X-ray

Question 1

Why can’t you assess heart size on an AP film?

Answer 1

Magnifies heart and diaphragm

Question 2

What should be checked when deciding if a CXR film is adequate ?

Answer 2

RIPE

R- rotation - clavicles straight and symmetrical (over lie transverse processes of T4-5)
I - inspiration - count 5-7 anterior ribs
P- position - costophrenic angles -> apex
E- exposure/penetration - ( see vertebral bodies through heart)

I.e. ‘This is a PA X-ray taken on (date) of a 20 year old male called X. X-ray taken in full inspiration, without rotation with good exposure and full position’

Question 3

What should be looked at when assessing a CXR ?

Answer 3

ABCDE approach:

A- airway - trachea deviated
B- breathing - lung fields/zones ‘hilum symmetrical and not bulky, lung zones clear no masses or consolidation’
C- cardiac - shape, position, borders, great vessels
D- diaphragm - costophrenic angles
E- extras: bones, soft tissue, lines, breast shadows

Question 4

In the extras part of ABCDE approach when assessing a chest X-ray, what should be looked for in bones ?

Answer 4

Fractures in clavicles or ribs

Arthritis in vertebrae

Question 5

In what condition would you lose the borders of the heart on a CXR ?

Answer 5

Collapse = silhouette sign

Question 6

End pieces for CXR .

Answer 6

• clinical history
• previous film
• is mass bronchoscopy

Question 7

If a film is unmarked which way should you assume it was taken ?

Answer 7

Postero-anterior (PA)

Question 8

Indications for AXR?

Answer 8

• renal colic (radio opaque stones)
• intestinal obstruction
• perforation of intestine
• intussusception
• detection of swallowed foreign bodies

Question 9

Appearance of small bowel obstruction on AXR ?

Answer 9

• ladder like series of small bowel loops >3cm
• centrally located
• valvulae conniventes (all way through lumen)

Question 10

Appearance of Large bowel obstruction on AXR ?

Answer 10

• peripherally located
• dilatation > 9cm
• characteristic taenia colon and haustra not seen in small bowel