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1Fall24 PoA II > Chest XR pt1 Exam1 > Flashcards

Chest XR pt1 Exam1 Flashcards

1
Q

In the U.S., CXR is routinely obtained for hospitalized adults. In other countries, due to cost, providers rely on physical examination. What are the inherent limitations to this?

A
  • Identifying lesions in the mediastinum, interstitium, and in the center of the lung.
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2
Q

What pathologies can be present even with a normal chest x-ray?

A
  • Interstitial, airway, and pulmonary vascular disease can not be recognized with CXR (i.e.: asthmatics).
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3
Q

Overexposure will cause a film to be too _______.

What structures are well seen in these conditions?

What structures can not be seen?

A
  • Dark
  • Bony structures can be well seen (thoracic spine, mediastinal structures, retrocardiac areas)
  • Small nodules and fine lung structures will be difficult to see.
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4
Q

Underexposure will cause a film to be too _______.

What structures are well seen in these conditions?

A
  • Bright/White
  • Small pulmonary blood vessels will appear prominent and may lead you to think that there are generalized infiltrates when none is really present.
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5
Q

How does breast tissue or an overly obese patient affect the X-ray image?

A

Breast tissue and large amounts of fat tissue can absorb X-ray beams which causes underexposure (white) of the tissue in the path.

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6
Q

How are chest X-rays on ambulatory patients routinely done?

A
  • Patient’s chest up and against the firm holder.
  • The X-ray passes from the back and exits in front to the chest.
  • This is called a PA projection (posterior to anterior).
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7
Q

If the patient is lying down, what will be the orientation of the X-ray projection?

A
  • AP Projection (anterior to posterior)
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8
Q

For interpretative purposes, what is the main difference between an AP and PA projection?

A
  • The heart will be magnified (flattened?) on an AP projection.
  • This is because the projection of the heart is farther from the film and the X-ray beam diverges as it goes farther from the X-ray tube.
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9
Q

Why do X-ray techs tell patients to take a deep breath and hold it before they shoot the X-ray?

A
  • Inspiration allows for the spreading of the pulmonary vessels and clearer visualization
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10
Q

What are two reasons why upright film is preferred over supine film?

A
  • Patients can have a greater inspiration.
  • Better visualization of pleural effusion since it will run into the normally deep costophrenic angle.
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11
Q

When standing, most adults can take an inspiration that brings the domes of the hemidiaphragm to which rib number?

A
  • Rib 10
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12
Q

When seated, most adults can take an inspiration that brings the domes of the hemidiaphragm to which rib number?

A
  • Anywhere from Rib 8 to Rib 10
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13
Q

If the lungs are hypoinflated, the radiography will show the diaphragm at which rib?

A
  • Rib 7
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14
Q

When doing a quick scan at a CXR, we start at the area of least importance to most importance. What will this order be?

A
  • Abdomen (first)
  • Thorax
  • Mediastinum
  • Individual Lungs
  • Bilateral Lung (last)
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15
Q

Pattern of how you will scan the abdomen of a CXR?

A
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16
Q

What is the red arrow indicating?
Is this a normal finding on a CXR?

A
  • Gastric bubble
  • This is a normal finding on a CXR

Free air: Instead of the air being contained inside the stomach to the unitlateral side of the diaphgram, air will be displaced bilaterally on both sides of the diaphragm.

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17
Q

Pattern of how you will scan the thorax of a CXR?

A
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18
Q

What are you scanning for when looking at the thorax of a CXR?

A
  • Bony Structures
  • Rib
  • Clavicles
  • Scapula
  • Continuity and Malformation (Fractures)
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19
Q

Which type of rib fracture is harder to detect on a CXR (Posterior or Anterior Ribs)?

A
  • Posterior Rib fractures are harder to detect.
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20
Q

The pattern of how you will scan the mediastinum and heart of a CXR.

A
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21
Q

What three structures in the mediastinum should be centrally located during a routine CXR?

A
  • Heart
  • Sternum
  • Trachea
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22
Q

Generally, the heart should be no larger than _______ of the chest diameter.

A
  • one-third
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23
Q

The pattern of how you will scan each lung on a CXR.

A
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24
Q

What is the systematic approach (detail) for viewing a CXR?

A
  • Bony Fragments/ Framework
  • Soft Tissues
  • Lung Fields and Hila
  • Diaphragm and Pleural Space
  • Mediastinum and Heart
  • Abdomen and Neck
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25
Q

What are bony fragments that can be viewed on a CXR?

A
  • Ribs - start at sternum and trace posteriorly
  • Sternum - look for continuity
  • Spine - best view on lateral image
  • Shoulder girdle - look for displacement
  • Clavicles - look for symmetry
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26
Q

What soft tissues are inspected on a CXR?

A
  • Breast tissue - breast tissue can hide diaphragmatic problems, fluid accumulation, free air
  • Soft Tissue in the supraclavicular area
  • Axillae
  • Tissue along the breast
27
Q

What can be viewed in the Hilum on a CXR?

A
  • Pulmonary arteries
  • Pulmonary veins
28
Q

What is another name for the hilum?

A
  • Lung Root
29
Q

What should be seen in the lungs of a healthy adult’s CXR? What is abnormal?

A
  • Normal Lung markings
  • Linear and fine nodular shadows of pulmonary vessels
  • Abnormalities in the lung field are marked by excessive radiolucency, excessive radiopacity, or opacified areas.
30
Q

What percent of the lung field and hila will be obscured by the tissue?

A
  • 40%
31
Q

What kind of shape should the diaphragm form on a normal CXR?

A
  • Dome-shape
  • Costophrenic angle (red circle)
32
Q

True or False: Normal pleura is not visible in a healthy person’s CXR.

A
  • True
  • You should not be able to see the pleura in a normal CXR.
  • The only time you should see the pleura is when air is trapping between the chest wall or the mediastinum and lungs.
33
Q

On a Posterior-Anterior CXR, the normal right heart and mediastinal border are made up of four structures. Name them from the bottom to the top.

A
  • Inferior Vena Cava (bottom)
  • Right Atrium
  • Ascending Aorta
  • Superior Vena Cava (top)
34
Q

On a Posterior-Anterior CXR, the normal left heart and mediastinal border comprise five structures. Name them from the bottom to the top.

A
  • Left Ventricle (bottom)
  • Left Atrium
  • Pulmonary Artery
  • Aortic Arch
  • Subclavian Artery/Vein (top)
35
Q

What side is the gastric bubble usually on?

A
  • Left side (unilateral) (patients left)
36
Q

What is assessed on the neck for a CXR?

A
  • Soft tissue mass
  • Air trapping (air bronchogram)
37
Q

Can you tell the content of a fluid by looking at a X-ray?

A
  • No
  • You can tell that the substance is a fluid, but not what it is made up of (blood, mucous, pulmonary edema).

similar densities are also difficult to distinguish

38
Q

Describe the appearance of the following on a CXR:

Air
Water
Bone
Tissue

A
  • Air tends to be black
  • Water is solid white
  • Bone is translucent white
  • Tissue is even more solid white than fluid.
39
Q

What factors can result in a poor quality x-ray film or interpretation?

A
  • Poor inspiration (poor visibility/ high diaphragms)
  • Over or under-penetration (can exaggerate important findings)
  • Rotation (obscure CXR view)
  • Forgetting the path of the X-ray beam

.

40
Q

On a properly penetrated posterior-anterior CXR, one can just make out the __________ overlying the image of the heart.

A
  • thoracic vertebrae
41
Q

How will you check if the patient is not rotated on CXR?

A
  • Check proper orientation by noting equal distance from vertebral spines to medial ends of the clavicle
42
Q

How many lobes are there on the right lung?

A
  • 3 lobes on the right lung
43
Q

How many lobes are there on the left lung?

A
  • 2 lobes on the left lung
44
Q

What type of CXR projection/orientation will have extensive lung overlap?

A
  • Posterior-anterior X-ray projection will show the lower lobes extending high over the lung field.
45
Q

How much of the right lung does the RUL occupy?

A
  • one-third
46
Q

Posteriorly, the RUL is adjacent to the first _____ to _____ ribs.

A
  • 3 to 5 ribs
47
Q

Anteriorly, the RUL extends down as far as the _______anterior right rib.

A
  • 4th anterior right rib
48
Q

What is the smallest lobe of the right lung?

What kind of shape does it look like in a lateral CXR?

A
  • The right middle lobe is the smallest lobe
  • Triangular shape with narrowest end near the hilum
49
Q

What is the largest lobe of the right lung?

A
  • RLL
  • RLL is also the most common place pt will develop pneumonia.
  • RLL will also be harder to see in patients with poor inspiration.
50
Q

Posteriorly, the RLL extends as far superiorly as high as the ______ vertebral body and extends inferiorly to the diaphragm.

A
  • 6th thoracic
51
Q

How many fissures separate the lobes of the right lung?

A
  • Two fissures
  • Minor Fissure - separates RUL and RML
  • Major Fissure - separates the RUL/RML from the RLL
52
Q

Which lobe covers most of the anterior portion of the left lung?

A
  • LUL
53
Q

Which lobe covers most of the posterior portion of the left lung?

A
  • LLL
54
Q

What lobe in the lungs is most prone to pneumonia development?

A

RLL

55
Q

What separates the LUL and LLL?

A
  • Major Fissure
56
Q

Label 1

A
  • Aortic Arch
57
Q

Label 2

A
  • Pulmonary Trunk
58
Q

Label 3

A
  • Left atrial appendage
59
Q

Label 4

A
  • Left Ventricle
60
Q

Label 5

A
  • Right Ventricle
61
Q

Label 6

A
  • Superior Vena Cava
62
Q

Label 7

A
  • Right hemidiaphragm
63
Q

Label 8

A
  • Left hemidiaphragm
64
Q

Label 9

A
  • Horizontal fissure

1Fall24 PoA II (34 decks)

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