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
What is one thing that causes a volume decrease int he lungs
collapse/atelectasis
What are 4 things that cause a volume increase in the lungs
- consolidation
- pleural effusion
- pneumothorax
- COPD
What is a lung collapse
when air enters the pleural space
What is a total lung collapse called
a pneumothorax
What is atelectasis
start of collapse/partial collapse
Condition where the alveoli are deflated down to little or no volume
What are some general features on a radiograph of a lung collapse/atelectasis
- Shift of landmarks: fissures, mediastinum, trachea, & diaphragm towards volume decrease
- Elevation of hemi diaphragm
- Decrease in spacing between the ribs and/or rib count
- Silhouette signs
Why may a lobar collapse appear white
- Affected lung tissue occupies a smaller volume
- It has no air in it
- Mucus secretions back up and collect in alveoli
What is consolidation
any pathological process which fills the alveolar
How do consolidated areas of lung appear
as areas of opacification which may conform to the outline of the lobe or segment
What is pleural effusion
fluid in the pleural space
how do pleural effusions appear? (large and small)
- Small: a blunted costophrenic angle
- Larger: increased opacification up the chest wall and there may be a mediastinal shift to the opposite side
What are the general features of consolidation/pleural effusion on a radiograph
- opacification
- often a variable amount of atelectasis with consolidation
- Silhouette signs
- Shift away from volume increase
- Small PE: blunting of costophrenic angle
What is a pneumothorax
total lung collapse
What is a hemothorax
blood gathering in pleural space
What is a tension pneumothorax
results from a wound in the chest wall, which allows air to enter the pleural cavity, but prevents its escapse
What is a spontaneous pneumothorax
spontaneous rupture of the lung occurs internally with no external trauma
What are 3 causes of pneumothorax
- trauma
- lung disease
- mechanical ventilation
What are 3 signs and symptoms of pneumothorax
- Chest pain
- SOB
- Respiratory distress
What are the general features of a pneumothorax on a radiograph
- Air in the pleural space will cause a dark area, usually begins at apex
- Absence of lung marking
- A fine line indicating the outline of the collapsed lung is usually seen
What is emphysema + it’s signs on a radiograph
- The lungs are hyperinflated with the ribs more horizontal and flattened diaphragms
- Hyperlucency of the lung fields with the development of bullae and loss of vascular marking
- The heart is more pear shaped as it rests on lower, flattened diaphragm
What is chronic bronchitis and what are the physiological changes seen with it
- Over inflation
- Thickened bronchial walls
- Decreased width of pulmonary vessels
