Chest X rays

Question 1

How does an x ray work

Answer 1

• X ray machine
• Pass through soft tissues, heart and lungs easily these appear darker on the x ray
• Bones/fluid absobr x rays and appear white

Question 2

what are 5 shades of grey

Answer 2

1. Black = air
2. Dark grey = fat
3. Light grey = soft tissue
4. White = bone and fluid
5. Brihgt white = metal

Question 3

why do we use x rays

Answer 3

• TO IDENTIFY CHEST PATHOLOGY I.E. PNEUMONIA, HEART FAILURE, PNEUMOTHORAX, LUNG LESIONS
• TO IDENTIFY ABDOMINAL PATHOLOGY - PNEUMOPERITONEUM IF SUSPICION OF BOWEL PERF air under the diapragram tells you something is wrong with it
• TO IDENTIFY FOREIGN OBJECTS ?INHALED
• TO CONFIRM PROPER PLACEMENT OF DEVICES AND LINES

Question 4

How do you do image interpretation

Answer 4

Firstly check 
-	Patient detials 
-	Date and time 
-	Any previous imaging 
Then RIPE
R otation 
I nspiration 
P rojection 
E xposure 
-	Clavicle should be equidistatn from spinous process

Question 5

what does RIPE stand for

Answer 5

R otation
I nspiration
P rojection
E xposure

Question 6

what should you see when inspiration happens in an X ray

Answer 6

• Should be able to identify 6 antieor ribs

- Should be able to identlfy 10 posterior ribs visible

Question 7

what are the projections of the x rays

Answer 7

• Normal is PA – x ryas goes in from behind

- AP veiws – bed bound patinets, nelagred hard

Question 8

why do you use PA over AP

Answer 8

• REDUCES MAGNIFICATION OF HEART THEREFORE PREVENTING APPEARANCE OF CARDIOMEGALY
• REDUCES RADIATION DOSE TO RADIATION SENSITIVE ORGANS I.E. THYROID, EYES, BREAST
• MOVES SCAPULA AWAY FROM LUNG FIELD so you can see the lung field clearer
• REDUCES PATIENT MOVEMENT AND STABILISES THE PATIENT – CAN HOLD ONTO THE UNIT IF NEEDS BE, reduces patient movement
• CLEARER IMAGE OF SPINE AND POSTERIOR RIBS

Question 9

what are the 3 ways to check that the view is PA

Answer 9

• Clavicel will be in lung field wherease in AP projected higher than usual
• Scaupla not in lung field whereas in AP it is lung field
• Heart magnification in AP

Question 10

what are the two types of exposure

Answer 10

• Overprentrated - too black

- Underprenentrated - too white

Question 11

what does ABCDE stand for

Answer 11

A – AIRWAY 
B BREATHIGN 
C CIRCULATION 
D DIAPHRGAM 
E EVERYTHING ELSe

Question 12

how do you interpret an airway

Answer 12

ABCDE

Question 13

Describe what part of the airway should be visible in the x ray

Answer 13

• TRACHEA, BRONCHI VISIBLE (BRANCHING AT CARINA)

* TRACHEA PASSES TO RIGHT OF AORTA

Question 14

what is it when the trachea is pushed away

Answer 14

• Due to an increase in volume or pressure in one side of the throax which pushes the treachea away from that side

Question 15

what can cause the trachea to be pushed away

Answer 15

• Mass
• Tension
• Pneumothorax

Question 16

what is it when the trachea is pulled towards the abnormality

Answer 16

• Due to a loss of volume/prssues in one hemithroax which pulls the traceha toward that side

Question 17

what can cause the trachea to move towards the abnormality

Answer 17

• Collapse

- Consodildation

Question 18

describe how breathing is interpreted

Answer 18

• Lungs assesed and described as zones
• zones do not equate to lungs
• Lung makring occupy enxtire zones
• Full of air so should be dark

Question 19

when are pleura spaces visible

Answer 19

• Pleura and plerual spaces only visible when there is an abnorality present
• Lung marking should reach thoracic wall

Question 20

what is the place called where the diaphragm and lung meet and what does it look like when it is abnormal

Answer 20

• costophrenic - blunted when it is abnormal

Question 21

what is the place called where the diaphragm and heart meet and what does it look like when it is abnormal

Answer 21

cardiphrenic angle – blunted when it is abnormal

Question 22

what circulations are made up of

Answer 22

• Aoritc knuckle
• Heart size
• Heart borders – RA – right border and LV – left border

Question 23

what is the aortic knuckle and what does it look like when it is abnormal

Answer 23

• Represents left lateral edge of the aorta – when the arota is benidng down and becoming the descendign aorta
• Loss of definiction due to aneurysm and adjacent cosolidation

Question 24

describe the heart border and size

Answer 24

• CTR = CARDIAC WIDTH : THORACIC WIDTH
• > 50 % CONSIDERED ABNORMAL
• LEFT HEART CONTOUR = LV
• RIGHT HEART BORDER = RA

Question 25

what does the diaphragm look like when it is normal

Answer 25

• RIGHT IS HIGHER THAN LEFT
• WELL DEFINED CARDIO/COSTOPHRENIC ANGLES
• STOMACH UNDERNEATH LEFT
• LOOK ABOVE + BELOW

Question 26

what is everything else

Answer 26

• BONES – FRACTURES, LYTIC LESIONS
• SOFT TISSUE – ?HAEMATOMA
• TUBES – NG
• VALVES – ARTIFICIAL VALVE
• PACEMAKER – BELOW LEFT CLAVICLE
• LINES – ECG