Respiratory Radiology

Question 1

What are the key features of a PA CXR?

Answer 1

Ribs and scapula.
Bifurcation of the trachea.
Lung hila.
Aortic knuckle.
Costodiaphragmatic recess.

Question 2

How can you differentiate between a male and female chest on a CXR?

Answer 2

Male - pectoralis major muscle.
Female - breast shadow.

Question 3

What can an angiogram of the pulmonary arteries detect?

Answer 3

Pulmonary emboli.

Question 4

How are CTs arranged?

Answer 4

The patient is lying on their back, with their feet coming at the screen towards you.

Question 5

What structures of the lung can be seen with a sagittal CT?

Answer 5

Lobes (upper, middle, lower).
Fissures (oblique, horizontal).

Question 6

What structures of the lung can be seen with a coronal CT?

Answer 6

Spleen.
Pulmonary arteries.

Question 7

What structures of the lung can be seen with a transverse CT?

Answer 7

Descending aorta.
Carina.
Costomediastinal recess.

Question 8

What do you check before viewing a CXR?

Answer 8

Orientation.
Patient details and position.
Date.
View.

Question 9

What is a systemic approach for viewing a CXR?

Answer 9

Name.
Marker.
Rotation.
Penetration.
Lines or metal work.
Heart.
Mediastinum.
Lungs.
Bones.
Diaphragm.
Soft tissues.

Question 10

How do you check for rotation in a CXR?

Answer 10

None if clavicles are equidistant from spinous processes.

Question 11

How do you check for penetration in a CXR?

Answer 11

Good if lower thoracic vertebral bodies are visible.

Question 12

How do you check for lines or metal work in a CXR?

Answer 12

Sternal wires (implies previous thoracic surgery).
NG tube.

Question 13

What details about the heart are important in a CXR?

Answer 13

Occupies <50% of the maximum internal thoracic diameter on a standard PA erect view.
Heart size is magnified in an AP view.

Question 14

What details about the mediastinum are important in a CXR?

Answer 14

Hilar vascular structures should be crisply defined.
No widening; trachea should be central.

Question 15

What details about the lungs are important in a CXR?

Answer 15

Compare upper, middle and lower zones.
Look between ribs and behind the heart for lung detail.

Question 16

What details about the bones are important in a CXR?

Answer 16

Look at each rib in turn (anterior and posterior).
Look at clavicle.
Look at spaculae and humeri (if visible).
Look at the lower cervical and thoracic spine.

Question 17

What details about the diaphragm are important in a CXR?

Answer 17

Both should form a sharp margin with the lateral chest wall.
Both contours should be clearly visible relative to the spine.
A stomach gas bubble may be present.

Question 18

What details about the soft tissues are important in a CXR?

Answer 18

Supraclavicular fossae (enlarged nodes).
Lateral chest wall (surgical emphysema).
Under the diaphragm (pneumoperitoneum).

Question 19

How do you capture an AP CXR?

Answer 19

1. The XR machine in front of the patient.
   The XR cassette is placed behind a seated patient / beneath a supine patient.
   XRs enter the patient from anterior to posterior.

Question 20

How do you capture a PA CXR?

Answer 20

The patient is stood erect.
Shoulders are pressed forward to move scapulae laterally.
The patient takes a deep breath hold while the exposure is taken.