Chest X Rays Lecture Powerpoint

Question 1

X ray definition

Answer 1

Form of electromagnetic radiation similar to light but has higher energy and can pass thru most objects, passes thru detector (radiograph) on the other side of the patient and an image shows “shadows” formed by objects in the path

Question 2

More dense tissue appears more ___ on x ray, while less dense tissue and air appears more ____

Answer 2

white, black

Question 3

Radiolucent vs radiopaque/radiodense

Answer 3

-The degree to which a structure allows x rays to pass thru producing a more black color determines its radiolucency, while structures that block x rays producing less blackening are defined as radiopaque

Question 4

Things that can affect image quality of an x ray (4)

Answer 4

• thickness of object
• motion artifact (creates blurring)
• scatter (determines contrast to allow differentiation of structures
• distortion (needed area of interest as close to perpendicular to image as possible

Question 5

The further an object is from x ray film, the ____ the magnification which ____ the image

Answer 5

greater, distorts

Question 6

3 primary checklist items to reading an x ray

Answer 6

1) correct patient using identifiers
2) correct date
3) comparison studies

Question 7

RIPE acronym for x rays

Answer 7

Rotation
Inspiration
Projection
Exposure

Question 8

Rotation - x ray film quality

Answer 8

Determined by identifying the medial ends of the clavicles which should be equidistant from the spinous processes

Question 9

Inspiration - x ray film quality

Answer 9

• Determined by counting # of ribs above diaphragm, anterior ends of ribs 5-7 should be visible above diaphragm in the mid clavicular line, if there are more than that it indicates hyperinflation, and if there are fewer then inadequate inspiration
• Expiratory film will only have 3 ribs or so intersect the diaphragm at mid clavicular line

Question 10

Projection - x ray film quality

Answer 10

Most of time going to get a PA (#1 choice) or AP, anatomy that is closest to the radiograph itself appears most true, PA sees the beam penetrate the patient’s back then anterior chest while AP is the opposite, both AP and PA projections are viewed as if looking at the patient face to face

Question 11

Never consider a heart size enlarged on an x ray if looking at a….

Answer 11

…AP view x ray

Question 12

Exposure - x ray film quality

Answer 12

Determined by being able to see left hemidiaphragm visible to the spinous process and vertebrae visible behind the heart

Question 13

Systematic approach to reading a chest film

Answer 13

• Airway
• Breathing
• Cardiac
• Disability
• Exposure

Question 14

Airway (systematic approach to reading a CXR)

Answer 14

• Trachea should be centrally located, pushing of trachea to opposite side indicates pleural effusion and tension pneumothorax, pulling of trachea to same side indicates atelectasis or non tension pneumothorax
• Bronchus carina should be visible
• Hila enlargement is due to different pathologies, bilateral might be sarcoidosis, unilateral might be malignancy

Question 15

Breathing (systematic approach to reading a CXR)

Answer 15

• Lungs, assess zones in each 3rd of lung and look for good lung markings, increased airspace shadowing in an area of the lung suggests pathology (consolidation or malignancy which is more rounded), complete absence of lung markings with a lung field should raise suspicion of pneumothorax
• pleura not normally visible in healthy individuals
• right hemidiaphragm should be elevated above left, costophrenic angles should be sharp

Question 16

Pneumoperitoneum

Answer 16

Evidenced on a CXR with air pocket between diaphragm (other than the gastric bubble) that is a medical emergency

Question 17

Cardiac (systematic approach to reading CXR)

Answer 17

• Cardio thoracic ratio on PA view only, should be <50%
• heart borders should be well defined (silhouette sign if lost, depending on where border is lost can correlate clinically to lobe of lung)
• Aortic knob, loss of definition can be aneurysm, aortopulmonary window can be lost with lymphadenopathy

Question 18

Disability (systematic approach to reading CXR)

Answer 18

-check all bones for fractures, dislocation, sublaxation, lesions, etc.

Question 19

Exposure systematic approach to reading CXR)

Answer 19

• look for soft tissue abnormalities

- Looking for any tubes, lines, or devices

Question 20

Patient history for CXR

Answer 20

-get a good surgical history!!!

Question 21

In an AP film, the heart appears ____ because it is ____ so it falsely _____

Answer 21

larger, more anterior, enlarges

Question 22

PA view vs AP view clavicle and rib orientation

Answer 22

PA view has flatter clavicles and more downturned ribs, AP has angled clavicles and more flat ribs

Question 23

Best film to order to demonstrate axillary ribs

Answer 23

Oblique

Question 24

Use of lateral decubitus in x ray film

Answer 24

Differentiate between fluid or air trapping (pleural effusion vs pneumothorax), fluid shifts with gravity while air does not

Question 25

Posterior vs anterior ribs

Answer 25

Posterior ribs will be more horizontal and attached at the vertebrae while anterior will be angled downward and fade where cartilage present