Interpretation of Normal Chest X-Rays Flashcards
What are important things to remember to fill out in an imaging request form?
- clinical history
- findings
What are the indications for a chest x-ray?
- acute deterioration in SOB
- acute chest pain
- suspected malignancy
- pneumonia
- pleural disease
- peritonitis
- chronic lung disease
- following invasive procedures (to check it was done right)
What are the important things to check when viewing an x-ray?
- right patient (2 point ID: CHI and specific radiological number)
- correct date
- PA/AP
- correct orientation
- exposure
- rotation
What can the radiographer ask the patient to do to improve the view for a PA x-ray?
Ask the patient to raise their arms to rotate the scapula off the thorax
Why can you only comment on the heart with PA chest x-rays?
- heart is an anterior organ so there is less magnification as it is closer to the x-ray plate
- in AP films, the x-rays diverge more
How do you know the x-ray image is well-exposed?
you can see the intervertebral discs
How can you tell there is no rotation in the x-ray image?
look at the spinous process and look at the clavicle, the distance should be equal, assess any asymmetry
What term is used for areas in a radiograph that are too black?
increased translucency
What are reasons for increased translucency in a radiograph?
- air/gas
- loss of tissue density
What term is used for areas in a radiograph that are too white?
opacification
What are reasons for opacification in a radiograph?
- fluid
- increased tissue
What are reasons for areas in a radiograph being really white?
- presence of man-made structure:
- pacemaker
- NG tube
- ETT
- sternal wiring
- prosthetic heart valves
- chest drains
What does ABCDEFGH stand for in the systematic approach to searching a chest x-ray?
A - airway B - breathing C - cardiac D - diaphragm E - external structures and equipment F - fat and soft tissue G - great vessels H - hidden areas
What is a common mistake made when looking at radiographs?
- search satisfaction
- abnormality found and doesn’t look further
- always do systematic search
A- airway
- check if trachea is straight
- look for carina (T4)
Where are you most likely to find abnormality when looking at the lungs on a chest x-ray?
- right bronchus
- more wider and shorter than the left bronchus so more likely to be obstructed
B- breathing
- check expansion of lungs: anterior (curves downwards) 6th rib should cross dome of right hemi-diaphragm
- lung markings, compare zones
What would you find at the level of the horizontal fissure of the right lung in a radiograph? (end of right upper lobe)
- 4th CC
- 5th intercostal space
What type of film would you be able to see the oblique fissure of the right lung in a radiograph ( end of right middle lobe)
lateral film
Where would you find the the end of the right lower lobe of the right lung in a radiograph?
behind the anterior part of the diaphragm
When describing abnormalities on a radiograph related to the lungs, what should you use to describe instead of lobes?
zones (upper/middle/lower)
Lung markings
- opacity increases from top to bottom
- left hilum higher than right
- right diaphragm higher than left
C- cardiac
- measure heart
- should be less than 50% diameter of chest
- 1/3 should be visible right side of sternum
D- diaphragm
- right hemi-diaphragm is one rib higher than left
- look for gastric bubble in left hemi-diaphragm
- look for free air
