Normal Chest X-ray

Question 1

What are the indications for chest x-ray

Answer 1

Acute deterioration in SOB, Acute chest pain, Suspected malignancy, pneumonia, pleural disease, Peritonitis, chronic lung disease and following an invasive procedure (central line or chest drain)

Question 2

What are the basics for every X ray

Answer 2

Ensure you have the corect patient via their CHI or radiological number, correct date of radiograph, PA or AP, are ensure correct orientation, exposure and rotation.

Question 3

What is meant by a PA and AP view

Answer 3

PA (posterior anterior) - Xrays coming from the back. AP - Xrays coming from the front

Question 4

What is the difference of appearance between AP and PA views and what one is more commonly used

Answer 4

In an AP view, because the heart is an anterior structure it will create a bigger heart shadow than a PA view. An AP view is more uncommon and tends to me the more sick patients as they couldn’t stand for a PA.

Question 5

Describe the appearance of an under-exposed and over-exposed X-ray

Answer 5

Under-expose will appear very white and cloudy where as an over-exposed X-ray looks dark and you can’t see much.

Question 6

What is the correct terminology to describe something as too black or too white

Answer 6

Black - Increased translucency (air/loss if tissue density) White - Opacification (fluid/increased tissue)

Question 7

If something is radio opaque what should you think of and do?

Answer 7

Try trace from beginning to end and think of: Pacemakaer, NG tube, sternal wiring, prosthetic heart valve, or chest drain

Question 8

Describe a systematic approach to searching a CXR

Answer 8

ABCDEFGH: Airway, Breathing, Cardiac, Diaphragm, External structures and Equipment, Fat and soft tissue, Great vessels, Hidden areas

Question 9

What should you look for under Airway?

Answer 9

-If trachea is straight & translucent, -Try see carina, -If suspect aspiration then check right bronchus as its more vertical.

Question 10

What should you look for in terms of breathing

Answer 10

As CXR should be taken on full inspiration, check for expansion (anterior 6th rib should cross dome of right hemi-diaphragm), look for over and under expansion.

Question 11

Describe some of the relevant pulmonary anatomy for the lungs

Answer 11

Opacity will increase from top to bottom, the Left hiLum should be higher than the right, and the DiaphRam should be higher on the Right.

Question 12

Describe what you should look for in terms of Cardiac

Answer 12

Size of heart in PA view only, it should be less than 50% of diameter of chest. If enlarged, this could indicate HF. 1/3 should be visible to right of sternum and 2/3rds to the left.

Question 13

Label this diagram

Answer 13

Question 14

When is it can you see the lung lobes and if you can’t then what should u use to describe locations?

Answer 14

Mist likely to see lobes when there is fluid in the fissures, sometimes can see them in normal. Use upper, middle and lower zone if cannot see lobes

Question 15

What should you be looking for when systematically looking at diaphragm?

Answer 15

• Right hemi-diaphragm should be higher, - Identify gastric bubble, - Look for air under diaphragm from a ruptured hollow abdominal viscus

Question 16

What does right and left hemi-diaphragm mena?

Answer 16

It just means the right or the left side of the diaphragm

Question 17

What should you be looking for when systematically looking at external structures and hardware?

Answer 17

Bones - Ribs, thoracic spine, clavicles, scapulae and humeral heads. Medical devices.

Question 18

What should you be looking for when systematically looking at fat and soft tissues

Answer 18

• Look for breast shadows, if only one the mastectomy, - Look for subcutaneous emphysema and pneumomediastinum

Question 19

What is a subcutaneous emphysema?

Answer 19

When air gets into the tissue under the skin, appears as white band on the outer edge of ribs

Question 20

What is a pneumomediastinum?

Answer 20

When air gets between the pericardium and visceral serous membrane of lungs. Appears as shadow around heart

Question 21

What should you be looking for when systematically looking at Great vessels

Answer 21

• Aortic arch, and pulmonary arteries and veins, - Look for calcium deposits

Question 22

What should you be looking for when systematically looking at Hidden areas

Answer 22

-Neck, Apices (apex of lungs), mediastinum, behind heart, costophrenic angel, behind or below diaphragm, soft tissues and bones

Question 23

Finally, what should you alwasy do and think about

Answer 23

ANSWER THE QUESTION YOU ARE TRYING TO FIND OUT FROM THE SCAN