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Questions and Answers
Which of the following is a standard chest X-ray view?
Which of the following is a standard chest X-ray view?
- Antero-posterior (AP) view
- Lateral view
- Postero-anterior (PA) view
- All of the above (correct)
Which structures are part of the cardiac silhouette?
Which structures are part of the cardiac silhouette?
- Main bronchus
- Clavicle
- Pulmonary veins (correct)
- Trachea
What is the primary advantage of the Postero-anterior (PA) view?
What is the primary advantage of the Postero-anterior (PA) view?
It provides a standard projection and is typically performed with full inspiration.
The right main bronchus is _____ and _____ than the left main bronchus.
The right main bronchus is _____ and _____ than the left main bronchus.
What is the typical position of the right hemidiaphragm compared to the left?
What is the typical position of the right hemidiaphragm compared to the left?
The lung hilum contains only the main bronchus.
The lung hilum contains only the main bronchus.
Which of the following factors affects the technical quality of a chest X-ray?
Which of the following factors affects the technical quality of a chest X-ray?
What is a consequence of inadequate inspiration during a chest X-ray?
What is a consequence of inadequate inspiration during a chest X-ray?
At what rib level should the 9th-10th posterior ribs be visible in a PA view?
At what rib level should the 9th-10th posterior ribs be visible in a PA view?
What does good exposure/penetration on a chest X-ray allow for?
What does good exposure/penetration on a chest X-ray allow for?
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Study Notes
Chest X-Ray Views
- PA View: Standard projection, performed standing with full inspiration
- Lateral View: Performed erect left lateral
- AP View: Portable chest X-ray, inferior in quality to the PA view
Systematic Approach to a Normal Chest X-Ray
- A- Airways: Trachea, Right main bronchus, Left main bronchus
- Right main bronchus: Straighter and wider, making aspirated foreign bodies more likely to end up there
- B- Bones: Ribs, Clavicle, Sternum, Vertebral bodies
- C- Cardiac Silhouette: Structures composing the silhouette are not specified in this text.
- D- Diaphragm: Right hemidiaphragm is slightly higher than the left due to the liver
- E- Effusion (Pleura): Double membrane surrounding each lung, Rt/Lt Costophrenic angles are the spaces where the diaphragm meets the thoracic wall.
- F- Fields (Lung Fields): Fissures divide the right lung into 3 lobes, and the left lung into 2.
- Horizontal fissure: Right lung only
- Oblique fissures: Right and Left lungs
- G- Gastric Bubbles: Air in the stomach, differentiate from pneumoperitonieum
- H- Hilum: Medial aspect of each lung, contains the following:
- Main bronchus
- Pulmonary artery
- Pulmonary veins
- Bronchial arteries & veins
- Lymph nodes
- Nerves
Lung Zones
- Apical Zone: Level of the clavicle or above
- Upper Zone: From the clavicle down to the superior aspect of the hilum
- Mid Zone: Level of the Hilum
- Lower Zone: Anything below the hilum
Lateral X-Ray View
- Retrosternal space
- Retrocardiac space
- Spine sign
Assessment of Technical Quality of Chest X-Ray Film
- Rotation:
- One or both costophrenic angles may not be visible
- Size and shape of cardiac silhouette may be distorted
- In PA chest X-ray, a line connecting the spinous process of the vertebrae should bisect the distance between the medial ends of the two clavicles. Any variation indicates rotation.
- Inadequate Inspiration:
- Chest X-ray should be taken during full inspiration (PA View)
- 9th-10th posterior ribs should be visible
- 6th-7th anterior ribs should be visible
- Consequences of Inadequate Inspiration:
- Lung volumes appear falsely low
- Lung markings appear falsely prominent leading to a false appearance of pulmonary edema
- Cardiac silhouette and mediastinum may appear falsely enlarged.
- Suboptimal Penetration:
- Physical factors determining penetration: Exposure duration, Energy of photons, Source to Image Distance (SID) (6 feet for standard PA, may need to be adjusted for portable)
- Radiology technologist parameters: mAs, kVp, SID determine contrast and over film brightness.
- Assessing Exposure/Penetration:
- Considered good when the outlines of the vertebral bodies are visible
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