Module 7 Chest Radiography Flashcards
Mostly theory; not much on CxR
Systemic approach:
What is PPPLBS
Person
Position
Penetration
Lines
Bones
Soft Tissue.
Factors to consider on Position
PA or AP
Chest visibility
Distance between costophrenic angles and spine
costophrenic angle
where the diaphragm meets the ribs
Level of inspiration:
what position would be expected for the diaphragm during inspiration?
8-10th ribs posteriorly
5-6 anteriorly
PA view
Back to front
(we see the front)
AP view
Front to back
(we see the back)
Penetration:
Overexposed vs Underexposed
Overexposed = dark
Under = light
Lines + Tubes:
ETT?
The endotracheal tube would be:
-Midline
-[3-5cm] above the carina.
Bones: Factors to consider?
Intercostal space symmetry and spacing
flattening and wide spaces = COPD
Fractures & deformtities?
Soft tissues
Extrathoracic soft tissues
Lungs-trachea, bronchi, parenchyma
Pleura
Diaphragm
Heart, great vessels, and mediastinum
Upper abdomen
Soft tissue:
What does a absence of tissue markings indicate?
COPD
Pneumothorax
Pneumonectomy
Soft tissue:
What does a increase in tissue markings in lungs parenchyma (tissue) indicate
Fibrosis
edema (alveolar or interstitial)
lung compression
what could lower diapghram problems indicate?
Hyperinflation (COPD)
or fluid in pleural space.
Diaphragm is being pushed down
Cardiomegaly = Large heart, what does it indicate?
Heart failure
Soft tissue: heart markers
Upper bulge on the left:
Superior vena cava and lower right atrium.
What would Respiratory use a CxR
-Use cxr findings to aid in patient diagnosis
-determine line or tube placement (**ETT)
-view trends in the cxr to understand advancement or resolution of pathology
-aid in the x-ray technician in proper positioning of the patient
Radiopaque
High density objects absorb more x-rays and appear white/grey
i.e bone
Radio lucena or radiolucent?
Less dense objects absorb less x-rays and appear black
i.e Air
Order of increasing densities and visibility on CxR
Gas (air) = black
Fat (adipose) = Dark Grey
Soft tissue (water) = light grey
Bone = White
Metal = bright white/reflective.
standard CxR views
PA
Lateral
AP
Special CxR views
Oblique
Lateral Decubitus
Apical Lordotic
Expiration film
Special CxRs:
Oblique view
5 degree turn for routine lateral
45 degree to help localize abonrmality
Special CxR:
Lateral decubitus
Suspect side down
Used to look for effusions
Special CxR:
Apical Lordotic
up angled shot
Special CxR:
Exploratory film
used to look for Pnemothorax
Why is an exploratory film taken when there is suspicion of a pneumothorax?
Expiratory film accentuates the pneumothorax.
If there is air trapping, it will also be used on expiration because all of the air will be out of the lungs except the area where air is unable to come out.
Difference between PA and AP view?
PA = back to front
-chest is against the film
AP = Front to back
-back is against the film
-portable
Lateral view purpose
To compliment an AP or PA.
-done to localize free air in thoracic or abdominal cavity.
-done also to localize pleural effusions
Lateral decubitus purpose
Often done to localize fluid and identify effusions.
Lung lobes on CxR
CxR landmarks
Clavicles
Trachea
Carina
Right main bronchi (more straight)
Left main bronchi (sharper angle)
Aortic arch
Diaphragm
Ribs (10 on inspiration)
PPP LBS
Person, position, penetration
Lines, bones, soft tissue
PPP ABCDEFGHI
Person, position, penetration.
Airway
Bones
Cardiac shadow/costophrenic angles.
Diaphragm
Edges of heart/effusions
Field of lung/fissure
gastric bubble
hila
instruments
Why should CxR’s be done a full inspiration, rather than expiration?
CxRs done on expiration have the lungs appear more dense. (they’re elevated and heart is falsely enlarged)
On inspiration: (what we want to see)
Hemi-diaphragm should be at the level of the 8-10 ribs posteriorly (5-6 anteriorly)
When would exhalation on a CxR be useful?
Identifying pneomothorax
Penetration: what do we look for?
the spinal processes should be visible to T6
we look at exposure (over/under)
Overexposed image
Very dark (radiolucent)
Underexposed image
very light (radiopaque)
CXR: What would elongation of the heart shadow indicate?
COPD
CXR: what are common features of asthma?’
keep in mind
Asthma is not usually identified via CXR
Hyperinflation
Flattened Hemidiaphragms
Elongated/narrowed heart shadow
Horizontal ribs
What would the following CxR potentially indicate?
Asthma or COPD
CxR: what would some features of COPD be?
Keep in mind
CxR is not a common diagnostic tool used to identify CxRs
Lung hyperinflation
Lung fields can appear dark
Flattened hemidiaphragms
Elongated/narrow heart shadow
Blebs/Bullae
Lateral CXR barrel chest with increased AP diameter
Atelectasis is described as a loss of air in a portion of lung tissue.
What are 2 typical factors that cause atelectasis?
Obstruction (absorption)
Change in transpulmonary distending pressures (compression)
What indicators are present on the CxR
More specifically, the lines?
Blebs/bullae
Most common identifier of COPD on CxR?
Elongated heart shadows
Dark lung fields
Wide thorax on AP view (barrel chest)
Where is Post-operative atelectasis most common?
Post-op in abdonimal/thoracic region.
obesity comorbidity
-Overweight risk factors like heart issues
CxR: RUL Atelectasis identifiers
Triangular density
Elevated right hilus
Tenting of diaphragm
What does the following CxR indicate?
RUL atelectasis
CxR: What indicator is present at the blue and red arrows?
Tenting of the right hemi diaphragm.
I believe there is bullae on the left
What does the following CxR indicate?
Right middle lobe atelectasis.
There is blurring of right heart boarder (silhouette sign).
Triangular density on the AP view bc of collapse.
What does the following CxR indicate?
LUL Atelectasis
Air bronchograms are normally associated with what?
Consolidation.
Normally associated with pneumonia and pulmonary edemas
What causes CHF?
When the heart fails to maintain adequate FORWARD flow.
CxR: Indicators of CHF
-Bilateral engorgment of upper lobe vessels
-HAZY APPEARANCES TO CxR
-Kerley B Lines
-Air Bronchograms
-potentially a pleural effusion (in conjunction)
-Cardiomegaly (enlarged heart)
What is Cardiomegaly?
An enlarged heart on a CxR.
It is a sign of another disease. It is caused by damage to the heart muscles bc of a need for increased pump strength.
For the following CxR of a Pulmonary Edema, what are the arrows pointing at?
Air Bronchograms
What does the following CxR indicate?
CHF
CxR: Kerley B lines
Typically at base of the lungs (edges)
Horizontal lines that start a periphery.
CxR: Pleural effusion basic indicators
Concave meniscus sign
Obscures heart boarder and diaphragm
Blunting of costophrenic angles
Effected area will be uniformly be white
What does the following CxR indicate?
Pleural effusion
What does the following CxR indicate?
hint look at the arrows, whats happening?
Pleural effusion
CxR: Characteristics of Pneumonia
Airspace opacity
Lobar or Diffuse (unilateral or bilateral)
Lobar consolidation
Loss of silhouette normally seen between denser tissue and air filled lung
Interstitial opacities
Air Bronchograms
What does the following CxR indicate?
bilateral pneumonia
Pneumothorax indicators
Hyperlucent with absence of lung markers
Trachea/midline shift
when there is air in the thoracic cavity but outside the lung.
- (air enters via external hole in chest or internal hole in lungs)
What are the following lines/tubes on the CxR?
Why is a tension pneumothorax the worst case scenrio?
Air can’t escape.
Air pushes the midline causing it to shift.
What is a silhouette sign?
Loss of normal borders between thoracic structures.
Usually caused by an intrathoracic radiopaque mass that touches the border of the heart or aorta.
