Intro to Chest Imaging/Radiology

Question 1

What landmarks should you look for in a CXR?

Answer 1

Trachea
Clavicles
Scapula
LV
Aortic arch
Costophrenic angles
Diaphragm

Question 2

How wide should the aortic arch be?

Answer 2

Width of mediastinum

Question 3

What other terms can be used when trachea is midline?

Answer 3

WNL
Nl
Unremarkable

Question 4

When does tracheal deviation go towards the diseased side?

Answer 4

Atelectasis
Agenesis of lung
Pneumonectomy
Pleural fibrosis

Question 5

When does tracheal deviation go away from the diseased side?

Answer 5

Pneumothorax
Pleural effusion
Large mass/tumor

Question 6

What is included in the other causes of tracheal deviation?

Answer 6

Mediastinal masses
Tracheal masses
Kyphoscoliosis

Question 7

What is an indication of an enlarged aortic arch/knob?

Answer 7

Worrisome for dissection

Question 8

What can a calcified aortic arch/knob indicate?

Answer 8

Can be nl variant in elderly, in young person, worrisome for CAD

Question 9

What should the size of the aortic arch/knob be?

Answer 9

Should be 1/2 the size of lower part of the heart

Question 10

Wide mediastinum

Answer 10

Dissection until proven otherwise

Mass vs. sarcoid vs lymphadenopathy

Question 11

Sinus inversus

Answer 11

All organ placement is reversed

Question 12

Dextrocardium

Answer 12

Position of heart is reversed

Question 13

What is the nl size of the heart

Answer 13

Should be 1/2 the size of the chest

Question 14

When will the costophrenic angle be blunted?

Answer 14

Pleural effusion

Question 15

What should you do if it is hard to determine costophrenic angle for obesity or large breasts?

Answer 15

Check the lateral image

Question 16

What to check for in diaphragms

Answer 16

Are they blunted?
Are they at even heights?
Is one elevated? Why?
Is there free air?

Question 17

What to check for in bony structures

Answer 17

Clavicles elevated?
Scapula out of lung fields?
Any fxs or other bony pathology?

Question 18

Where are scapula on AP view?

Answer 18

Scapula medial border in lung field

Question 19

What to look for in lung markings

Answer 19

Present?
Absent? What’s filling the gap? Black or white?
Extra lines? (Kurley B)
Thickened lines? (Cephalization)

Question 20

Who needs a CXR in the age range of 18-50 yrs?

Answer 20

Cough with fever for several days
SOB
Hx of pneumonia
Hemoptysis
Dyspnea
Trauma
Chest pain
Positive PPD
Smoker

Question 21

Who needs a CXR >50 yo?

Answer 21

Cough with or without fever
SOB
Hx of pneumonia
Hemoptysis
Dyspnea
Trauma
Chest pain
Weakness
Dizziness
Positive PPD
Smoker

Question 22

Other indications for a CXR

Answer 22

Sepsis
Tachycardia
Elevated WBC
Pleuritic pain
Coarse breath sounds and crackles
Wheezing- reactive air dz- usually reversible
Positive egophany
Tactile fremitus
Dull to percussion

Question 23

What does an obscured right heart border indicate?

Answer 23

RML pneumonia

Question 24

What are CXR findings in emphysema?

Answer 24

Flat diaphragm
Inflated lungs
Barrel chest

Question 25

What are indications of CHF on a CXR?

Answer 25

Cephalization | Enlarged heart

Question 26

What will an advanced CHF pt have on a CXR?

Answer 26

Pleural effusions and cardiomegaly

Question 27

What can cardiomyopathy be in a young person?

Answer 27

HCM

Question 28

What can be confused for CHF on a CXR?

Answer 28

Pneumocystis jiroveci pneumonia

Question 29

In rib fxs, who should get a CT instead of a CXR?

Answer 29

Get one with contrast in a >50 yo pt

Question 30

What are CXR findings in a tension pneumo?

Answer 30

Blunting on affected side Tracheal deviation to opposite side Increased haziness on opposite side d/t shift of heart and great vessels

Question 31

What is key to diagnosing pleural effusion?

Answer 31

Position of pt Upright Decubitus

Question 32

When is pleural effusion seen?

Answer 32

Primarily with CHF and/or pneumonia | Also could be trauma, lung cancer, PE

Question 33

Atelectasis

Answer 33

Decrease in lung volume Incomplete expansion of the lung or "collapse" Primary finding on CXR Deviation towards dz Unrealistic expectation of your interpreting this

Question 34

Cavitations

Answer 34

A lucent area in the lung (that may or may not contain air/fluid levlels) is surrounded by walls Necrotic process

Question 35

What are the four types of cavitations, and what do they indicate?

Answer 35

Suppurative: lung abscess Caseous: TB Ischemic: infarction Obstructive: cancer or PCP (pneumocystis pneumonia)

Question 36

What does an abscess look like on a CXR?

Answer 36

Air fluid level with a straight line

Question 37

What does an infarct look like on a CXR?

Answer 37

Wedge shape

Question 38

Projection

Answer 38

Path of the central ray

Question 39

What is a crucial principle in imaging?

Answer 39

Get imaging in 2 positions

Question 40

When do you not need protective gear from shielding?

Answer 40

Within 6 feet away | Make sure to shield your thyroid

Question 41

What are the advantages of u/s?

Answer 41

No radiation Cheaper Good for use in pregnant pts and children

Question 42

What to take into consideration for radiation safety

Answer 42

``` Time Distance Shielding Prior imaging, both recent and/or lifetime Order exams AFTER you examine the pt ```

Question 43

Penetration

Answer 43

Refers to strength of radiation vs the thickness of tissue being imaged

Question 44

How can you tell a good inspiration?

Answer 44

Should see 8 or more ribs | Increased diaphragm with good inspiration: check liver

Question 45

What is black on an X-ray?

Answer 45

Air

Question 46

What is white and gray on an X-ray or CT?

Answer 46

Fluid-white Organs- white or gray Bone and teeth-white Vessels-gray or white

Question 47

What is black on an u/s?

Answer 47

Fluid | Vessels

Question 48

What is gray on an u/s?

Answer 48

Organs/tissues

Question 49

When could vessels be white on an X-ray?

Answer 49

Calcification

Question 50

Left lateral CXR components

Answer 50

Decreases heart magnification Arms above head Standing or sitting upright only

Question 51

What is a cross table lateral position used?

Answer 51

Primarily for extremities when injury is severe, pt unable to move from their current position Cervical spines in children with trauma