Interpretation of a Normal Xray Flashcards
What are some indications for a chest X-ray
- Acute deterioration in SOB
- Acute chest pain
- Suspected malignancy
- Pneumonia
- Pleural disease (mesothelioma)
- Peritonitis (erect for at least 10 mins pre image)
- Chronic lung disease
- Following invasive procedure e.g. central line, chest drain
what are the two types of chest X-ray
PA AND AP
are they supine or erect
what are the three stages of penetration
underexposed
well-exposed
over-exposed
what’s important when looking at the rotation of an xray
look for asymmetry between trachea and clavicles etc
what does it mean if a structure is too black
Increased translucency
• Air (gas)
• Loss of tissue density
what does it mean if a structure is too white
Opacification
• Fluid
• Increased tissue e.g lymphadenopathy
what if something is EXTREMELY white
Think hardware: pacemaker ETT NG tube Sternal wiring prosthetic heart valves CVP line chest drain
Systematic Approach to Searching a CXR
A Airway B Breathing C Cardiac (heart) D Diaphragm E External Structures & Equipment F Fat & soft tissue G Great vessels H Hidden areas
airway
- Check if trachea is straight • Aim to see carina (T4)
* Right main bronchus is more vertical, wider & shorter than the left main bronchus
Breathing
• Check expansion
• Anterior 6th rib should cross dome
of right hemi-diaphragm • Under-expansion
• Over-expansion
if you can’t see the lobes of the lung what can you use
upper zone
middle zone
lower zone
Lung Markings
- Opacity will increase from top to bottom
* Diminution of lung markings as you move out
cardiac
- Measure the heart
- Should be <50% diameter of the chest
- 1/3 should be visible to the right of the sternum (2/3 to the left)
Diaphragm
- Right hemi-diaphragm is usually one rib higher than the left
- Identify the gastric bubble
- Look below the right (and the left) hemi-diaphragm for air from a ruptured hollow abdominal viscus
external structures, including hardware
Bones • Ribs, thoracic spine, clavicles, scapulae & humeral heads Medical devices • Oxygen tubing • Pacemakers / heart valves / sternotomy wires • Chest drains • NG tubes
