wirske

Question 1

steps of cxr

Answer 1

Airway: trachea, carina, bronchi and hilar structures

Breathing: lungs and pleura

Cardiac: heart size and borders

Diaphragm: including assessment of costophrenic angles

Everything else: mediastinal contours, bones, soft tissues, tubes, valves, pacemakers and review areas

Question 2

RIPE stands for

Answer 2

rotation –> spinous process in line w vertebral bodies AND clavicle equidistant from spinous process

Inspiration –> 5-6 anterior ribs, lung apices, both costophrenic angles and the lateral rib edges should be visible.

Projection –> AP or PA (if shoulderblades in chest = AP)

Exposure –> vertebrae visible behind heart

Question 3

Answer 3

AP

Question 4

Answer 4

PA

Question 5

Sail sign

Answer 5

L Lower lobe collapse

Question 6

things to say in A of CXR

Answer 6

trachea –> central?
carina + bronchi –> (does NG tube disect carina)
hilar region –> any adenopathy / symmetrical / enlargement?

Question 7

things to say in B of CXR

Answer 7

lung fields
pleura

Question 8

things to say in C of CXR

Answer 8

size - cardiothoracici ratio of less than 0.5
borders - reduction in definition suggests consolidation

Question 9

things to say in D of CXR

Answer 9

free gas
costophrenic angles

Question 10

things to say in E of CXR

Answer 10

aortic knucle / aortopulmonary window
bones
soft tissues
tubes / valves / pacemakers

Question 11

Abdo xray approach

Answer 11

Exposure + projection
B - bowel and other organs
b - bones
c - calcification

Question 12

B(ow) for AXR

Answer 12

small bowel –> valvulae conniventes obstruction = coiled spring appearance
large bowel = haustra
dilated?
sigmoid = coffee bean
caecal = looks like foetus
3/6/9 rule - small / large / caecum
riglers sign = double walled = pneumopertioneum

Question 13

Fx of IBD on AXR

Answer 13

Thumbprinting: mucosal thickening of the haustra due to inflammation and oedema causing them to appear like thumbprints projecting into the lumen (wall of whiter bit looks poked in)

Lead-pipe (featureless) colon: loss of normal haustral markings secondary to chronic colitis

Toxic megacolon: colonic dilatation without obstruction associated with colitis.

Question 14

B(on) Fx of AXR

Answer 14

Ribs
Lumbar vertebrae
Sacrum
Coccyx
Pelvis
Proximal femurs

Sclerotic / lytic lesions!!!
Fractures

Question 15

C Fx on AXR

Answer 15

Calcified gallstones in the right upper quadrant
Renal stones/staghorn calculi
Pancreatic calcification
Vascular calcification
Costochondral calcification
Contrast (e.g. following a barium meal)
Surgical clips
Jewellery

Question 16

for ?NOF fracture imaging

Answer 16

XRAY AP pelvis
XRAP R/L lateral hip

Question 17

confusion imaging clinical details

Answer 17

“to rule out reversible cause”