Interpretation of Chest Radiographs Flashcards
What is the most opaque (white) thing you will see in an x-ray?
metal
What appears large in a pediatric chest c-ray, becomes smaller by age 2 and disappears from imaging by age 8?
thymus
What should you make sure of when you order a chest x-ray?
- make sure you ordered the right test/c-ray
- make sure you have the patient’s x-rays in your hand or on the computer
- make sure that the correct date and time are on your films
- compare to old x-rays when possible
Where can you find the gastric bubble?
on the left side of the plain film (patients left side)
What is the term for the condition with completely mirror positioning of abdominal organs and heart?
situs inversus
The mirrored silhouette of the heart in situs inversus is called what?
dextocardia
What should you remember when looking at chest x-rays?
- Position
- Inspiration
- Penetration
- Rotation
Which view is always the best for chest x-rays?
PA
What type of film will slightly magnify the heart?
AP
What is better if the patient is standing upright as opposed to supine?
chest x-ray
What do you want your patient to do when taking a chest x-ray and how many ribs do you want to see?
inspiration
- want to see at least 8-10 ribs
What does PIPR stand for?
- position
- inspiration
- penetration
- rotation/angulation
What view is preferred unless patient is unable to stand or is acutely ill, in which case another view can be used at bedside?
PA
Which view can be used at bedside?
AP
In which view may there be diminished quality of the CXR since a patient who is supine is less likely to be able to take a full inspiratory breath, reducing the quality of the film?
AP view
What should you not compare when looking for progression of disease, especially cardiac disease/heart size?
AP and PA films
What is this describing:
- taken in standing or sitting position
- scapulae not overlapping lung fields
- clavicle is not foreshortened
- no cardiac magnification
- fundic air bubble seen
PA view
What is this describing:
- taken in supine position
- scapulae overlapping lung fields
- clavicle is foreshortened
- cardiac magnification
- fundic air bubble not seen
AP view
What word describes when an object is shown closer than it really is?
foreshortened
Portable chest x-rays usually give you what type of view?
AP view
How can you assess the quality of inspiration in a chest film?
counting the ribs visible within the lung field
How many ribs do you want to see in the lung field in a chest x-ray?
- 6 anterior
- 8-10 posterior
Ideally, the diaphragm should be intersected by which ribs in the mid-clavicular line?
ribs 5-7
What should be visualized in a well-penetrated chest x-ray?
- vertebrae behind heart
- left hemidiaphragm to edge of spine
What should lie equidistant from the medial aspect of each clavicle?
the spinous processes
If you have a patient that is rotated in chest x-rays, what can happen?
it can obscure important findings within the chest
What happens if a patient is rotated left in a CXR?
heart is exaggerated
What happens if a patient is rotated right in a CXR?
the true size of heart may be underestimated
After PIPR, what do you look at?
ABCDEs
What do the ABCDEs stand for?
- airway
- bones (clavicle, ribs)
- cardiomediastinal silhouette
- diaphragms
- everything else (lung field, soft tissue, tubes, etc)
When looking at the airway in a CXR, what are you looking at?
position of the trachea
What should be at the midline over the thoracic vertebrae and is air-filled?
trachea
What signs should you look for when looking at the trachea in a CXR?
- deviation
- foreign body or ET tube
What should you look for/do when looking at the bony structures in a CXR?
- count ribs
- clavicle placement at 2-3 intercostal space (may be rotated if not)
- evaluate for trauma or fracture of ribs or clavicles if suspected
- find a bone pattern and stick to it (shoulders, scapula, ribs, spine)
When looking at the cardiomediastinal silhouette, what are you comparing?
the size of the diaphragm to size of the heart (cardio-thoracic ratio)
Cardio-thoracic ratio is only looked at in what view?
PA
If the cardio-thoracic ratio is over 50%, what does this mean?
considered abnormal in an adult
What are possible causes of a cardio-thoracic ratio >50%?
- heart failure
- left or right ventricular hypertrophy
What symptoms might a person have with a cardio-thoracic ratio >50%?
- SOB
- fatigue
- edema
When looking at diaphragms in a CXR, which diaphragm is usually slightly higher?
the right diaphragm
What is eventration of the diaphragm mean?
one diaphragm is elevated abnormally
When looking at “expanded lungs,” what should you evaluate?
- hilar region of the lungs
- the lung fields from top to bottom and right to left
When looking at the hilar region of the lungs, what should you look for?
enlarged hilum (TB, lymphoma, cancer, sarcoidosis)
When evaluating lung fields from top to bottom and right to left, what should you look for?
- follow bilaterally top to bottom and compare both sides
- lung parenchyma usually becomes lighter as you go down the lung
- varying shades of grey in lung fields
- look for areas of altered density in areas it would not be suspected
When looking at “everything else,” what should you evaluate?
- soft tissue structures
- tubes, lines, and wires
- presence of any devices, such as pacemaker
What should you follow in evaluating CXRs from beginning to end?
PIPR
- position
- inspiration
- penetration
- rotation
ABCDEs
- airway
- bones
- cardiomediastinal silhouette
- diaphragm
- expanded lungs and everything else
When a PA view is obtained, what other type of view is usually also obtained?
lateral view
What can be helpful in identifying some pneumonias especially and afford a view into the retrocardiac space?
lateral views
When evaluating lateral CXR, what should you do?
- look for abnormalities present in airway/hilar structures
- look for distinct border of left ventricle and normal cardiac position and size
- pay attention to retrosternal and retrocardiac spaces as they should be clear
- evaluate each vertebrae and ribs for abnormalities or trauma
