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PA 1 (RESP 214) > Module 7 Chest Radiography > Flashcards

Module 7 Chest Radiography Flashcards

Mostly theory; not much on CxR

1
Q

Systemic approach:

What is PPPLBS

A

Person
Position
Penetration
Lines
Bones
Soft Tissue.

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2
Q

Factors to consider on Position

A

PA or AP
Chest visibility
Distance between costophrenic angles and spine

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3
Q

costophrenic angle

A

where the diaphragm meets the ribs

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4
Q

Level of inspiration:

what position would be expected for the diaphragm during inspiration?

A

8-10th ribs posteriorly

5-6 anteriorly

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5
Q

PA view

A

Back to front

(we see the front)

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6
Q

AP view

A

Front to back

(we see the back)

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7
Q

Penetration:

Overexposed vs Underexposed

A

Overexposed = dark

Under = light

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8
Q

Lines + Tubes:

ETT?

A

The endotracheal tube would be:
-Midline
-[3-5cm] above the carina.

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9
Q

Bones: Factors to consider?

A

Intercostal space symmetry and spacing

flattening and wide spaces = COPD

Fractures & deformtities?

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10
Q

Soft tissues

A

Extrathoracic soft tissues
Lungs-trachea, bronchi, parenchyma
Pleura
Diaphragm
Heart, great vessels, and mediastinum
Upper abdomen

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11
Q

Soft tissue:

What does a absence of tissue markings indicate?

A

COPD
Pneumothorax
Pneumonectomy

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12
Q

Soft tissue:

What does a increase in tissue markings in lungs parenchyma (tissue) indicate

A

Fibrosis
edema (alveolar or interstitial)
lung compression

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13
Q

what could lower diapghram problems indicate?

A

Hyperinflation (COPD)
or fluid in pleural space.

Diaphragm is being pushed down

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14
Q

Cardiomegaly = Large heart, what does it indicate?

A

Heart failure

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15
Q

Soft tissue: heart markers

Upper bulge on the left:

A

Superior vena cava and lower right atrium.

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16
Q

What would Respiratory use a CxR

A

-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

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17
Q

Radiopaque

A

High density objects absorb more x-rays and appear white/grey

i.e bone

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18
Q

Radio lucena or radiolucent?

A

Less dense objects absorb less x-rays and appear black

i.e Air

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19
Q

Order of increasing densities and visibility on CxR

A

Gas (air) = black

Fat (adipose) = Dark Grey

Soft tissue (water) = light grey

Bone = White

Metal = bright white/reflective.

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20
Q

standard CxR views

A

PA
Lateral
AP

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21
Q

Special CxR views

A

Oblique
Lateral Decubitus
Apical Lordotic
Expiration film

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22
Q

Special CxRs:

Oblique view

A

5 degree turn for routine lateral
45 degree to help localize abonrmality

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23
Q

Special CxR:

Lateral decubitus

A

Suspect side down

Used to look for effusions

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24
Q

Special CxR:

Apical Lordotic

A

up angled shot

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25
Q

Special CxR:

Exploratory film

A

used to look for Pnemothorax

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26
Q

Why is an exploratory film taken when there is suspicion of a pneumothorax?

A

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.

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27
Q

Difference between PA and AP view?

A

PA = back to front
-chest is against the film

AP = Front to back
-back is against the film
-portable

28
Q

Lateral view purpose

A

To compliment an AP or PA.

-done to localize free air in thoracic or abdominal cavity.
-done also to localize pleural effusions

29
Q

Lateral decubitus purpose

A

Often done to localize fluid and identify effusions.

30
Q

Lung lobes on CxR

A
31
Q

CxR landmarks

A

Clavicles
Trachea
Carina
Right main bronchi (more straight)
Left main bronchi (sharper angle)
Aortic arch
Diaphragm
Ribs (10 on inspiration)

32
Q

PPP LBS

A

Person, position, penetration

Lines, bones, soft tissue

33
Q

PPP ABCDEFGHI

A

Person, position, penetration.

Airway
Bones
Cardiac shadow/costophrenic angles.
Diaphragm
Edges of heart/effusions
Field of lung/fissure
gastric bubble
hila
instruments

34
Q

Why should CxR’s be done a full inspiration, rather than expiration?

A

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)

35
Q

When would exhalation on a CxR be useful?

A

Identifying pneomothorax

36
Q

Penetration: what do we look for?

A

the spinal processes should be visible to T6

we look at exposure (over/under)

37
Q

Overexposed image

A

Very dark (radiolucent)

38
Q

Underexposed image

A

very light (radiopaque)

39
Q

CXR: What would elongation of the heart shadow indicate?

A

COPD

40
Q

CXR: what are common features of asthma?’

keep in mind
Asthma is not usually identified via CXR

A

Hyperinflation
Flattened Hemidiaphragms
Elongated/narrowed heart shadow
Horizontal ribs

41
Q

What would the following CxR potentially indicate?

A

Asthma or COPD

42
Q

CxR: what would some features of COPD be?

Keep in mind
CxR is not a common diagnostic tool used to identify CxRs

A

Lung hyperinflation
Lung fields can appear dark
Flattened hemidiaphragms
Elongated/narrow heart shadow
Blebs/Bullae
Lateral CXR barrel chest with increased AP diameter

43
Q

Atelectasis is described as a loss of air in a portion of lung tissue.

What are 2 typical factors that cause atelectasis?

A

Obstruction (absorption)

Change in transpulmonary distending pressures (compression)

44
Q

What indicators are present on the CxR

More specifically, the lines?

A

Blebs/bullae

45
Q

Most common identifier of COPD on CxR?

A

Elongated heart shadows

Dark lung fields

Wide thorax on AP view (barrel chest)

46
Q

Where is Post-operative atelectasis most common?

A

Post-op in abdonimal/thoracic region.

obesity comorbidity
-Overweight risk factors like heart issues

47
Q

CxR: RUL Atelectasis identifiers

A

Triangular density
Elevated right hilus
Tenting of diaphragm

48
Q

What does the following CxR indicate?

A

RUL atelectasis

49
Q

CxR: What indicator is present at the blue and red arrows?

A

Tenting of the right hemi diaphragm.

I believe there is bullae on the left

50
Q

What does the following CxR indicate?

A

Right middle lobe atelectasis.

There is blurring of right heart boarder (silhouette sign).

Triangular density on the AP view bc of collapse.

51
Q

What does the following CxR indicate?

A

LUL Atelectasis

52
Q

Air bronchograms are normally associated with what?

A

Consolidation.

Normally associated with pneumonia and pulmonary edemas

53
Q

What causes CHF?

A

When the heart fails to maintain adequate FORWARD flow.

54
Q

CxR: Indicators of CHF

A

-Bilateral engorgment of upper lobe vessels
-HAZY APPEARANCES TO CxR
-Kerley B Lines
-Air Bronchograms
-potentially a pleural effusion (in conjunction)
-Cardiomegaly (enlarged heart)

55
Q

What is Cardiomegaly?

A

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.

56
Q

For the following CxR of a Pulmonary Edema, what are the arrows pointing at?

A

Air Bronchograms

57
Q

What does the following CxR indicate?

A

CHF

58
Q

CxR: Kerley B lines

A

Typically at base of the lungs (edges)
Horizontal lines that start a periphery.

59
Q

CxR: Pleural effusion basic indicators

A

Concave meniscus sign
Obscures heart boarder and diaphragm
Blunting of costophrenic angles

Effected area will be uniformly be white

60
Q

What does the following CxR indicate?

A

Pleural effusion

61
Q

What does the following CxR indicate?

hint look at the arrows, whats happening?

A

Pleural effusion

62
Q

CxR: Characteristics of Pneumonia

A

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

63
Q

What does the following CxR indicate?

A

bilateral pneumonia

64
Q

Pneumothorax indicators

A

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)

65
Q

What are the following lines/tubes on the CxR?

A
66
Q

Why is a tension pneumothorax the worst case scenrio?

A

Air can’t escape.

Air pushes the midline causing it to shift.

67
Q

What is a silhouette sign?

A

Loss of normal borders between thoracic structures.

Usually caused by an intrathoracic radiopaque mass that touches the border of the heart or aorta.

PA 1 (RESP 214) (11 decks)

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