Chest X Rays Flashcards
What’s a chest x ray
A CXR is produced by the electromagnetic beams passing through the thorax and exposing a photographic film, Image based on the anatomy of the patient blocking the transmission by varying degrees which results in an image caused by the degree of exposure of the photographic plate
What’s radio-density
Less dense tissue such as air or air filled structures are referred to as radiolucent (black) more dense structures are referred to as radiopaque (white)
What are the 4 basic radio densities
Gas= black e.g air filled lungs
Fat= grey e.g lipid tissue around muscle
Soft tissue= grey e.g heart, blood vessels
Bone of metal= white e.g ribs and sternum
What are the types of CXR
Posteroanterior- most common, passes post to ant
Anteroposterior- commonly used for portable x rays
Lateral
Oblique
How do you interpret a CXR
Easy to kiss significant abnormalities so use a systematic approach, preliminary check: name + date, projection, exposure, position, inspiration
What questions to ask in a cxr
Who?what?when?why?how?
What system to follow in a cxr
A- alignment, b-bones, c-cardiac, d-diaphragm, e-expansion, f-lung fields, g-gadgets(drips: drains and tubes)
What to look for in alignment
Is this a straight film, look at prox end of clavicles in relation to spinous processes
What to look for in bones
Are they all there, intact in a normal position, don’t just look at ribs
What to look for in cardiac
Is there a clear Heart border, normal size, is there anything else to note in the mediastinum, evidence of shifting structures
What to look for in diaphragm
Are both hemi diaphragm clearly visible? What about angles, cardiophrenic and castrophrenic
What to look for in expansion
How well expanded is the chest, 10th rib posteriorly should bisect the right hemi diaphragms or mid clavicular line and rib the 6th rib anteriorly
What to look for in fields
Are the lung fields clear? Any areas of density, increases or decreases, can you see a lung edge, fluid level?collapse and compnsolidayion you will see increased opacity, collapse you can see shifting of structures
What to look for in gadgets
What drips, drains, tubes, limes and other gadgets are visible, are they in or around the patient
What are some common abnormalities
Consolidation, atelctasis, collapse, pleural effusion, pneumothorax, pulmonary oedema
What are other imaging that can be used
CT, MRI, U/S, CTPA
How would you see consolidation on x ray
Lung tissue has become firm due to accumulated fluids, white grey shadow, no loss of volume, increased breath sounds ore decreased breath sounds with or without crackles, mainly due to pneumonia or lung infection
How would you see atelectasis on a chest x ray
Airless state of lung, tissue (collapsed lung) can affect all or part of the lung, white grey shadow. With loss of volume and shifting of structures, only visible if collapse is significant, total collapse may pull mediastinum to affected side, quiet breath sounds p, fin end inspiratory crackles
What would you see on cxr with pleural effusion
Excess fluid in pleural cavity, fluid white on CXR, small amount of fluid results in loss of Costco phrenic angle, large amount of fluid will push mediastinum to non affected side
What would you see on cxr with pneumothorax
Air in pleural space secondary to rupture in pleural layer, lung squashed towards hilum, air in pleural space black, no lung markings, lung squashed appears as white density towards hilum, mediastinum pushed to unaffected side
What would you expect to see on cxr of pulmonary oedema
Extra vascular water in lungs, bilaterally fleecy opacifies spreading from hila known as bats wing shadows, may also be enlarged, crackles in dependent regions, sometimes fine
