Chest X-rays Flashcards by Tori Mupandawana

What are the different parts of the chest?
(5)

Skeletal

Cartilaginous structures

Respiratory

Digestive

Circulatory

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What makes up the skeletal part of the chest?
(5)

Ribs

Spine

Scapulae

Clavicles

Sternum

Proximal humerus

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What makes up the cartilaginous structures of the chest?
(2)

Xiphoid process

Costal cartilage

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What makes up the digestive part of the chest?

Oesophagus

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What makes up the circulatory part of the chest?
(4)

Heart

Major blood vessels

Arterial

Venous

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What makes up the respiratory part of the chest?
(3)

Lungs

Airways

Diaphragm

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What is the diaphragm made of?

Muscle

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How many lobes does the right lung have?

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How many lobes does the left lobe have?

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Why does the left lung only have 2 lobes?

Because the heart is behind it

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What side of the body is the heart on?

Left side

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Why is a chest x-ray important?

It shows all the anatomy in a 2D image

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What do we x-ray the chest for?
(5)

Mainly to demonstrate the lung field

Clinical indications, e.g. lung diseases

Cardiac/heart assessments

Airway assessments

Bony assessments

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Why are chest x-rays good for primary treatment?
(3)

Because they’re cheaper than other, e.g. CT

They’re done quickly

They’re easily accessible to do

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What does CXR stand for?

Chest x-ray

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What are the 2 categories of the projections of CXR?
(2)

Standard

Non-standard

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What are the standard projections of CXR?
(2)

PA (main projection)

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What are the non-standard projections for CXR?
(2)

Lateral

Oblique

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What CXR view is the gold standard?

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How do we know if an CXR used a PA view?

There’ll be no annotation on the image- annotations are only used when an alternative projection has been used, e.g. AP, supine, etc

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Why is PA used on a CXR?
(4)

The heart is an anterior structure inside the chest cavity, so if AP was used, it’d be close to the detector- so PA reduces the magnification of the heart

It prevents breast tissue compression

Less dose is given to the thyroid gland. The thyroid gland is radio-sensitive, so it protects it

It improves image quality and provides a sharper image

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Is the image sharper when it’s closer or further away from the detector?

Closer

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How do we position a patient for a CXR?
(9)

Patient stood upright

Chest close to the detector

Median saggital plane at right angles to detector (patient is stood straight up)

Shoulders shrugged forwards

Dorsum of hands on the back of the hips

Elbows partially flexed and forwards

Head and neck straight and forward

Breathe in but leave shoulders relaxed

Exposure patient at deepest breath in- remember to tell them to breathe again!

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Why do the shoulders need to be shrugged forwards during a CXR?

To move the scapula out of the way of the lung fields

What is the SID of an adult PA CXR? Why?

180cm To help reduce the magnification of the heart

Is a grid/bucky used in an adult PA CXR?

Yes

Which type of projection does an adult PA CXR use? Why?

Lateral Because it’s not over the heart

What is the detector size of an adult PA CXR? Why?

43cm x 35cm A large detector is needed because the chest is a large body part

What is the centering point for an adult PA CXR?

T7 (the T7 is in line with the bottom of the scapula)

What is the collimation for an adult PA CXR?

From the shoulders to just above the lower costal margins (lower ribs) (shoulders to diaphragm)

Is the focal spot for an adult PA CXR small or large?

Large

What are the exposure factors for an adult PA CXR?

120 kV 1.6 mAs

How does paediatric CXR differ from adult CXR?

Paediatric CXR requires adjustment based on their age and size, using your knowledge and judgement.

How do we know if the exposure of the chest is good?

Can you see the vertebrae all the way through the heart? If you can, the exposure is good

How do we make sure that the patient took a deep enough breath? (2)

Look at the image If you can count about 8-10 ribs in the image, then they took a deep enough breath

Does this CXR have good exposure? Why?

Yes Because we can see the vertebrae through the heart

How can we assess a CXR for good patient position? (3)

We can see the medial ends of the clavicles The scapula is out of the way of the lung fields The vertebra can be seen behind the heart shadow

Fill this in:

What’s wrong with the centering point of this image?

The centering point isn’t at T7

What is the cardiothoracic ratio?

The ratio of the greatest transverse dimension of the hart to the greatest transverse dimension of the chest cavity (how big the heart is in relation to how big the chest is)

What is the normal cardiothoracic ratio?

0.42-0.50

How do we know is the cardiothoracic ratio is normal?

If the heart is less than half of the chest, it’s normal

Why is the cardiothoracic ratio important?

It detects enlargement of the heart. Further cardiac investigation are normally needed for a higher ratio than 0.42-0.50

What a cardiomegaly?

An enlarged heart

Is this a normal heart? Why?

Yes Because the heart is less than half of the chest cavity

Is this a normal heart? Why?

No Because the heart is bigger than 1/2 of the chest cavity

How do we position a patient for a AP CXR? (8)

AP is down when PA is not possible Patient sat upright or supine (lying on their back- put the detector under their trolley) and as straight as possible Median saggital plane at right angles to the detector (straight up) Patient’s back against the detector (put detector behind patient) Scapula as lateral as possible- shrug forwards Chin up Practice a breath in and holding X-ray beam perpendicular (right angles) to the detector

What’s the SID for an erect AP CXR?

180cm

What’s the SID for a supine AP CXR?

100cm

Fill this in:

How do we locate where the mid sternum is?

It’s at T7 but at the front

How can we assess an AP CXR image? (2)

Do the 10 point check Use AP annotation on the image

What is an example of an emergency situation when a CXR has to be done?

Pneumothorax (collapsed lung)- air leaks into the pleural space between the lung and chest wall

What is the pleura?

The lining of the lungs that sits between the ribs and lung field

What happens if air gets into the pleura?

The air pushes the lung downwards (the lung collapses)

What has to happen to get air out of the pleura?

The chest has to be drained to re-inflate the lung

What happens in tension pneumothorax? (4)

After trauma, e.g. the ribs break, there’s a puncture of the pleural space. This can displace the heart and airways. Air enters the pleural cavity with no way to escape, causing the lung to collapse. The heart, blood vessels and airways are displaced

What pathology is this? How do you know?

Tension pneumothorax Because the heart isn’t in the middle of the chest cavity