chest x-rays

Question 1

1st line eval for

Answer 1

-respiratory
-cardiovascular
-GI
-musculoskeletal

Question 2

pros of 2D

Answer 2

-cheap
-fast
-no absolute contraindications
-no prep
-can be used for screening and pre/post-op eval

Question 3

cons of 2D

Answer 3

-ionizing radiation(~0.05 mSv)
-shadowgram- requires skill for proper interpretation
-requires 2 views to visualize location
-only detects structural abnormalities -> cannot assess function
-interpretation requires clinical correlation **
-compare with prior imaging

Question 4

different types of CXR

Answer 4

-AP vs PA
-Upright vs Supine
-Lateral vs. Lateral Decubitus
-What does your patient need?
-What are the disadvantages of each film?

Question 5

PA vs AP? Left lateral vs Right lateral?

Answer 5

-Upright PA view of the chest best represents all aspects of a chest x-ray
-It’s all because of the heart!
-PA and left lateral: heart closest to film reduces magnification
-It’s all about position! -> standing for fluid, pneumothorax
-PA: best inspiratory effort, easiest to position patient to reduce rotation
-scapula out of the way
-Clavicles project up
-Keep patient and clinical indication in mind!!
-left is better to view the heart -> closer*

Question 6

lateral film

Answer 6

-Indications:
-Help determine the location of disease identified on frontal view
Fluid between fissures
-Confirms presence of disease when unsure on frontal view alone:
-Mass
-Pneumonia
-Demonstrate disease not visible on frontal image

Question 7

steps to interpret x-ray

Answer 7

1) Assessment:
-Identification of pt
-Type: PA vs AP, upright vs portable
-Adequate: Centered, Inspiration, no rotation, and Exposure**
2) ABCs:
-Patience

Question 8

assessment

Answer 8

-Patient name, MRN, and time/date of film
-AP vs. PA, upright vs. portable vs. lateral…
-Adequate:
-Centered: Must have view of lung apices, costophrenic angles, and ribs.
-Inspiration: See at least 8 posterior or 6 anterior ribs.
-Rotation: Clavicle heads equal distant from cervical spine.
-Exposure: Thoracic spine visible through cardiac shadow

Question 9

Centered

Answer 9

-Centered: Must have view of lung apices, costophrenic angles, and ribs.

Question 10

Inspiration

Answer 10

-Inspiration: See at least 8 posterior or 6 anterior ribs.
- in expiration: less of thorax visible, can miss seeing important diseases

Question 11

Rotation

Answer 11

-Rotation: Clavicle heads equal distant from cervical spine.
-medial ends of spinous process should be equal distance from the clavicles

Question 12

Exposure

Answer 12

vertebral bodies visible through the cardiac shadow

Question 13

silhouette sign

Answer 13

-When two objects of the same density touch each other, the edge between them disappears.
-It’s the loss of distinct borders normally present that represent a silhouette sign
-An intrathoracic water density, when in contact with the border of the heart or diaphragm, will obscure that border, helping to localize the density

Question 14

ABCs

Answer 14

-Airway: Centered, deviated, cleared, obstructed, intubated
-Bone: Fractured, decreased density, lytic lesion
-Cardiac: Borders visible, size, location, shape
-Diaphragm: Position, blunting, hyperinflated, air below
-Equal lung Fields: Radiolucency, consolidation, bat wing sign, Kerley A/B/C, air bronchogram, fissure, absent lung marking
-Gastric Bubble: Present, absent, over insufflated
-Hilum: Enlargement, abnormal positioning
-Instruments: ET tube, EKG leads, chest tube, NG tube, defibrillator/pacemaker