Frontal Chest Radiography Interpretation Flashcards
What is the order for tissue absorption of X-ray from least to most
Air or gas Fat Soft tissue Bone or calcium Metal
how does air appear on a radiograph
black
What are the 11 steps to reading a frontal radiograph
- Is it PA or AP?
- Is it over or under exposed??
- Is it satisfactory inspiration
- Is the patient rotated
- Is the heart enlarged?
- SIlhouette signs
- What is the position of the mediastinum
- Can you se the landmarks in the mediastinum
- Are the hilla/fissures normal
- Are the bones normal?
- Remember your clinical reasoning skills
the most standard beam goes from ___ to _____
posterior to anterior
What are 3 disadvantages to AP x-rays
- Mediastinum is magnified
- sometimes difficult for patients to take full inspiration
- Patient position compromised
50 shades of grey is an indication of a
pathology
uniform grey is an indication of
healthy individual
How many ribs do you need to see for it to be adequate inspiratory level
- 9 ribs posteriorly
- 6 ribs anteriorly
What is different between the right and left hemi diaphragm
right side is typically 1-2 ribs higher than left
How do you determine if an xray is rotated
make a vertical line from T1-T5, measure from this line to medial end of the clavicles
When determining rotation if left side is rotated what does this mean
posterior rotation on the left
What might you also see with a posterior leftward rotation
increased heart size
How do you determine appropriate heart size
draw two lines
1. spanning each lateral heart border
2. spanning from each lateral thoracic border
heart line should be <50% of thorax line
When you have a positive silhouette sign you ____ see the silhouette
do not
What are some silhouette signs you look for
arch of aorta
Costocardiac angles
Costophrenic angles
Heart borders
Loss of silhouette gives you positive silhouette sign and from whatever structure is missing you can correlate that to
a pathology in this lobe of the lungs
How do you determine mediastinum shift
draw a horizontal line from one edge of the heart border to one edge of the thorax. The ratio between right and left should be 2:1
how do you determine tracheal shift
- Draw a vertical line down the spinous processes of T1-T5, SP should be midline inside the silhouette of the trachea
a volume increase causes a tracheal or mediastinal shift in which direction
away from the volume increase
What are two mediastinum landmarks
- pulmonary artery
2. general vascularity
where do you see the pulmonary artery
1-2 rib counts below arch of aorta
should be bent
Where do you find the hila
- 1-2 rib counts below the inferior aspect of the arch of the aorta
- same level as pulmonary artery
Where do you find the transverse fissure
at the level of the right hila
What other 2 things should you look at when looking for rib fractures
- shape/contour of the ribs
2. shape/contour of the hemi diaphragms
