can check for pulmonary emboli
  • can make vessels more white
• DO NOT USE
  
  • Impaired renal function

Question 11

How do we view X-rays and Chest CTs?

Answer 11

• Chest CT - look at like feet are coming at us.
• X-ray - look at like the person is facing us.

Question 12

What is important to know about CT’s and Xrays as family physicians?

Answer 12

• How to read chest x-rays
• indications for ordering chest x-rays
• when to order contrast w/the CT