chest x-rays Flashcards
what medium appears black on an x-ray?
air
what medium appears dark grey on an x-ray?
fat
what medium appears light grey on an x-ray?
soft tissue
what medium appears white on an x-ray?
bone/fluid
what medium appears bright white on an x-ray?
metal
what are the uses of x-rays?
- Identify lung pathology e.g. fluid, infection, pneumothorax
- Identify bowel pathology e.g. pneumoperitoneum
- Identify foreign objects
- Confirm placement of lines and tubes
how do you intepret an x-ray?
- Details
- RIPE
- ABCDE
what details do you need to check on an x-ray?
- Check patient ID
- Check date/time of image
- Any previous imaging?
what does RIPE stand for?
- Rotation
- Inspiration
- Projection
- Exposure
what do you look for in rotation?
- Medial aspect of each clavicle in relation to the spinous process – should be equidistant
- Spinous process vertically orientated against vertebral bodies
what do you check for in inspiration?
- 5-6 anterior ribs
* Lung apices, costophrenic angles and lateral rib edges should be visible
how can you tell if an x-ray is AP or PA?
• If the scapula aren’t projected on the film it’s PA
what do you look for in exposure?
- Left hemidiaphragm visible to the spine
* Vertebrae visible behind the heart
what does ABCDE stand for?
- Airways
- Breathing
- Circulation
- Diaphragm
- Everything else
what do you check for with the airways?
- Trachea and bronchi visible – branches at the carina
* Trachea passes down right hand side of aorta
how does an airway get pushed?
increase in volume or pressure on one side (ipsilateral) pushes it towards to the opposite (contralateral) side.
what causes an airway to get pushed to one side?
Mass, Effusion, Tension pneumothorax
how does an airway get pulled?
decrease in volume or pressure on one side (ipsilateral) pulls it towards to the same (ipsilateral) side.
what causes an airway to be pulled?
collapse
how is breathing described?
at zones on radiographs
where should lung markings be visible?
should occupy entire field to thoracic wall
when should pleura and pleural space be visible?
only in abnormality
how should the diaphragm look?
higher on the right
what things do you look for in “everything else”?
- Bones – fractures, lesions
- Tubes – ETT, NGT, CVC
- Artificial valves
- Pacemaker – usually left-sided
- Thoracotomy wires
- Soft tissue – effusion, haematoma, emphysema
what are features of COPD?
- Hyperinflation
- Flattened hemidiaphragms
- Bullae
