Chest X Rays

Question 1

What mnemonic is used for assess the image quality of a chest X ray

Answer 1

RIPE
Rotation
Inspiration
Projection
Exposure

Question 2

How do you assess the image quality of a chest X ray?

Answer 2

RIPE
- Rotation: medial aspect of clavicle should be equidistant from spinous processes (which should be vertically orientated)
- Inspiration: posterior ribs 8-10 lung apices, both costophernic angles + lateral rib edges should be visible
- Projection: AP or PA? (If scapulae is not projected within the chest it’s PA)
- Exposure: left hemidiaphragm should be visible to the spine + vertebra should be visible behind the heart

Question 3

What is the ABCDEF approach on a chest X ray?

Answer 3

Airways
Bones
Cardiac contour
Diaphragm
Effusion
Fields

Question 4

Normal position of the trachea on a chest X ray

Answer 4

Centrally or very slightly to the right

Question 5

What could a deviated trachea be due to?

Answer 5

• large pleural effusion or tension pneumothorax if pushed
• lobar collapse if pulled

Question 6

What is a true vs apparent tracheal deviation on a chest X ray?

Answer 6

• True means the trachea is actually deviated
• Apparent is when there is the appearance of deviation due to the rotation of the patient (inspect clavicles to see if rotated)

Question 7

Which main bronchus are inhales forgein objects are more likely to be lodge in and why?

Answer 7

• right
• right main bronchus is wider, shorter + more vertical

Question 8

Normal cardiothoracic ratio

Answer 8

0.4 - 0.55

Question 9

Why should you not draw any conclusion about heart size from a AP film?

Answer 9

AP films exaggerate heart size

Question 10

Reasons for doing a chest X-ray

Answer 10

Evaluating:
- symptoms
- signs
- lines, tube + pacemakers
- effects of treatment

Question 11

What must be seen for the inspiration of a chest x ray to be adequate?

Answer 11

Must be able to count 8-10 posterior ribs
(More horizontal)

Question 12

Differentiate between anterior and posterior ribs on a chest x ray

Answer 12

Posterior are more horizontal
Anterior angled down

Question 13

What is the cardiac contour made from?

Answer 13

The borders of the heart:
Right atrium
Left ventricle

Question 14

What is the lung hilum formed from?
What shape is it?

Answer 14

Superior pulmonary vein
Inferior pulmonary artery
Concave

Question 15

What is the aorto-pulmonary window?

Answer 15

A space between the arch of the aorta + pulmonary arteries

Question 16

What is the paratracheal stripe?

Answer 16

There should be nothing next to the trachea on the right side

Question 17

What is looked for under the diaphragm on a chest x ray?

Answer 17

• Gastric air bubble (normal) under the left hemidiaphragm (location of the stomach)
• the diaphragm should be indistinguishable from the underling liver
• accumulation of free gases (from bowel perforation) under the diaphragm causes it to lift + visibly separate from the liver
• If air is in incorrect place, indicative of pathology

Question 18

What are the fissures of the lungs?

Answer 18

Oblique (both)
Horizontal (right)

Question 19

Why must lung markings be seen until the edge in a chest x ray?

Answer 19

Lost in pleural effusion + pneumothorax

Question 20

What is seen on a chest x ray in a lower lobe collapse?

Answer 20

Obscured hemidiaphragm on affected side

Question 21

What is seen on a chest x ray in a upper lobe collapse?

Answer 21

Both hemidiaphragm seen
Affect lung is more hazy + smaller
Affected side of heart border is gone

e.g. left ULC: left lung smaller +hazy with left heart border gone

Question 22

What is seen on a chest x ray in a right middle lobe consolidation?

Answer 22

• both hemidiaphragms seen
• right heart border obscured

Question 23

What is seen on a chest x ray with military nodules + paraspinal mass?

Answer 23

• multiple small dots
• FINISH CHECK ***

Question 24

What is seen in a chest x ray of a patient with bilateral hilar lymphadenopathy?

Answer 24

Hilar angle is obliterate (not concave)

Question 25

What is seen on a chest x ray of a patient with a pleural effusion?

Answer 25

• blunting of costophernic angle
• dense opacities (higher on lateral sign)
• meniscus sign (concave line)

Question 26

What is the bats wing appearance on a chest x ray?

Answer 26

Bilateral fluffy appearance around hilum
Due to pulmonary oedema
>\???

Question 27

What is seen on a chest x ray in a patient with pneumothorax?

Answer 27

Lung markings don’t go to the edge of the lungs

Question 28

What is the unfolding of the aorta?

Answer 28

Not pathological - age related
Aorta looks larger
Compare with previous x rays to see if the same

Question 29

What makes up the right heart border?

Answer 29

Right atrium

Question 30

What makes up the left heart border?

Answer 30

Left ventricle

Question 31

What is reduced definition of the right heart border typically associated with?

Answer 31

Right middle lobe consolidation

Question 32

Normal position of the right and left hemidiaphragm

Answer 32

The right hemidiaphragm is normally higher than the left due to the presence of the liver

Question 33

How can air accumulate under the diaphragm?

Answer 33

From a bowel perforation

Question 34

What are the costophernic angles formed from?

Answer 34

Dome of each hemidiaphragm + lateral chest wall

Question 35

What is blunting of the costophrenic angles indicative of?

Answer 35

Presence of fluid or consolidation

Question 36

What is dextrocardia?

Answer 36

Heart is positioned on right side of chest instead of left
Aortic arch on right ride instead of left