Chest X-Ray Study Guide

Question 1

Chest X-Ray Interpretation

Answer 1

• X-rays-describe radiation which is part of the spectrum which includes visible light, gamma rays, and cosmic radiation.

Question 2

How to adjust patient

Answer 2

• First determine is the film a PA or AP view.

• PA- the x-rays penetrate through the back of the patients on to the film

• AP- the x-rays penetrate through the front of the patient on to the film.

• All x-rays in the PIC are portable and are AP view.

Question 3

• Tracheal Deviation

Pulled to Abnormal Side

Answer 3

Pulmonary atelectasis

Pulmonary fibrosis

Pneumonectomy

Diaphragmatic paralysis

Question 4

Chest X-Ray Interpretation

Pushed to normal Side

Answer 4

Massive pleural effusion

Tension pneumothorax

Neck or thyroid tumors

Large mediastinal mass

Question 5

• Proper artificial airway placement

Answer 5

• The tip of the endotracheal tube should be positioned below the vocal cords and no closer that 1-6 cm above the carina, approximately at the same level of the aortic knob or aortic arch; this will assure bilateral ventilation (clavicle is too high).

Question 6

Patency and size of major airways

Answer 6

The right lung should comprise 55% of the total lung volume and should appear larger than the left lung.

Question 7

Evidence of endotracheal or tracheostomy tube cuff hyperinflation

Answer 7

The cuff should not overextend the end of the endotracheal or tracheostomy tube.

Question 8

• Anatomical Landmarks-chest x-ray

Trachea

Answer 8

Trachea-seen as a dark area midline tracheal shifts to one side would indicate a pathological problem. Should be the same size as the vertebral column.

Major bronchi should not be narrowed at the carina or at the distal end. If narrowing is present, the may indicate bronchogenic.

Question 9

• Anatomical Landmarks-chest x-ray

Mediastinum

Answer 9

• Mediastinum- The area between the lungs where the heart, lymphatics, blood vessels and major bronchi are found. May shift, pleural effusion or pneumothorax. Hilar region

Question 10

• Anatomical Landmarks-chest x-ray

A-P diameter

Answer 10

• A-P diameter- increased with COPD, barrel chest, hyperinflation.

Question 11

• Anatomical Landmarks-chest x-ray

Costophrenic angles

Answer 11

• Costophrenic angles- angle made by the outer curve of the diaphragm and the chest wall. These angles are obliterated by pleural effusions.

Question 12

• Anatomical Landmarks-chest x-ray

• Diaphragm

Answer 12

Dome shaped normally, flattened with COPD. Left or right hemidiaphragms may shift downward with left or right pneumothorax; appearing flattened on one side.

Question 13

• Anatomical Landmarks-chest x-ray

Vascular markings

Answer 13

• Vascular markings- blood vessels, lymphatics, lung tissue

Question 14

• Anatomical Landmarks-chest x-ray

Heart Shadow

Answer 14

left ventricle normally seen cardiomegaly (enlarged heart) is seen with COPD.

Question 15

• Anatomical Landmarks-chest x-ray

Soft tissue

Answer 15

• Soft tissue- tissue surrounding the chest and above in the neck area. Subcutaneous emphysema is when air (hyperlucency) is seen in the surrounding soft tissue.

Question 16

Positions

Answer 16

• AP, anterior, posterior- film behind back, bedridden patients

• PA, posterior, anterior- film touching the chest with back to x-ray

• Lateral position 1. Projection from either the right or left side. 2. Adds a their dimension to structures viewed on AP or PA films.

• Oblique position. 1. Slanting or diagonal view. 2 aid in localizing lesions

Question 17

Positions

Part 2

Answer 17

• Lateral decubitus. 1. Patient lying on the affected side. 2. Valuable for detecting small pleural effusions. Bad lung down

• Apical lordotic. 1. Projection of the lung apices.

Question 18

Normal Chest X-Ray/Radiograph

Answer 18

• Both hemidiaphragms are rounded (dome-shaped)

• The right hemidiaphragm is slightly higher than the left

• The right hemidiaphragm is at the level of the sixth anterior rib

• Trachea is midline, bilateral radiolucency, with sharp costophrenic angles.

Question 19

Position of Tubes and Catheters

Answer 19

• Chest tubes should be located in the pleural space surrounding the lung

• Nasogastric tubes and feeding tubes should be positioned in the stomach and small bowel below the diaphragm.

• Pulmonary artery catheters should appear in the right lower lung field.

• Pacemaker should be normally positioned in the right ventricle

• Central venous catheters are placed in the right or left subclavian or jugular vein and should rest in the vena cava or right atrium of the heart.

Question 20

• Croup

Answer 20

• Croup (laryngotacheobronchitis) is a viral disorder common in infants and young children. It causes subglottic swelling, increased work of breathing, stridor, and a classic seal bark cough. The x-ray of the neck will reveal tracheal narrowing in a classic pattern called a steeple sign. Visualization of the neck is not generally required.

Question 21

• Epiglottitis

Answer 21

• Epiglottitis is a potentially life-threatening inflammation of the supraglottic airway caused by a bacterial infection. When epiglottitis is suspected, visualization of the airway should be avoided. The definitive diagnosis can be obtained from a lateral neck x-ray that shows supraglottic narrowing with an enlarged and flattened epiglottis and swollen epiglottic folds. The presentation is known as the thumb sign.

Question 22

Radiolucent

Answer 22

Describ dark pattern, air Diagn normal for lungs

Question 23

Radiodense

Answer 23

Describ White pattern, solid, fluid Diagn normal for bones, organs

Question 24

Infiltrate

Answer 24

Describ any ill-defined radiodensity Diagn atelectasis

Question 25

Consolidation    

Answer 25

 Describ solid white area                Diagn  pneumonia/pleural effusion

Question 26

Hyperlucency

Answer 26

Describ extra pulmonary air         Diagn COPD, asthma attack Pneumo

Question 27

Vascular markings

Answer 27

Describ lymphatics, vessels, lung tissue Diagn Increased with CHF

Question 28

Diffuse

Answer 28

Describ Spread throughout             Diagn atelectasis/ pneumonia

Question 29

Opaque

Answer 29

 Describ fluid solid                        Diagn     consolidation

Question 30

Bilateral    

Answer 30

Describ on both sides

Question 31

Unilateral

Answer 31

Describ on one side

Question 32

Fluffy infiltrates

Answer 32

Describ diffuse whiteness Diagn pulmonary edema

Question 33

Butterfly/batwing pattern

Answer 33

Describ  infiltrate in shape of butterfly Diagn pulmonary edema

Question 34

Patchy infiltrates

Answer 34

Describ Scattered densities Diagn Atelectasis

Question 35

Platelike infiltrates

Answer 35

Describ thin-layered densities Diagn Atelectasis

Question 36

Ground Glass Appearance

Answer 36

Describ Reticulogranular Daign ARDS/IRDS

Question 37

Honeycomb Pattern

Answer 37

Describ Reticulonodular Diagn ARDS/IRDS

Question 38

Air Bronchogram

Answer 38

Pneumonia

Question 39

Peripheral wedge-shaped infiltrate

Answer 39

pulmonary embolus

Question 40

Concave superior interface border

Answer 40

Pleural effusion

Question 41

Basilar infiltrates with meniscus

Answer 41

Pleural effusion

Question 42

ABCs of X Rays 

Answer 42

• Assessment of quality • Bones and soft tissues • Cardiac • Diaphragms • Effusions • Fields and fissures • Great vessels • Hila and mediastinum • Impression

Question 43

• Assessment of quality

Answer 43

You should see 10 to 11 ribs with a good inspiratory effect

Question 44

• Cardiac

Answer 44

• Evaluate the heart size: the heart should be <50% of the chest diameter on PA films and <66% on AP films. Check for the heart shape, calcifications, and prosthetic valves.

Question 45

• Diaphragms

Answer 45

• Check diaphragms for the position (the right is slightly higher than the left due to the liver) and shape (may be flat in asthma or COPD).

Question 46

• Effusions

Answer 46

Pleural effusions may be large and obvious or small and subtle. Always check the costophrenic angles for sharpness (blunted angles may indicate small effusions). Check a lateral film for small posterior effusions.

Question 47

• Fields and fissures

Answer 47

• Check lung fields for infiltrates (interstitial vs. alveolar), masses, consolidation, air bronchograms, pneumothoraces, and vascular markings. Vessels should taper and should be almost invisible at the lung periphery.

Question 48

• Great vessels

Answer 48

• Check aortic size and shape and the outlines of pulmonary vessels. The aortic knob should be clearly seen.

Question 49

• Hila and mediastinum

Answer 49

• Evaluate the hila for lymphadenopathy, calcifications, and masses. The left hilum is normally higher than the right. Check for widening of the mediastinum (which may indicate aortic dissection) and tracheal deviation (which may indicate a mass effect or tension pneumothorax). In children, be careful not to mistake the thymus for a mass!

Question 50

Bronchography

Answer 50

• Injection of radio-opaque contrast medium into the tracheobronchial tree • Identifying the location of involved areas will allow better administration of postural drainage in bronchiectasis

Question 51

Pulmonary Ventilation/Perfusion Scan

Answer 51

 If the results indicate a normal ventilation scan but abnormal perfusion scan = pulmonary emboli.

Question 52

Magnetic Resonance Imaging (MRI)

Answer 52

• Magnetic resonance imaging is used to obtain two-dimensional views of an organ or structure without the use of radiation. The patient lies in a large hollow, cylindrical magnet that exposes the body to brief bursts of the magnetic field. The computer creates an image of the body part on a monitor and on x-ray film.

Question 53

Computerized Tomography (CT)

Answer 53

• The computer calculates the amount of x-ray penetration through a specific plans of the body part to be examined. This numerical data is evaluated by the computer and is visually displayed as differing shades of gray. The images appear as narrow slices of the organ or body part. • Useful in detecting the presence of a mediastinal mass, pleural and parenchymal masses and pulmonary nodules and lesions not visualized on a chest x-ray

Question 54

Computerized Tomography (CT) Used to Diang

Answer 54

• Lung tumors - Differentiate lymph nodes or tumor - As small as 2 to 3 mm • Pulmonary embolism • Chronic interstitial disease - Superior to conventional CXR • AIDS - Early detection of pneumonias, abscesses, and cavities • Occupational lung disease - Parenchymal and pleural changes - Pleural plaques in asbestosis • Pneumonia - Cost has restricted its use for pneumonias • Bronchiectasis • COPD - Remarkable clarity and detail

Question 55

Barium Swallow

Answer 55

• A barium swallow or an esophagram is performed to assist in the diagnosis of abnormalities in the hypopharynx, esophagus, or stomach. A quantity of barium which is radiopaque is ingested by the patient and traced through the hypopharynx and into the esophagus by fluoroscope. Suspected esophageal malignancy. Dysphagia (difficulty in swallowing).