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Questions and Answers
Which of the following is a normally accepted indication for ordering a chest x-ray?
Which of the following is a normally accepted indication for ordering a chest x-ray?
- Routine pre-employment screening
- Asymptomatic preoperative evaluation
- Suspected elevated diaphragm (correct)
- Daily routine intensive care portable with no clinical change
A patient presents with acute onset chest pain and shortness of breath. Which of the following, if present in their history, would be considered a normally accepted indication for a chest x-ray?
A patient presents with acute onset chest pain and shortness of breath. Which of the following, if present in their history, would be considered a normally accepted indication for a chest x-ray?
- Minor chest trauma reported the day prior
- Uncomplicated acute exacerbation of asthma
- Suspicion for pulmonary embolism (correct)
- Thoracic aneurysm follow up
Which of the following is NOT generally considered an appropriate indication for a chest x-ray?
Which of the following is NOT generally considered an appropriate indication for a chest x-ray?
- Positive TB skin test
- Routine monitoring in ICU without clinical changes in the patient (correct)
- Hemoptysis
- Suspected pneumonia
A clinician orders a chest x-ray on an asymptomatic patient to screen for lung cancer. Is this an appropriate indication?
A clinician orders a chest x-ray on an asymptomatic patient to screen for lung cancer. Is this an appropriate indication?
When assessing chest x-ray quality using the acronym RIPE, what does 'I' stand for?
When assessing chest x-ray quality using the acronym RIPE, what does 'I' stand for?
You are evaluating a PA chest x-ray. Which of the following is characteristic of a well-inspired film?
You are evaluating a PA chest x-ray. Which of the following is characteristic of a well-inspired film?
On a chest x-ray, what does rotation affect the most?
On a chest x-ray, what does rotation affect the most?
What does overexposure of a chest x-ray result in?
What does overexposure of a chest x-ray result in?
In which type of chest x-ray view is the heart most likely to appear magnified?
In which type of chest x-ray view is the heart most likely to appear magnified?
In a PA view radiograph, which structure should NOT be visible?
In a PA view radiograph, which structure should NOT be visible?
If you were to identify the carina on a PA chest x-ray, where would you expect to find it?
If you were to identify the carina on a PA chest x-ray, where would you expect to find it?
Which of the following is TRUE regarding the hilum of the lung?
Which of the following is TRUE regarding the hilum of the lung?
What does the silhouette sign on a chest x-ray typically indicate?
What does the silhouette sign on a chest x-ray typically indicate?
On a frontal chest radiograph, the right hemidiaphragm is typically higher than the left. What is the primary reason for this?
On a frontal chest radiograph, the right hemidiaphragm is typically higher than the left. What is the primary reason for this?
A patient with suspected pleural effusion undergoes a chest x-ray. Which view is MOST effective in identifying small effusions?
A patient with suspected pleural effusion undergoes a chest x-ray. Which view is MOST effective in identifying small effusions?
Which of the following best describes the correct positioning for a posteroanterior (PA) chest radiograph?
Which of the following best describes the correct positioning for a posteroanterior (PA) chest radiograph?
Of the options below, what is the MOST likely finding of an anteroposterior (AP) film compared to a PA film?
Of the options below, what is the MOST likely finding of an anteroposterior (AP) film compared to a PA film?
Which view is taken routinely with a PA view to localize lung lesions that may be hidden behind the heart or diaphragm?
Which view is taken routinely with a PA view to localize lung lesions that may be hidden behind the heart or diaphragm?
What finding on a chest x-ray would lead you to suspect dextrocardia with situs inversus?
What finding on a chest x-ray would lead you to suspect dextrocardia with situs inversus?
Elongation of the clavicles, rib fractures, and increased space between the ribs could mean that the reading should include what?
Elongation of the clavicles, rib fractures, and increased space between the ribs could mean that the reading should include what?
What is the normal cardiothoracic ratio (CTR) on a PA chest x-ray?
What is the normal cardiothoracic ratio (CTR) on a PA chest x-ray?
You are examining a chest x-ray and note that the mediastinum appears widened. Which of the following is the MOST likely significance of this finding?
You are examining a chest x-ray and note that the mediastinum appears widened. Which of the following is the MOST likely significance of this finding?
From the list below, what is a key characteristic of the mediastinum?
From the list below, what is a key characteristic of the mediastinum?
What do infiltrates visualized on a chest x-ray indicate?
What do infiltrates visualized on a chest x-ray indicate?
What is the clinical significance of identifying Kerley B lines on a chest radiograph?
What is the clinical significance of identifying Kerley B lines on a chest radiograph?
What does the acronym RIPE stand for when evaluating chest x-rays?
What does the acronym RIPE stand for when evaluating chest x-rays?
What is the MOST likely finding of underexposure to a chest x-ray?
What is the MOST likely finding of underexposure to a chest x-ray?
Where would you expect to find the major (oblique) fissure in a chest radiograph?
Where would you expect to find the major (oblique) fissure in a chest radiograph?
What can pneumothorax obscure on a chest x-ray, making it hard to see?
What can pneumothorax obscure on a chest x-ray, making it hard to see?
Regarding fractures, what area should be focused on?
Regarding fractures, what area should be focused on?
Regarding the diaphragm, what would indicate to you to be problematic?
Regarding the diaphragm, what would indicate to you to be problematic?
After reviewing the chest radiograph of a 60-year-old male complaining of one week of dyspnea, you notice blunting of the patient's right costophrenic angle. What is the next appropriate step?
After reviewing the chest radiograph of a 60-year-old male complaining of one week of dyspnea, you notice blunting of the patient's right costophrenic angle. What is the next appropriate step?
In an upright patient who has a right-sided tension pneumothorax, which of the following would you expect to be displaced toward the left side?
In an upright patient who has a right-sided tension pneumothorax, which of the following would you expect to be displaced toward the left side?
The tip of a correctly placed central venous catheter (CVC) should ideally be located where?
The tip of a correctly placed central venous catheter (CVC) should ideally be located where?
How far above the carina should the tip of an endotracheal tube (ET tube) be ideally positioned on a chest radiograph?
How far above the carina should the tip of an endotracheal tube (ET tube) be ideally positioned on a chest radiograph?
On a chest radiograph, at what level is a tracheostomy tube typically located?
On a chest radiograph, at what level is a tracheostomy tube typically located?
Which of the following anatomical landmarks should a nasogastric tube (NG tube) pass through or bisect on a chest radiograph to confirm correct placement?
Which of the following anatomical landmarks should a nasogastric tube (NG tube) pass through or bisect on a chest radiograph to confirm correct placement?
Where is the pulse generator typically located in a patient with a pacemaker?
Where is the pulse generator typically located in a patient with a pacemaker?
Which of the following best describes the radiographic appearance of an aortic valve replacement on a chest x-ray?
Which of the following best describes the radiographic appearance of an aortic valve replacement on a chest x-ray?
What is the significance of surgical clips visualized on a chest radiograph?
What is the significance of surgical clips visualized on a chest radiograph?
A chest radiograph reveals a coin-shaped object in the lower airway of a child. Which of the following diagnostic procedures is the gold standard for both diagnosis and removal of the foreign body?
A chest radiograph reveals a coin-shaped object in the lower airway of a child. Which of the following diagnostic procedures is the gold standard for both diagnosis and removal of the foreign body?
What radiographic finding suggests hyperinflation in a child with suspected foreign body aspiration?
What radiographic finding suggests hyperinflation in a child with suspected foreign body aspiration?
What anatomical area is defined as the retrosternal space on a chest radiograph?
What anatomical area is defined as the retrosternal space on a chest radiograph?
On a lateral chest radiograph, increased soft tissue density in the retrosternal space may indicate pathology in which anatomical area?
On a lateral chest radiograph, increased soft tissue density in the retrosternal space may indicate pathology in which anatomical area?
In the context of chest radiography, what are airspaces referring to?
In the context of chest radiography, what are airspaces referring to?
In chest radiography, what does the term 'interstitium' refer to?
In chest radiography, what does the term 'interstitium' refer to?
After a median sternotomy, which of the following would be expected to be seen on a chest x-ray?
After a median sternotomy, which of the following would be expected to be seen on a chest x-ray?
Radiopaque foreign bodies are best visualized with which imaging modality?
Radiopaque foreign bodies are best visualized with which imaging modality?
A patient has undergone a CABG. What radiographic finding would be least likely to be present?
A patient has undergone a CABG. What radiographic finding would be least likely to be present?
Flashcards
Indications for chest X-ray
Indications for chest X-ray
Normally accepted indications include acute respiratory/cardiac disease, major chest trauma, hemoptysis, chronic dyspnea, suspected PE/pneumonia, positive TB skin test.
Contraindications for chest X-ray
Contraindications for chest X-ray
Routine/regular orders for asymptomatic patients, daily ICU portables with no clinical change, minor chest trauma, uncomplicated URI/COPD exacerbations, routine post pacemaker/tracheostomy.
Systematic CXR Interpretation
Systematic CXR Interpretation
Name, DOB, film direction, technical quality (RIPE), cardiac shadow, mediastinum, hila, lungs, plural space, bones, soft tissue.
PA View
PA View
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AP View
AP View
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Lateral View
Lateral View
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Decubitus View
Decubitus View
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CXR Rotation
CXR Rotation
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CXR Inspiration
CXR Inspiration
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CXR Position
CXR Position
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CXR Exposure
CXR Exposure
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Cardiothoracic Ratio (CTR)
Cardiothoracic Ratio (CTR)
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Mediastinum Assessment
Mediastinum Assessment
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Hila Contents
Hila Contents
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Lung Assessment
Lung Assessment
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Pleural Space Assessment
Pleural Space Assessment
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Rib Fracture Diagnosis
Rib Fracture Diagnosis
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Diaphragm Assessment
Diaphragm Assessment
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Central Venous Catheters (CVC) Placement
Central Venous Catheters (CVC) Placement
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Endotracheal Tube (ET tube) Placement
Endotracheal Tube (ET tube) Placement
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Tracheostomy Tube Placement
Tracheostomy Tube Placement
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Nasogastric Tube (NG Tube) Placement
Nasogastric Tube (NG Tube) Placement
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Pacemaker on CXR
Pacemaker on CXR
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Sternotomy Wires and Aortic Valve Replacement on CXR
Sternotomy Wires and Aortic Valve Replacement on CXR
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Artifact Recognition on CXR
Artifact Recognition on CXR
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Foreign Body Aspiration (FBA) – Direct Signs, Diagnosis
Foreign Body Aspiration (FBA) – Direct Signs, Diagnosis
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Foreign Body Aspiration (FBA) – Indirect Signs
Foreign Body Aspiration (FBA) – Indirect Signs
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Normal Air Spaces
Normal Air Spaces
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Retrosternal Space Assessment
Retrosternal Space Assessment
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Interstitium
Interstitium
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Study Notes
- Chest radiography helps to evaluate the placement of support lines, cardiac support devices, post-surgical changes, and artifacts.
- Chest radiography also helps identify foreign body aspiration and to explain the radiographic appearance of air space and interstitium.
Common Support Lines
- Central Venous Catheters (CVC) tip should be within the SVC at or just above the level of the carina.
- Endotracheal tube (ET tube) should be 5-7 cm above the carina.
- Tracheostomy tube should be at the level of the clavicles.
- For a Nasogastric Tube (NG Tube) look for midline descent, carina bisection, diaphragm crossing, left hemidiaphragm.
Cardiac Support Devices
- Pacemakers have a pulse generator in the right pectoral region.
- Pacemaker leads go through the right subclavian vein into the superior vena cava.
- Pacemakers have two electrodes in the right ventricle.
Post-Surgical Changes
- Sternotomy wires should be midline after sternotomy.
- Aortic valve replacements are somewhat medially located over the spine.
- Surgical clips are sometimes seen.
Artifact
- Types include motion, external objects, hair, and skin folds.
- An example of an artifact in the right lung can be hair braids.
Foreign Body Aspiration (FBA)
- Inspiratory and Expiratory Films can help visualize hyperinflation.
- CT Scan can be used if high clinical suspicion but the CXR is inconclusive.
- Fluoroscopy can be used.
- Bronchoscopy is the gold standard for diagnosis and removal.
- Direct signs of radiopaque Foreign Bodies are metal objects visible.
- Indirect signs of radiolucent Foreign Bodies include hyperinflation, mediastinal shift away from the affected lung, and atelectasis/lobar consolidation
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