Technically Adequate Chest Radiograph

Question 1

Five technical factors to determine if na chest xray is adequate

Answer 1

penetration
inspiration
Rotation
Magnification
Angulation

Question 2

Penetration us adequate if?

Answer 2

You can see the thoracic spine thru the heart -> over penetration
Under penetration:
Left hemidiaphragm not visible en face
Pulmonary markings appear more prominent

Question 3

Adequate inspiration

Answer 3

8-9 posterior ribs above the diaphragm

Question 4

Poor inspiration results in?

Answer 4

Will compress and crowd the lung markings especially at the bases

Question 5

No rotation of the body of the patient if

Answer 5

The position of the medial ends of each clavicle relative to the spinous process is “equidistant”

Question 6

Pitfalls of excessive rotation

Answer 6

Hilum may appear larger on the side rotated
Distorted contours of the heart
Hemidiaphragm appear higher on the side rotated

Question 7

The distance bet the xray and the pt in a portable is….

While on PA chest is…

Answer 7

40 inches and 72 inches respectively

Question 8

Excessive angulation when..

Answer 8

The clavicles project at or above the posterior first ribs on frontal image

Question 9

Difference between anterior and posterior ribs in image

Answer 9

Posterior: more immediately apparent to the eye en face
Each pair of posterior ribs attaches to the thoracic vertebral body
The posterior ribs are oriented more or less horizontally

Anterior:
Difficult to see
Oriented downward toward the feet
Anterior ribs attach to the sternum or each cartilage

Question 10

Angulation

Answer 10

Clavicle normally has an ‘s shape and superimpose on the third or fourth rib

Question 11

Magnification

Answer 11

AP films will magnify the heart slightly

Question 12

Rotation

Answer 12

Spinous process should fall equidistant between the medial ends of the clavicles

Question 13

Inspiration

Answer 13

Should see at least eight to nine posterior ribs

Question 14

Penetration

Answer 14

Should see spine through the heart

Question 15

Why look at lateral chest films?

Answer 15

Determines location of disease
Confirms presence of disease
Sees disease not present en face

Question 16

Five key areas to look for on lateral chest films

Answer 16

Retrosternal clear spaces
Hilar region
Fissures
Thoracic spine
Diaphragm and post costophrenic sulci

Question 17

On lateral the major fissure is located at

Answer 17

From the level if the fifth thoracic vertebrae to a point on the diaphragm a few cm behind sternum

Question 18

Minor fissure on lateral xray

Answer 18

Lies at the level of fourth anterior rib on the right side only horizontally oriented

Question 19

Fissure visible en face

Answer 19

Minor fissure

Question 20

Thickening of a fissure when no other signs of fluid on chest is due to

Answer 20

Fibrosis

Question 21

Small bony spurs along the margins of the vertebral bodies

Answer 21

Osteophytes

Question 22

How to tell the right or left hemidiaphragm on lateral xray?

Answer 22

right: usually visible for its entire length front to back

Left: seen sharply posterior but silhouetted by the heart
Air in stomach or splenic flexure

Question 23

It only takes about ….ml to blunt the posterior costophrenic angle on lateral film but takes …..ml on frontal films ( lateral costophrenic angles)

Answer 23

75 ml

250 to 300 ml

Question 24

3 things to see before interpreting xrays

Answer 24

Is the study technically adequate, is it normal or abnormal, if abnormal what is your strategy for deciding what abnormality it is