Chest X-rays

Question 1

What is a chest X-ray

Answer 1

Produces electromagnetic beams passing through the thorax & exposing photographic silver film/plate

Question 2

What are less dense tissues referred to as

Answer 2

Radiolucent

Question 3

What colour do less dense tissues such as air of air filled structures show up as

Answer 3

Black

Question 4

What colour do more dense structures show up as

Answer 4

White

Question 5

What is more dense structures referred to as

Answer 5

Radiopaque

Question 6

What shows up as grey on a chest X-ray

Answer 6

Fats e.g. lipid tissue around muscle or soft tissue e.g. heart, blood vessels & muscles

Question 7

Name the 2 types of chest X-rays

Answer 7

Posteroanterior = most common. X-ray passed posteriorly to anteriorly with patient upright & scapula rotated out the way

Anteroposterior = portable X-ray. Passes anteriorly to posteriorly. Heart size is magnified

Question 8

When looking at a chest X-ray what 2 things should you consider when deciding if it’s a good X-ray

Answer 8

Quality = over exposed (intensity too high OR been projected for too long), under exposed (intensity too low OR not been projected long enough)

Rotation = normal X-ray the clavicle should be of equal distance between the spinous processes

Question 9

What 5 things should you preliminary check when interpreting a chest X-ray

Answer 9

Name & date
Projection
Exposure
Position
Inspiration

Question 10

What questions should you ask first about a chest X-ray

Answer 10

Who
What
When
Why
How

Question 11

What system should you follow when looking at a chest X-ray

Answer 11

A-G
Alignment
Bones
Cardiac
Diaphragm
Expansion
Lung fillers
Gadgets

Question 12

What are you looking for in alignment

Answer 12

Is it a srptraight film?
Look appt the proximal ends of clavicle in relation to the spinous processes

Question 13

What are you looking for when looking at bones

Answer 13

All there
All intact & normal position
And fractures

Question 14

Cardiac interpreting

Answer 14

Clear heart border
Normal size = 1/3 of the chest diameter
Any evidence of shifting structures

Question 15

Diaphragm interpretation

Answer 15

Both hemidiaphragms clearly visible
Angles, cardiophrenic & costophrenic angles visible & clear

Question 16

Expansion interpretation

Answer 16

How well expanded is the chest
10th rib posteriorly show bisect the right hemidiaphragm at mid clavicular line & 6th rib anteriorly

Question 17

Fields interpretation

Answer 17

Lung fields clear?
Any areas where the density either increases or decreases
Can you see the lung edges?
Can you see fluid level?

Question 18

Gadgets interpretation

Answer 18

What drips, drains, tubes, lines & other gadgets are visible?
Are they in, on or around the patient?

Question 19

Name the 6 common abnormalities on a chest X-ray

Answer 19

Consolidation
Atelectasis
Pleural effusion
Pneumothorax
Pulmonary oedema
Fractures

Question 20

What is consolidation

Answer 20

Lung tissue becomes firm & solid instead of elastic & airfilled due to accumulated fluids & tissue debris

Question 21

How does consolidation show up on a X-ray

Answer 21

White/grey shadows
No loss of volume

Question 22

What will you hear on auscultation for consolidation

Answer 22

Increased breath sounds/broncial breath shounds or decreased breath sounds with or without crackles

Question 23

3 main causes of consolidation

Answer 23

Pneumonia
Chest injection
Lung contusion following trauma

Question 24

What is atelectasis

Answer 24

Airless state of the lung tissue which may involve all or part of the lung

Question 25

How does atelectasis show up on X-ray

Answer 25

White/grey shadow with loss of volume & shifting or structures Total collapsed lung may displace (pull) the mediastinum towards the affected side

Question 26

Auscultation for atelectasis

Answer 26

Quite breath sounds if occulued bronchus or bronchial breath sounds if patent bronchus, fine end inspiration crackles with smaller atelectasis

Question 27

Some causes of atelectasis

Answer 27

Shallow breathing Bronchial obstruction Surfactant depletion Absorption of trapped gas

Question 28

What is pleural effusion

Answer 28

Excess fluid in pleural cavity

Question 29

Signs of pleural effusion on an X-ray

Answer 29

Fluid is white around lung field space

Question 30

Auscultation signs of pleural effusion

Answer 30

Quiet breath sounds over the pleural effusion with bronchial breathing above top of fluid level

Question 31

Causes of pleural effusion

Answer 31

Pneumonia Malignancy Hear, kidney or liver failure Abdominal or cardiothoracic surgery

Question 32

What will a small & large amount of fluid result in on a chest X-ray for pleural effusion

Answer 32

Small = Loss of the costophrenic angles Large = displace (push) the mediastinum towards non-affected side

Question 33

What is a pneumothorax

Answer 33

Air in pleural space secondary to a rupture in either pleural layer Lung squashed towards the hilum in proportion to the amount of pleural air

Question 34

CXR pneumothorax

Answer 34

Air in pleural space is black as no lung markings Significant pneumothorax the lung is squished and appears as a white density towards helium Mediastinum may be displaced to non-affected side

Question 35

Ax pneumothorax

Answer 35

Quiet over area

Question 36

What is pulmonary oedema

Answer 36

Extravascular water in the lungs

Question 37

CXR pulmonary oedema

Answer 37

Bilateral fleecy opacities spreading from the hila Depending on the cause it can cause an enlarged heart

Question 38

Ax pulmonary oedema

Answer 38

Crackles that are more evident in dependent regions Sometimes fine or bubbly noises