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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?
Which structures are part of the cardiac silhouette?
Which structures are part of the cardiac silhouette?
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.
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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?
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The lung hilum contains only the main bronchus.
The lung hilum contains only the main bronchus.
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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?
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What is a consequence of inadequate inspiration during a chest X-ray?
What is a consequence of inadequate inspiration during a chest X-ray?
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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?
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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
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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.
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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
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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
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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.
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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.
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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.
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Assessing Exposure/Penetration:
- Considered good when the outlines of the vertebral bodies are visible
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Description
Explore the various views of chest X-rays, including PA, lateral, and AP projections. Understand the systematic approach for interpreting a normal chest X-ray, focusing on airways, bones, the cardiac silhouette, diaphragm, effusion, and lung fields.
