CxR

Question 1

indications for CxR vs contra-indications

Answer 1

Cough Chest pain Occupational exp Shortness of breath Trauma no absolute contra indications: caution used in cases of pregnancy

Question 2

1) directions for PA radiography 2) from which direction is the x ray approaching?

Answer 2

1) patient erect 2) scapulas retracted (arms rolled anteriorly) 3) deep inspiration required (suboptimal inspiration does not expand lungs on radiograph)

Question 3

in this imaging technique, the heart is further away from the cassette. what are potential problems?

Answer 3

Anterior-Posterior xray heart is further away from the cass. Less efficient inspiratory effort Overshadowing of the scapulae Hemidiaphragms often elevated - Abdominal contents are pushed upward, against the diaphragm

Question 4

Assessment of X ray

Answer 4

1. identify patient
2. gender
3. date and time
4. artefacts (the patient’s clothing, hair, bullets)
5. therapeutic items: Tubes, wires, sutures, pacemakers, shunts, vascular coils

Question 5

tubes, lines, catheters on x ray

Answer 5

1. ET
2. Chest Tube (there’s a high one for pneumothorax and a lot one for pleural effusions)
3. CVP/Hickman line- tip in distal SVC
4. Swan-Ganz chatheter- measures pulmonary wedge pressure
5. NG tube

Question 6

what is being measured in this image?

Answer 6

Swan Ganz catheter measures pulmonary wedge pressure

Question 7

Diagnostic “hidden area” on x ray

Answer 7

A- apices

B- behind the cardiac sillouette

C- carina

D- diaphragms (underneath)

Question 8

Superior Mediastinum and Inferior Mediastinum

Answer 8

1. SM: T1-T4 (angle of louis), line runs between intervertebral discs T4 and T5
2. IM:T4- T12(? maybe ?)

dividing marker is angle of louis/T4

Question 9

superior mediastinum: contents

Answer 9

1. Thymus
2. Great Arteries & Veins associated with the Heart
3. Trachea + Esophagus
4. The Vagus & Phrenic nerves course thru the mediastinum
5. Note that the Pulmonary Trunk & arteries are located completely in the MIDDLE Mediastinum.

Question 10

inferior mediastinum: organization, content

Answer 10

divided into three parts: middle, anterior and posterior (MAP)

anterior Inferior mediastinum: between sternum and pericardium, contains (fat, thymus, areolar tissue “FAT”)

middle mediastinum: contains…

1. HEART
2. Roots of PULM.TRUNK & AORTA
3. PERICARDIUM (encloses & protects the heart)
   
   1. visceral & parietal (fibrous) layers
4. lymphatics
   
   1. drain into 4 groups of LN:
      
      1. Parasternal
      2. Tracheobronchial
      3. Supradiaphragmatic
      4. Post. Mediastinal

Question 11

borders of the heart

Answer 11

superior border: R/L atria

Right Border: Right atria

Inferior Border: Right ventricle

Left border: Left ventricle

Question 12

posterior mediastinum

Answer 12

posterior surface of the pericardium

thoracic vertebrae T5-T12

closed inferiorly by diaphragm

Question 13

lines the inner chest wall; reflects from the parietal layer at the hilum and follows the contour of the lungs.

1. Lateral and lines inner surfaces of the ribs and intercostal spaces
2. lines the thoracic surface of the diaphragm
3. is medial and lines the mediastinum
4. extends into the neck above the 1st. Rib, and covers the apex of the lung

Answer 13

PARIETAL Pleura- lines the inner chest wall; VISCERAL Pleura – reflects from the parietal layer at the hilum and follows the contour of the lungs.

1. COSTAL PARIETAL PLEURA – Lateral and lines inner surfaces of the ribs and intercostal spaces
2. DIAPHRAGMATIC PARIETAL PLEURA – lines the thoracic surface of the diaphragm
3. MEDIASTINAL PARIETAL PLEURA – is medial and lines the mediastinum
4. CERVICAL PARIETAL PLEURA- extends into the neck above the 1st. Rib, and covers the apex of the lung

Question 14

Tendinous part of the diaphragm

muscular part of the diaphragm

Crus

Answer 14

1. T8: IVC
2. T10
   
   1. Esophagus
   2. anterior and posterior vagal trunks
   3. esophageal branches of the Left Gastric Arteries and tributaries of the Left Gastric Vein
3. T12
   
   1. AORTIC HIATUS=‘OPENING’- Rt. & Lt. Crus of the diaphragm:

Question 16

pediatric patient radiograph: how its taken, what to look for, name the “sign”

Answer 16

1. Usually taken supine (AP)
   
   1. Some distortion- mediastinal structures
2. Thymus-(normal)
   
   1. “sail sign’(50% Neonates
   2. Absent: -
      
      1. DiGeorge (chr.22)
      2. Syndrome/Agenesis
   3. Reduced: Severe
      
      1. Stress Atrophy.

Question 17

sail sign

Answer 17

1. On a chest X-ray, sail sign is a radiologic sign that
   
   1. suggests
      
      1. left lower lobe collapse
   2. 50% of neonates show it
   3. children: sail sign could be normal–>reflecting shadow of the thymus.
   4. The thymic sail sign or spinnaker-sail sign is due to elevation of the thymic lobes in the setting of pneumomediastinum.

Question 18

V/Q mismatch

Answer 18

RadioNucleotide: pulmonary scintigraphy

1. Ventilation: Xi122/134
2. Perfusion: TC99MAA (Macro Aggregated Albumin)

Question 19

Mammography

Answer 19

US- adjuvant

MR- very sensitive

CT- new

Question 20

CT

Answer 20

incremental, spiral (helical), MultiSlice

Question 21

the CT “Comprises a…”

Answer 21

Comprises a regular matrix of picture elements (PIXELS) – with a mean x-ray attenuation value for all the tissues contained within the pixel

Scale is established by comparing attenuated values to attenuated values of those in water: HOUNSFIELD Scale

Water is said to have an attenuation = 0 HU

Air typically has HU number of -1000 HU

Fat being -120 -> -100 HU

Soft tissues +20 -> +70HU

Blood +30 to +45HU

Bone +400HU or more

400 BONE > (70-20) ST > (45-30) BLOOD > Fat -100 to -120 > air (-1000)

Question 22

significant structures at T2-T3

Answer 22

origin of the great vessels

Question 23

T2-T3 arteries

Answer 23

1. origin of the great arteries: brachiocephalic a.,
2. left common carotid
3. subclavian artery