exam 2 pulmonary radiography Flashcards
What causes black, white, and gray on CXR?
Disposition of xray beam photons, differential absorption result in radiographic images
CXR black color indicates
air
CXR white color indicates
fluid/mass/bone
CXR radio dense
bone, fluid, solid
appears lighter
CXR radio lucent
air, appears darker
term posterior-anterior refers to
direction of xray beam
lateral CXR view- cassette is where
left side of chest is against cassette
lateral CXR better identifies what
lung lesion, pl effusion
which nodule will appear larger on lateral CXR
right sided nodule will appear larger than left sided nodule bc beam direction
farthest away from film
AP CXR
Portable
Beam traverses patient anterior to posterior
Film behind patient
Less sharp
Heart looks bigger: magnifies due to location of beam/film
Film closest to spine/back
Beam shot front to back
Can trick you into thinking pt has HF or cardiomegaly
PA and left lateral CXR
Standard frontal view Upright full inspiration Horizontal beam, 6ft from film Beam traverses patient posterior to anterior Inspiratory film PA and Lateral views Expiratory film Air Trapping
heart ratio to chest on PA CXR
should be half ratio of chest
pleural effusion on cxr
fluid at base of lung
causes lung to push up and that’s where you’ll see the change
pneumothorax cxr
air rises
if you are not sure if fluid is trapped, you would order lateral decubitis film where pt lays on their side to see if fluid will trap up
expiratory film
detects air trapping
partial bronchial obstruction
air in obstructed lung cannot be expelled
how much fluid is required to show on cxr
PA erect- minimal 175 ml
lateral- 75 ml min
decubitis > 5 ml
supine- 100s ml
differential dx for pl effusion
Infections and non infectious causes
Pl effusion can be associated with PNA
Infectious process or malignancy if with one lung
Cardiac sees pl effusion- esp chf
Post ohs- sees one sided pl effusion, think dresslers
oblique views for pl effusion
localize lesions
assess free fluid
fluid will move with position change
vertebral fx
swimmers view xray to assess
Classic presentation = Tight rope right around area just around rib case, like someone is tightening a rope around them
maxillary sinusitis
sinus xray series
Are There Many Lung Lesions
abdomen thoracic cae mediastinum lungs individually compare lungs left and right
right heart border obscured, can indicated what
RML PNA
important to listen in this area
CXR indications
Annually (not anymore)
COPD
Immuno-compromised
Screening (pre op, positive TB reactor, etc)
Diagnostic (pt new to practice c/o coughing and SOB, can be part of dx w/u, treating someone for o/p bronchitis and they are not getting any better)
Follow up acute process, resolution (about 2-3 wk after finishing ATB for PNA, have repeat CXR)
CT w/ contrast indications
Initial diagnostic: be aware of creatinine/renal disease/DM
F/U LAD
CT w/o contrast indications
Q6mo follow nodules 2yr stability
Low dose screening
