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Radiograph Flashcards

1
Q

Another name for radiograph

A

Roentgenogram (named after the man who discovered it)

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2
Q

Do you want an x-ray done on inspiration or expiration

A

inspiration

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3
Q

X-ray Technique

A

The x-ray will pass through the body to hit the film behind it and produce a black image The further away the heart the larger it will appear

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4
Q

Standard Views

A

Posterior Anterior (PA) Lateral Anterior Posterior (AP)

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5
Q

Postier Anterior (AP)

A

Done in a standing position The anterior chest will be placed against the chest Should should be rotated downwards to move scapula from lung field Smaller heart shadow Preferred type of x-ray

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6
Q

Lateral X-Ray

A

Often done to complement AP and PA x-ray Film placed on pt side If no side is preferred than film will be placed on the left side to minimize magnification of heart Done to localize free air in thoracic or abdominal cavity or to localize plural effusion

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7
Q

Anterior Posterior (AP)

A

Portable machine for bed ridden pt Film place at pt back The heart is magnified because of the anterior position of the heart

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8
Q

Special X-ray Views

A

Oblique Decubitus Apical Lordotic Expiratory Film

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9
Q

Oblique View

A

Slight rotation of the body Used for very specific localized abnormalities A routine oblique x-ray will have a 5 degree turn laterally May be 45 degree in order to help localize an abnormality

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10
Q

Decubitus

A

Often called lateral decubitus Used for pleural effusions with the suspected side down as fluid is gravity dependant allowing it to pool and for us to see the depth (how severe) When the patient is laying on their right it is considered to be a right lateral decubitus The pt is lying on their side and the film is on the anterior chest and the x-ray will go though aosterior to anterior

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11
Q

Apical Lordotic

A

Up angle shot Will show area of the lung apices that are normally obstructed in an PA/AP view May be used in cases of tuberculosis

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12
Q

Expiratory Film

A

Pneumothorax

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13
Q

Density

A

The denser the object the fewer the x-ray that will pass through which is why dense objects will appear as white or grey

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14
Q

Radiopaque

A

High density objects such as bone will absorb more x-rays and appear white

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15
Q

Radiolucent

A

Low density objects such as air that will absorb less x-rays and appear black

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16
Q

The Four Different Densities

A
  1. Gas/Air-Darkest 2. Fat (adipose) 3. Soft Tissue or water –Will look grey or white 4. Bone or Metal-Brightest
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17
Q

Subcutaneous Emphysema

A

Black streaks/cloudy (air)

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18
Q

Tumors

A

Clumps of white shadows

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19
Q

PPPLBS

A

Person Position Penetration Lines Bones Soft Tissues

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20
Q

Person

A

Check to make sure it is the right person

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21
Q

Position

A

Is it PA or AP Is what we need to be see visible The vertebral column should be between the medial ends of the clavicles The distance between the costa-phrenic angles and the spine should be equal on both sides

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22
Q

Penetration

A

What is the strength of the x-ray The spinal processes should be visible up to T6 Too Dark=Overexposure Too Light= Underexposure

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23
Q

Lines

A

Lines or tubes in the patient

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24
Q

Soft Tissues

A

Lungs-Trachea, Bronchi, and Parenchyma Heart, Great Vessels, and Mediastinum Upper Abdomen Lower Neck Pleura

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25
Level of Inspiration
If the film was done on a full inspiration the semi-diphram should be at level of the 8-10th ribs posteriorly and 5-6 anteriorly If an x-ray is done on expiration then the lungs will appear more dense and the hemi-diaphrams will be elevated and the heart is false enlarged
26
Assessing Artificial Airway Position
End of Endotracheal Tube (ETT) should be 3-5 cm above the carina in an adult Relative to the carina the endotracheal tube placement will following the chin so if you flex you chin the ETT will be closer to the carina We want the endotracheal tube just above the carina to get good ventilation
27
COPD
The intercostal spaces may be increased and far apart due to hyperinflation May be absence of tissue markings X-ray not used to diagnose! In some patient’s (more severe): • Lung hyperinflation • Flattened hemidiaphragms • A small heart, longer or narrower • And possible bullous changes. On the lateral radiograph, a "barrel chest" with widened anterior-posterior diameter may be visualized.
28
Bony Thorax
The intercostal space should be symmetrical and equal Check for any fractures or deformities
29
Extra-Thoracic Soft Tissues
In women you will be able to see the breast shadow After a tracheostomy you need to inspect these areas for accumulation of air especially when the patient is ventilated Obesity and over-muscularization can be mistaken for increased densities
30
Trachea
Will appear as a translucent band that overlies the vertebral column in the midline The carina (bifurcation) should be seen
31
Lung Parenchyma
Will help to compare one lung to another Normally all tissue markings should be seen throughout the lung fields
32
Pneumothorax
Absence of tissue markings Air in the thoracic cavity but outside the lung Increased lucency with the absence of lung markings A tension pneumo is large enough to displace the mediastinum
33
Recent Pneumonectomy
Absence of tissue markings
34
Fibrosis
Increase amount of tissue markings
35
Edema (Alveolar or Interstitial)
Increase amount of tissue markings
36
Lung Compression
Increase amount of tissue markings
37
Hilum
The left hilarious region is located 2 cm higher than the right Vertical displacement of the hilum may indicate a volume loss from the upper lobes of the affected side An increased density of the hilar region can be caused by engorgement of the hilar vessels resulting from an increase in pulmonary resistance (PVR) Large lymph nodes will be located in the hilar region can become enlarged in response to conditions such as histoplasmosis and tuberculosis
38
Pleura
The border of the lungs should be examined for any accumulating fluid or air, lesions, and the thickening of the pleura
39
Pulmonary Effusion
Blunting of costophrenic angles Diaphragm may appear lower
40
Diaphragm
2 hemidiaphragms should be visible with the right 2 cm above the left due to the placement of the liver The diaphragm appear lower then expected in SOPD or fluid collecting in the pleural space Elevation of a hemidiaphragm may be caused by the collapse of the right middle lobe or lower lobe on the affected side
41
Costophrenic Angles
The costophrenic angles should be clear The costophrenic angles should be examined for any blunting as this is a sign that fluid has accumulated
42
Gastric Bubble
Seen under the left hemi diaphragm
43
Heart
The width of the heart shadow to the thorax is \<1/2 (50%) on a standard PA shot of the chest AP view may have slightly enlarged heart but still should exceed 50% Two bulges should be located on the right cardiac border The upper bulge is the superior vena cava The lower bulge is the inferior vena cava Three structure should be located on the left cardiac border (from top to bottom) o Aorta o Main pulmonary artery o Left ventricle
44
Mediastinum
Located in the middle of the thorax as an area of high density Contains all the viscera except the lungs o Trachea o Carina o Heart o Aortic Arch o Superior Vena Cava
45
Other Thoracic Imaging Techniques
CT Chest MRI Chest Angiogram Fluoroscopy Bronchogram Sonography Transillumination: Neonatal
46
Fluoroscopy Bronchogram
Uses an x-ray or CT in addition with a contrast medium (radio-isotope) to focus in on a specific area
47
Sonography
Ultrasound technology using high frequency sound waves which reflect back to the monitor to transcribe an image
48
Transillumination: Neonatal
Utilizes a light source to either inspect for a pneumothorax or to view a peripheral artery for cannulation Presence of a halo indicates a pneumothorax
49
Asthma Clinical Presentation
Paroxysmal respiratory distress Recurrent cough Wheezing Tightness in the chest Hyperinflation
50
Asthma Diagnosis
Evaluation for reversibility of airflow obstruction and bronchial hyperresponsivenss Mainly will involve the medium size and small bronchi Will not be dependant upon a chest radiograph (may appear normal in 75% of patients with asthma) Chest radiography is not routinely recommended because it has been shown to alter the care of patients with an uncomplicated asthma exacerbation
51
RUL Atelectasis
Triangular density Elevated right hilus “Tenting” of diaphragm Obliteration of the retrosternal clear space (arrow)
52
RML Atelectasis
]Blurring of the right heart border (silhouette sign) Triangular density on the lateral view as a result of collapse of the middle lobe
53
CHF
CHF is a common abnormality evaluated by CXR. Will occur when the heart is no longer able to maintain adequate flow May progress to pulmonary venous hypertension and pulmonary edema where fluid will leak into the interstitum, alveoli, and pleural space Earliest finding is cardiomegaly which is detected through an increase to the cardiothoacic ration (\>50%)
54
Pleural Effusion
A uniformly white area, Concave meniscus heart borders, costophrenic angles and hemidiaphragm will become obscured
55
Pneumonia
Airspace opacity Lobar consolidation Interstitial opacities Loss of silhouette normally seen between denser tissue and air filled lung
56
PA View Normal Chest X-ray
57
AP View
58
COPD
59
Pleural Effusion
60
Pneumonia
61
Flail Chest
62
Pneumothorax
63
Pleural Effusion
64
COPD
65
COPD
66
COPD
67
CHF
68
Cardiomegaly CHF
69
Lateral X-Ray
70
Lateral Decibutis x-ray
71
Red- Right & Left Upper Lobes Green-Right Middle Lobe Purple-Right & Left Lower Lobes
72
Right Upper Lobe Atelectasis
73
Right Upper Lobe Atelectasis X-ray
* triangular density * elevated right hilus * “Tenting” of diaphragm * obliteration of the retrosternal clear space (arrow)
74
Right Middle Lobe Ateleclasis
75
RML atelectasis
76
RML atelectasis X Ray
* Blurring of the right heart border (silhouette sign) * Triangular density on the lateral view as a result of collapse of the middle lobe
77
RLL Atelectasis
78
RLL Atelectasis X-ray
•abnormal right border collapse with some loculated fluid
79
RLL atelectasis
80
LUL atelectasis
81
LUL atelectasis X-Ray
* Minimal volume loss with elevation of the left diaphragm * Band of increased density in the retrosternal space, which is the collapsed left upper lobe * Also, an abnormal left hilus, i.e. possible obstructing mass
82
LUL Atelectasis
83
COPD X-Ray
* Not used to diagnose! * In some patient’s (more severe): * Lung hyperinflation * Flattened hemidiaphragms * A small heart, longer or narrower * And possible bullous changes. * On the lateral radiograph, a "barrel chest" with widened anterior-posterior diameter may be visualized.
84
CHF X-Ray
* CHF is a common abnormality evaluated by CXR. * CHF occurs when the heart fails to maintain adequate forward flow. * CHF may progress to pulmonary venous hypertension and pulmonary edema with leakage of fluid into the interstitium, alveoli and pleural space
85
Cardiomegaly ## Footnote * The earliest CXR finding of CHF is cardiomegaly * Detected as an increased cardiothoracic ratio (\>50%)
86
Pleural Effusion
* Left lower area uniformly white * Concave meniscus * Left heart border, costophrenic angle and hemidiaphragm are obscured * Slight blunting of R costophrenic angle provides hint of a small R effusion
87
Pneumonia
◦Airspace opacity ◦Lobar consolidation ◦Interstitial opacities •Loss of silhouette normally seen between denser tissue and air filled lung
88
Pneumothorax
* Air in the thoracic cavity but outside the lung * Increased lucency with the absence of lung markings * A tension pneumo is large enough to displace the mediastinum
89
COPD

Patient Assessment (5 decks)

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