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Advanced Health Assessment > The Chest Xray > Flashcards

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
Q

Define the silhouette effect.

A

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
Q

How does magnification affect the image on an X-ray film?

A

As the patient is moved away from the X-ray film the image on the film is magnified.

27
Q

What is the concept of summation on an X-ray?

A

The larger the tissue, the lighter it looks on an Xray

Ex: diaphragm

28
Q

How does summation change the appearance on an X-ray?

A

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
Q

What is a pleural effusion?

A

Fluid leaking into the pleural space between the lungs and chest wall

30
Q

What is a pulmonary infiltrate?

A

Fluid and cells in the alveoli and interstitial tissue

31
Q

What is pulmonary edema?

A

Fluid in the alveoli and interstitial tissue, continuum of fluid transudate (vascular cuffing, interstitial fluid and alveolar edema)

32
Q

Define atelectasis?

A

Collapsed lung due to failure to expand or reabsorption

33
Q

What is loculation?

A

Formation of numerous small cavities

34
Q

Define consolidation.

A

Solidification into a dense mass

35
Q

How can you tell a patient has CHF by looking at their X-ray?

A

Their heart border is 50% or more of their chest wall diameter

36
Q

What pathology are Kerly’s B-lines associated with?

A

Seen early in pulmonary edema, horizontal stacked lines (look like stretch marks)

37
Q

How do you differentiate pulmonary infiltrate compared to other pathology?

A

It is more generalized and not widespread

38
Q

How can the provider tell the difference between pulmonary edema and an effusion on a chest X-ray?

A

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
Q

What are the ABCDEF of viewing a chest X-ray?

A 
Airway
Bones
Circulation
Diaphragm
Edges
Fields
40
Q

When you are looking at an anterior view of a chest X-ray, what are the most prominent cardiac ventricles?

A

Right atria and left ventricle

41
Q

How can you differentiate the right from the left diaphragm in a chest X-ray?

A

The right runs anterior to posterior while the left hemidiaphragm is a silhouette of the heart

42
Q

What should the provider be assessing when looking at the airway on a chest X-ray?

A

The trachea: midline

The carina: T4-T6

43
Q

If a patient is intubated where should the ETT be located in relation to the carina?

A

3-5cm above the carina

44
Q

What should the provider be assessing when looking at the bones on a chest X-ray?

A

Examine the clavicle, ribs and vertebrae

Inspect the intercostal spaces

45
Q

What should the provider suspect if the intercostal spaces are widened on a chest xray?

A

Widening suggests hyperinflation

46
Q

What should the provider be assessing when looking at the circulation on a chest X-ray?

A

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
Q

What should the provider be assessing when looking at the diaphragm on a chest X-ray?

A

The outline of the diaphragm should be smooth

The right should be higher than the left by about 3cm

48
Q

When does diaphragm elevation occur?

A

When less than 9-10 ribs are visualized, results from atelectasis , abd distention and phrenic nerve damage

49
Q

When does diaphragm depression occur?

A

When 11-12 ribs are visible, results from COPD and Pneumothorax

50
Q

What is suspected if the gastric bubble is unable to be visualized on a chest X-ray?

A

Hiatal hernia

51
Q

What should the provider be assessing when looking at the edges on a chest X-ray?

A

Inspect the lung borders for fluid or air collection

Pay attention to costalphrenic angles

52
Q

What pathology can distort the lung borders?

A

Pneumothorax
Hemothorax
Atelectasis
Pleural effusion

53
Q

What should the provider be assessing when looking at the fields on a chest X-ray?

A

Lungs should be equal density

Should be able to visualize right and left hillier areas and vasculature

54
Q

Where does the horizontal fissure extend?

A

Only on right side from the right hilum to the 6th rib at the axillary line

55
Q

What is indicated if the horizontal fissure is displaced?

A

Pneumothorax

56
Q

What is the most important clinical use of a chest X-ray?

A

The ability to serve as a baseline reference

57
Q

How much can the ETT tube move with flexion or extension?

A

The ETT can travel up 2cm with extension and travel down 2cm with flexion

Advanced Health Assessment (7 decks)

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