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The Chest Xray Flashcards

1
Q

What causes penetration and image formation in an Xray?

A

Force
Magnitude
Density of the Object

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2
Q

What type of wavelength and frequency are X-rays?

A

Short wavelength high frequency

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3
Q

Adjusting what feature allows ticker and more dense tissues to be penetrated?

A

Increasing the force measured in Kilovolts

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4
Q

How is magnitude adjusted in an X-ray?

A

Adjusting the mass or the total number of photons emitted per unit time

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5
Q

What determines a good film when assessing an anterior view?

A

Faintly see vertebral disks through the mediastinum
Vasculature through the heart
Good inspiratory film count 9-10 ribs

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6
Q

What ribs are being seen on an anterior film?

A

Posterior ribs, the anterior ribs are penetrated

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7
Q

What determines a good film when assessing a lateral view?

A

The vertebral bodies get darker moving down the spine
Should see two sets of ribs (L and R)
Be able to see the sternum

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8
Q

Why might a physician purposefully order a film to be over or under exposed?

A

To assess pathology

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9
Q

What are the major factors that contribute to the density of an object?

A

Thickness
Composition
Atomic number
Physical compactness

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10
Q

What factors would cause less penetration on a chest X-ray film?

A

Increased thickness, atomic number and compactness

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11
Q

What factors would cause more penetration on a chest X-ray film?

A

Decreased thickness, anatomic number and compactness

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12
Q

What are the four body tissues that are radiologically distinguishable?

A

Fat
Calcium
Gas
Water

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13
Q

What items will show up white on an X-ray?

A 
Bone
Diaphragm
Surgical wires
Prostetic valves
Jewelry
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14
Q

What items will show up black on an X-ray?

A

Lung
Trachea
Bronchi

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15
Q

What items will show up gray on an X-ray?

A

Blood
Arteries/Veins
Fat

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16
Q

What are the components of the cassette?

A

Film
Fluorescent screen
Grid system

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17
Q

How does exposure affect the film?

A

Greater the radiation exposure the blacker the film

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18
Q

What is the purpose of the fluorescent screen?

A

Concerts the radiation (photon beams) to light photons that actually expose the film

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19
Q

What is the purpose of the grid system?

A

It improves contrast and detail by limiting scatter

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20
Q

How can the provider tell if the grid is improperly centered?

A

There may be whiteness seen outside of the chest wall

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21
Q

What is the best way to get a chest X-ray?

A

Standing PA

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22
Q

Why should the standing PA position be shot from the back?

A

Magnification

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23
Q

What does the vertebral S axis refer to in a standing PA X-ray?

A

The S should be lined up between to the two clavicular heads at the level of T3
Shows symmetry

24
Q

What does the term interface refer to when examining an X-ray?

A

The line of demarcation between tissues of different radiologic density.

25
Define the silhouette effect.
When tissues of similar radiographic density abut each other their interface cannot be visualized (same color on X-ray overlap each other, can't tell borders)
26
How does magnification affect the image on an X-ray film?
As the patient is moved away from the X-ray film the image on the film is magnified.
27
What is the concept of summation on an X-ray?
The larger the tissue, the lighter it looks on an Xray | Ex: diaphragm
28
How does summation change the appearance on an X-ray?
If there are three different shades of gray that overlap each other, the shade of gray creates is a summation of the overlapping tissues
29
What is a pleural effusion?
Fluid leaking into the pleural space between the lungs and chest wall
30
What is a pulmonary infiltrate?
Fluid and cells in the alveoli and interstitial tissue
31
What is pulmonary edema?
Fluid in the alveoli and interstitial tissue, continuum of fluid transudate (vascular cuffing, interstitial fluid and alveolar edema)
32
Define atelectasis?
Collapsed lung due to failure to expand or reabsorption
33
What is loculation?
Formation of numerous small cavities
34
Define consolidation.
Solidification into a dense mass
35
How can you tell a patient has CHF by looking at their X-ray?
Their heart border is 50% or more of their chest wall diameter
36
What pathology are Kerly's B-lines associated with?
Seen early in pulmonary edema, horizontal stacked lines (look like stretch marks)
37
How do you differentiate pulmonary infiltrate compared to other pathology?
It is more generalized and not widespread
38
How can the provider tell the difference between pulmonary edema and an effusion on a chest X-ray?
A pleural effusion is mobile if you compare and AP film to a lateral, the fluid will settle based on gravity Pulmonary edema is fixed
39
What are the ABCDEF of viewing a chest X-ray?
``` Airway Bones Circulation Diaphragm Edges Fields ```
40
When you are looking at an anterior view of a chest X-ray, what are the most prominent cardiac ventricles?
Right atria and left ventricle
41
How can you differentiate the right from the left diaphragm in a chest X-ray?
The right runs anterior to posterior while the left hemidiaphragm is a silhouette of the heart
42
What should the provider be assessing when looking at the airway on a chest X-ray?
The trachea: midline | The carina: T4-T6
43
If a patient is intubated where should the ETT be located in relation to the carina?
3-5cm above the carina
44
What should the provider be assessing when looking at the bones on a chest X-ray?
Examine the clavicle, ribs and vertebrae | Inspect the intercostal spaces
45
What should the provider suspect if the intercostal spaces are widened on a chest xray?
Widening suggests hyperinflation
46
What should the provider be assessing when looking at the circulation on a chest X-ray?
Examine the heart for normal size and shape Compare width of heart to width of thorax Mediastinal borders should be clear and generally well defined
47
What should the provider be assessing when looking at the diaphragm on a chest X-ray?
The outline of the diaphragm should be smooth | The right should be higher than the left by about 3cm
48
When does diaphragm elevation occur?
When less than 9-10 ribs are visualized, results from atelectasis , abd distention and phrenic nerve damage
49
When does diaphragm depression occur?
When 11-12 ribs are visible, results from COPD and Pneumothorax
50
What is suspected if the gastric bubble is unable to be visualized on a chest X-ray?
Hiatal hernia
51
What should the provider be assessing when looking at the edges on a chest X-ray?
Inspect the lung borders for fluid or air collection | Pay attention to costalphrenic angles
52
What pathology can distort the lung borders?
Pneumothorax Hemothorax Atelectasis Pleural effusion
53
What should the provider be assessing when looking at the fields on a chest X-ray?
Lungs should be equal density | Should be able to visualize right and left hillier areas and vasculature
54
Where does the horizontal fissure extend?
Only on right side from the right hilum to the 6th rib at the axillary line
55
What is indicated if the horizontal fissure is displaced?
Pneumothorax
56
What is the most important clinical use of a chest X-ray?
The ability to serve as a baseline reference
57
How much can the ETT tube move with flexion or extension?
The ETT can travel up 2cm with extension and travel down 2cm with flexion

Advanced Health Assessment (7 decks)

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