Chest X-Rays Flashcards
What does A-H stand for?
Alignment, Bones, Cardiac, Diaphragm, Expansion and exposure, fields and fissures, gadgets, hidden areas
What do we check for under alignment?
Is there a vertical line through T1-T3? (equal between clavicles) – if not x-ray is rotated
Is the trachea central? Is it black?(air present), or is it clear?
Can you see the carina? (where the left and right bronchi divide)
What do we check for under Bones?
Do they appear white? (due to being more dense than air)
Do they look normal? (density, shape, fractures)
Check the spinal alignment- is there scoliosis?
Check the scapula position – in a frontal xray scapula should be rotated off thorax. There could be a misleading shadow if the scapula overlies a lung.
Are there any foreign bodies?
Is there air around tissues in the thorax? (black lines following tissue). This can mean surgical emphysema.
What do we check for under cardiac?
Heart should be positioned 1/3 to the right and 2/3 to the left.
The heart should take up less than 50% of the chest xray.
Are the borders well defined?
Hilar markings – left should be higher or equal to right, should be smooth and a similar density.
Dextrocardia – rare condition where organs are flipped to opposite side.
What should we check for under diaphragm?
Is it clearly visible and well defined?
Right should sit higher than left due to liver position.
Costophrenic angles should be sharp.
Height and shape: level of 5-7th rib posteriorly and level of 10th rib anteriorly.
Is it over inflated? Can be due to a lack of inspiration or atelectasis.
Is it low and flat? Can be due to hyperinflated lungs or COPD.
What should we check for in expansion and exposure?
Exposure: can you see vertebral bodies at heart level?
Too black means image is overexposed.
Too white means image is underexposed.
Expansion: Anterior 6 ribs should lie above left dome of diaphragm.
Look at rib spacing.
Depends on the patients ability to take adequate inspiration – it will affect xray.
What should we check for in fields and fissures?
Are lung markings visible? Are they evident all over both lungs?
Is the horizontal fissure visible? It separates the right middle and upper lobes, but can be displaced with volume loss.
Kurly b lines – Show fluid in the lungs rather than infection.
What should we check for under gadgets?
Are there any extra attachments? NG tube, tracheostomy, pacemaker, chest drain, staples/wires from surgery.
Are the gadgets where they are meant to be.
What should we check for under hidden areas?
Apices.
Superimposed over the heart.
Around each hilum.
Below domes of diaphragm.
