Chest X-ray's

Question 1

Why does the right hemidiaphragm tend to be higher than the left?

Answer 1

The liver pushes it up slightly

Question 2

What is the acronym for film technical factors of a good x-ray and what do each mean? (4 answers)

Answer 2

Rotation (Angle of body)
Inspiration (How many ribs can you see?)
Projection (AP or PA?)
Exposure/penetrance (can you see the structures well?)

Question 3

How many anterior ribs should you see on an chest x-ray?

Answer 3

6-8

Question 4

How many posterior ribs should you see on an chest x-ray?

Answer 4

8-10

Question 5

What do we check inspiration (RIPE)? (2 answers)

Answer 5

Checking the number of ribs is a good indication of how well a patient can take for a deep breath (normal anatomy)

Question 6

What is meant by the “cardiothoracic ratio?

Answer 6

This is the size of the heart from R to left boarders

Question 7

What size is considered abnormal for the heart?

Answer 7

50% of the chest from one wall to another

Question 8

What does an enlarged heart suggest?

Answer 8

Heart conditions such as HF, high BP, CHD

Question 9

What approach would you use to assess a chest x-ray?

Answer 9

Airways
Breathing
Cardiac
Diaphragm
Everything else

Question 10

What do you look for in the approach for A (airway) on a chest x-ray?

Answer 10

Positioning of the trachea

Question 11

What do you look for in the approach for B (breathing) on a chest x-ray?

Answer 11

Compare right to left zones of the lungs for differences

Question 12

What do you look for in the approach for C (cardiac) on a chest x-ray?

Answer 12

Are the boarders of the heart smooth?
How large is the heart?

Question 13

What would blunt angles of both costophrenic angles suggest on a chest x-ray?

Answer 13

Systemic pathology like HF/Pleural effusion

Question 14

What would block white marking suggest on a chest x-ray?

Answer 14

Pleural effusion

Question 15

What would grey markings on a chest x-ray suggest?

Answer 15

Infection/pneumonia

Question 16

What is pleuritic chest pain?

Answer 16

Pain on inspiration due to pleura rubbing over each other

Question 17

Can you explain what the silhouette sign is?

Answer 17

It is where the R or L boarder of the heart is obscured by markings

Question 18

What is the diagnosis of a silhouette sign of the R side?

Answer 18

R middle lobe consolidation

Question 19

What is the diagnosis of a silhouette sign of the L side?

Answer 19

L Lower zone consolidation

Question 20

How would you determine between a simple and a tension pneumothorax on an x-ray?

Answer 20

‘Simple’ has no tracheal deviation
‘Tension’ has deviation which can cause stress on organs such as the heart

Question 21

How would a transudate pleural effusion present on a chest x-ray?

Answer 21

Bilateral angle or lobe white out

Question 22

What would cause a transudate pleural effusion?

Answer 22

Some form of organ failure

Question 23

How would a exudate pleural effusion present on a chest x-ray?

Answer 23

Singular angle/lobe white out

Question 24

What would cause a exudate pleural effusion? (2 answers)

Answer 24

Infection
Cancer

Question 25

What would ‘batwinging’, Kerley B lines’, Cephilization of vessels’ and increased cardiothoracic ratio/silhouette indicate on a chest x-ray and what is this caused by?

Answer 25

Pulmonary oedema caused by heart failure

Question 26

What would sail sign suggest? (Diaphragm) unable to be seen by heart)

Answer 26

Left lower lobe collapse