Introduction to radiology Flashcards
Label structures on the CXR
This is a normal CXR
What do you do before you even look at a CXR?
-
Patient Details
(Name, DOB, Medical Record Number) -
Image Details
(Image of What? When was it taken? Why was it taken?)
How do you check the technical quality of the image?
- ROTATION
- INSPIRATION
- PROJECTIO
- EXPOSURE
How do you check rotation in a CXR?
AND
What can make it difficult?
- The medial ends of the clavicles should be equidistant from the spinous process.
- The spinal processes should be aligned vertically.
What can make it difficult?
- This x-ray is significantly rotated and therefore more difficult to interpret.
- Usually when using a portable CXR and patient is in bed
How do you check inspiration on a CXR?
- 5-6 ribs should be visible anteriorly above the diaphragm (10 ribs posteriorly)
How do you check projection in a CXR?
- Describes the direction of the x-ray beam in relation to the patient.
- Anteroposterior (AP) (from anterior to posterior - heart will look larger) or Posteroanterior (PA)
- Standard position is PA
How do you check exposure in CXR?
- This is assessed by looking at the cardiac shadow:
- The vertebral bodies should only just be visible through the cardiac shadow.
- If very visible: over-exposed
- If not visible: under-exposed
How do you check airway on a CXR and what could happen?
- The airway should be central.
- Movement of the airway may be secondary to a PUSH (e.g. effusion) or PULL (e.g. lobe collapse) effect
What is this condition shown on the CXR?
Moves to the right (push pathology as pleural effusion)
How do you check breathing on a CXR?
- The lung fields should be clear.
- Divide the lung fields into 3 zones – looking for comparisons on each side. Look for areas of increased opacity, check for lung markings.
- Pleura should not be visible.
What is this condition on a CXR?
- Consolidation seen in right lung
- At top bubble areas seen as the tissue is less dense hence the appearance
What is this condition on CXR?
How do you check circulation on a CXR?
-
Mediastinum
- Cardiothoracic ratio should be <_0.5_. Anything larger = cardiomegaly. This can only be assessed on an PA film
-
Heart Borders
- Loss of definition of heart borders can help to identify consolidation
What is this condition on CXR?
How do you check the diaphragm on a CXR?
- The Costophrenic Angles (orange) should be clear
- Air SHOULD NOT BE SEEN under the diaphragm (other than the gastric bubble)
Note: It is normal for the R hemi-diaphragm to be higher than the left. Loss of diaphragm can also help to identify consolidation.
What is this condition on a CXR?
What is this condition seen on CXR?
Explain what everything else is in PRO ABCDE?
- Gastric Bubble
- Breast Shadows
- Bones
- Hilar Structures
- Lines/Pacemakers/Tubes/Drains
What is the pneumonic to use to interpret CXR?
- P Patient Details
- R ‘RIPE’ (Rotation, Inspiration, Projection, Exposure)
- O Obvious abnormality
- A Airway (Central? Occluded?)
- B Breathing (Lung Fields)
- C Circulation (Heart Size)
- D Diaphragms (CP angle, pneumoperitoneum)
- E Everything else (gastric bubble, hila, breast, bones)
+ Check regions (behind the heart, lung apices) → as sometimes able to see cancer etc
Interpret this CXR…
Mr Cyril Smith has an x-ray arranged by his GP after presenting with a 6 week history of cough. He has a background of ischaemic heart disease and smokes 20 cigarettes/day for the past 50 years.
Please report his CXR.
Answer:
- Confirm demographics.
- Discuss RIPE.
- Discuss A-E. In B there is a well defined mass in the middle zone of the left lung, adjacent to the mediastinum.
- Highly suspicious of lung cancer.
Interpret this CXR…
A repeat chest x-ray is requested for this 25 year old male who presented with acute breathlessness and left-sided chest pain.
Please report his CXR.
- Confirm demographics.
- Discuss RIPE.
- A - trachea is deviated to the right.
- B – lung markings are not seen extending to the pleura on the left side, indicating there is a pneumothorax on the left side.
- C – heart size appears normal.
- D – diaphragm appears normal.
- E - bones and soft tissues appear normal. A surgical chest drain has been inserted into the left pleural cavity.
- The patient developed a spontaneous pneumothorax and has had a chest drain inserted to allow the lung to re-inflate.
