20. Intro to Chest X-Rays Flashcards
Briefly describe how X-Rays work.
X-ray machine sends X-rays to chest, dense/hard tissue stops most x-rays, some light lands on photographic plate making a negative picture
What kinds of things make the different shades of grey A-E?
A: black - air
B: dark grey - fat
C: light grey - soft tissues/organs/muscles
D: white - bone/fluid
E: bright white - metal
What are the 8 things to look for during the ‘first look’ at an X-ray?
1. patient details (top/bottom of film)
2. date/time of x-ray
3. Orientation: PA or AP (PA most common, preferred, performed in radiology, AP = mediastinum larger, performed on wards/bedbound)
4. coverage - good = lung apices, costophrenic angles
5. rotation - spinous processes should be straight and lie mid-way between head of clavicles
6. inspiration - can count 7 anterior ribs
7. skill
8. penetration - vertebrae just visible behind heart
Determine whether A and B are PA or AP Xrays and why.
A: AP because scapula lies over lung fields and clavicles are horizontal, ribs more horizontal, heart shadow larger
B: PA because clavicle in lung field, ribs slanted, scapula outwards from lung field, heart shadow smaller
Label 1-10
1: trachea
2: hilum
3. lungs
4. diaphragm
5. heart
6. aortic knuckle
7. Ribs (P and A)
8. scapulae
9. breasts
10. stomach
How do you distinguish posterior and anterior ribs on an Xray?
Posterior = more horizontal and articulate with midline
Are these Xrays rotated?
A is, B isn’t
Spinous processes should be straight and lie mid-way between medial head of clavicles.
With A : clavicles asymmetrical, no clear spinous process in middle
How would you describe the following two Xrays?
A: underpenetrated
B: overpenetrated
What system is used for image interpretation?
Airways, Breathing, Circulation, Diaphragm, Everything else
Label A-E
What part of the X-ray examination is this?
A: R. main bronchus
B: trachea
C: aorta
D: L. main bronchus
E: carina
Airways
What has happened in this Xray?
List possible causes.
Pushed airway
Masses, tension pneumothorax
What has happened in this Xray?
List possible causes.
Pulled airways.
collapse of lobe, loss of lung volume, consolidation, fibrosis
Describe how you would assess the ‘breathing’ part of the Xray examination.
Divide lungs into zones (U/M/L), compare and look for asymmetry e.g. lung fields and hilar. Lungs must fill thoracic cavity and markings must extend to chest wall.
What 3 things must you look for in the ‘circulation’ part of the Xray examination?
1. mediastinum (aortic knuckle, not widened)
2. heart contours (if not clearly seen, may be due to pathology in adjacent lung)
3. cardiothoracic ratio (heart size compared to thoracic cavity) (>50% is considered abnormal - cardiomegaly)
What can you observe here?
Metal wires from cardiothoracic surgery (top arrow)
Valve replacement (bottom arrow)
In aorta- breakdown of epithelial cell wall, get pale lumen, aorta swollen with blood,
Label A, B and C
A: costophrenic recess
B: costophrenic angle
C: cardiophrenic angle
What does this Xray show and what could have caused it?
Blunted costophrenic angle (L and R)
Can be caused by fluid in pleural cavity - pleural effusion
What is this line?
Visceral pleural edge
