The Chest Radiograph Flashcards
Describe and be able to recognise the key features of a plain film radiograph of the chest
Trachea, spinous processes, aortic notch, hila, lingula, heart, breast shadows, scapula
What is an x-Ray?
An electromagnetic wave of high energy and very short wavelength absorbed to different degrees
Describe the features of and recognise the following on CXR: pleural effusion, pneumothorax, consolidation, space occupying lesions within the lung, lung or lobar collapse
Pleural effusion - collection of fluid in the pleural space, loss of costaphrenic angle, meniscus
Pneumothorax - air trapped in the pleural space, lung edge >2cm from inner chest wall
Consolidation - filling of small airways/alveoli, dense opacification (more white)
Space occupying lesions - nodule 3cm
Lobar lung collapse - volume loss, sail sign
Identify cardiac enlargement on CXR and estimate the cardiac index
Cardiac index - cardiothoracic ratio must be <50% on PA radiograph
Describe the difference in projection of a CXR
PA (posterior anterior)
AP (anterior posterior) - used for very ill patients in bed, heart looks magnified, scapula in chest
Describe how to determine adequacy of a CXR
Rotation - alignment of spinous processes and clavicles, location of trachea
Inspiration - 1.5cm dome of diaphragm, 5-7 anterior ribs at MCL
Penetration - vertebrae just visible through heart
Artefacts - external/iatrogenic material obstructs view
Explain reasons for mediastinal shift
Push - increased volume/pressure e.g. tension pneumothorax, consolidation, pleural effusion
Pull - decreased volume/pressure e.g. collapse
Explain how to evaluate a chest radiograph
Patient demographics Projection Adequacy (rotation, inspiration, penetration) Airway - trachea, bronchi hila Breathing - lungs, pleural spaces Circulation - mediastinum Diaphragm/Dem bones - free gas, fractures Review areas
