Introduction to Respiratory Radiology

Question 1

What does chest X-ray show?

Answer 1

Different x-ray densities on a CXR (chest x-ray)

Question 2

What tone of white does air, fat, soft tissue/muscle, bone and metal come up on a chest x-ray.

Answer 2

Air - Black
Fat - Grey
Soft tissue/muscle - Grey/white
Bone - white
Metal - Bright white

Question 3

What different things can an ultra-sound pick up?

Answer 3

Fluid, soft tissue, air, bone.

Question 4

What do the different things that an ultrasound pick up show up as on the scan and why they show up like that?

Answer 4

Fluid allows passage of sound waves - black

Soft tissue allows passage of sound waves - bright

Air blocks the passage of sound waves - shadow

Bone blocks passage of sound waves - shadow

Question 5

What are the instructions for a standard PA view?

Answer 5

1. the patient stands 2m from the x-ray apparatus, facing the digital cassette. 2. The shoulders are braced forward do that they scapulae do not obstruct the lungs. 3. The radiograph is taken at full inspiration.

Question 6

The x-ray passes from what to what to make what?

Answer 6

The x-ray pass from posterior to anterior producing a PA radiograph.

Question 7

The heart lies where and why is PA views good for this?

Answer 7

The heart lies anteriorly to the thorax, Pa views minimise magnification of the cardiac shadow.

Question 8

How can patients who can’t stand get a x-ray?

Answer 8

They get a AP radiograph which is anterior to posterior

Question 9

Why are AP x-rays inferior to PA views?

Answer 9

The heart shadow is magnified, the scapular overlie and partly obscure the lungs, and it can be diffuclt for the patient to take an adequate inspiration.

Question 10

What else can be used to get a better view of the body?

Answer 10

Lateral view

Question 11

Why are lateral views less used?

Answer 11

Because a CT scan can get a 360 view.

Question 12

What are the 3 checks you must make before analysing a CXR?

Answer 12

Check the patients name and CHI - are you look at the right CXR?

Is there a side marker on the CXR - is the CXR the right way round?

Is it technically adequate? Enough inspiration, rotation and penetration.

Question 13

What can happen if the CXR that is poorly inspired or rotated?

Answer 13

It can simulate pathology when there is none!

Question 14

What are the markers of adequate inspiration and is centred?

Answer 14

For inspiration, at least 6 ribs should be visible.

For centred the medial ends of the clavicles should be equidistant from the spinous process and upper thorax.