Radiology Flashcards
What are the indications for CXR?
- Evaluating symptoms (cough, chest pain)
- Evaluating signs (hypoxaemia or pulmonary exam)
- Evaluating lines, tubes and pacemakers
- Evaluating effects of treatment
What systematic approach should be taken when reviewing CXR?
- Patient demographics (Name, age, sex)
- Side marker
- Quality of image (exposure, coverage, symmetry)
- Patient factors (PA, AP, lateral CXR)
What is meant by exposure of an X-ray?
- How much radiation has passed through patient
Compare PA to AP X-rays
- PA: beam passes through patient’s back
- No magnification of heart
- AP: do not use to measure size of heart - heart is maginified
How do we interpret inspiration from a CXR?
- Count number of posterior ribs
- If 8-10 ribs are seen - good inspiratory film
After we assess technical quality of a CXR, what system should we use to interpret it?
- Airways - trachea and bronchi
- Bones - soft tissues too
- Cardiac contour (and mediastinum)
- Diaphragm
- Effusions (pleural and pericardial)
- Fields
- Don’t forget lines, tubes and devices
What should you check the ribs for in a CXR?
- Fractures
- Tumours
- Secondary deposits
- Previous surgery
What do you need to check the heart for on a CXR?
- Right heart border
- Left heart border
- Cardio-thoracic ratio 0.4-0.55
- Assess for cardiomegaly
Which parts of the heart can be seen on CXR?
- Paratracheal stripe
- Aortic arch
- Descending aorta
- Aorto-pulmonary window
- Hilum
- Concave angle
What features of the diaphragm can be seen on CXR?
- Right and left hemi-diaphragm
- Gastric air bubble
How do you check for effusions on CXR?
- Costo-phrenic angles
- Blunting of these angles could suggest pleural effusion or pericardial effusion
What are the lung fields?
- Right lung: upper lobe, middle lobe, lower lobe
- Left lung: upper lobe, lower lobe
What do we need to see on a chest radiograph?
- 1st rib
- Lateral margin of ribs
- Costophrenic angle
What should the rotation of the thorax be like on chest radiography?
- Alignment of spinous process and clavicles
What is a normal lung volume for the inspiratory phase?
- 5th to 7th anterior ribs at MCL
- Problems with incomplete inspiration could be due to cardiomegaly or increased lung markings
- Exaggerated expansion could be due to obstructive airways disease
What is meant by penetration in terms of X ray?
- Degree to which x-rays have passed through body
- Adequate penetration indicated by vertebrae being just visible through heart and visible complete left hemidiaphragm
Define artefact
- External/iatrogenic material which obstructs view
- Clothes e.g. buttons
- Hair
- Surgical/vascular lines
- Pacemaker
What might be seen on a CXR that indicates pneumonia?
- Air space shadowing
- Air bronchograms
- Bulging or thickening of fissures
What might be seen on a CXR that indicates lung cancer?
- Rounded opacity
- +/- pleural effusion
- +/- lymphadenopathy
What might be seen on a CXR that indicates pulmonary oedema?
- Bats wing perihilar shadowing
- Interstitial fluid - lots of peripheral lines
- Pleural effusions
- Upper lobe venous distensuin
What might be seen on a CXR that indicates situs inversus totalis?
- Dextrocardia
- Aortic arch on right
- Stomach on right
What might be seen on a CXR/CT scan that indicates COVID?
- Multifocal peripheral opacities
- Fluffy appearance
- Ground glass density on CT
What might be seen on a CXR/CT that indicates cystic fibrosis?
- Bronchiectasis
- Thickened parallel bronchial walls
- Airway plugging
- +/- venous catherter
What might be seen on a CXR/CT that indicates PE?
- Often normal CXR
- Peripheral opacity due to infarction
- CT: filling defects
- Straightening of interventricular septum
What might be seen on a CXR/CT that indicates pneumomediastinum?
- Streaky linear lucencies parallel to mediastinum
- Gas in neck and axillae
- Boerhaave syndrome: oesophageal tear
What might be seen on a CXR/CT that indicates pleural plaques?
- Usually calcified
- Asbestos exposure
- En-face: holly leaf
- On diaphragm surface
What might be seen on a CXR/CT that indicates mesothelioma?
- Lung encased by rind of tissue
- Associated with asbestos exposure
- Lung becomes frozen
- Presents late
- Difficult to resect
