Normal Chest X-Ray Flashcards
Describe the PA erect radiograph
X-rays travel from the posterior of the patient to the film, which is held against the front of the patient.
The scapula can be rotated out the way, and accurate assessment of the cardiac size is possible.
The radiograph is performed in the erect position because:
Gas passes upwards, making the detection of pneumothorax easier
Fluid passes downwards, making the detection of pleural effusion earlier
Blood vessels in mediastinum and lung are presented accurately.
Describe the lateral radiograph
Lateral views help to localise lesions in PA views, but also give a good idea of the mediastinum and thoracic vertebrae. Valuable information can be obtained by comparison with older films, if available. In women of reproductive age, radiography should be performed within 28 days of last menstruation.
What clinical data must you always report
Patient’s Name
Age and Sex
Clinical problem
Date of radiography
How do dense tissues and soft tissues appear on X-Ray
- Dense tissues absorb X-rays and appear white on the film, i.e. radio-opaque
- Soft tissues and air absorb some or no X-rays and appear grey (tissues) or black (air), i.e. radiolucent
How do bone, blood, fat and air appear on X-ray
Bone (white)
Blood (gray)
Fat (darker gray)
Air (black)
What is the key difference between PA and AP
AP- heart and mediastinum magnified (closer to X-ray tube)
PA- heart, smaller
Can’t fairly comment own heart size in AP- will always appear magnified so you can’t tell whether this is pathological or not
Describe how you can assess the penetration of the X-Ray
With good penetration of X-Rays, you should just be able to see the spinous processes of the vertebral bodies through the cardiac shadow.
In over penetration, the lung fields appear too black (will lose resolution)
Conversely, in under-penetration, the lung fields appear too white (won’t see spinous processes, vessels will also be more prominent)
Describe the importance of assessing inspiratory effort
With adequate inspiration, you should be able to count 6/7 ribs anterior to the diaphragm. Make sure that the whole lung field is included
Describe assessment of rotation
Patient should be face on to the beam
To assess rotation, comment on the medial end of the clavicle to the midline (spinous processes)- trachea can be deviated- so. to reliable.
Label the parts of the airways
- Trachea
- Right Bronchus
- Left Bronchus
- Right lung
- Left Lung
- Air in stomach
Label the soft tissue structures
- Aortic Arch
- Descending Aorta
- Left Ventricle
- Right Atrium
- Diaphragm
- Breasts
- Hilum
- Pulmonary vessels- branch from hilum
RA- right heart border
LV- left heart border
Label the bony structures
- Clavicle
- Scapula
- Spine
- Ribs (down and round in PA)
Label the angles and borders that should be seen on the C-XR
- Costophrenic angle (if blunted or obtuse- sign of pleural effusion)
- Cardiophrenic angle
- Right Heart Border
- Left heart border
The costophrenic angles are formed by the points at which the chest wall and diaphragm meet. The costophrenic recesses contain the lower edges of the lungs which contact the diaphragm.
The cardiophrenic angle is the angle between the heart and the diaphragm, as seen on imaging.
What should you comment on in all Chest X-Rays
Rotation
• Inspiration • Penetration
Airway • Breathing • Cardiac/Circulation • Diaphragm • Extra/Everything else
Give an example summary
“This is a PA erect chest radiograph of
a female patient. The patient is not rotated. A good inspiratory effort has
been made. The film is adequately penetrated.
The trachea is not deviated. The lungs and pleural spaces are clear. The heart is not enlarged. There is no free air under the diaphragm. The bones are unremarkable.
In summary, this is a normal chest radiograph.”
