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Questions and Answers

What is the primary purpose of a chest x-ray?

To evaluate symptoms and signs of lung cancer (correct)

To evaluate the density of tissue and radio opacity

To evaluate the placement of devices and tubes

To screen for lung cancer

What is the correct orientation of a chest x-ray?

Patient's right side on the left, patient's left side on the right

Gastric bubble on the right, aortic knob on the left

Patient's left side on the left, patient's right side on the right (correct)

Patient's right side on the right, patient's left side on the left

What is the importance of assessing the technical quality of a chest x-ray?

To determine the patient's age

To ensure proper inspiratory effort, penetration, and positioning (correct)

To determine the diagnosis

To evaluate the patient's symptoms

What is the characteristic of a properly exposed chest x-ray?

The thoracic intervertebral disc space is just visible Signup and view all the answers

What is the purpose of a decubitus view?

To detect small pleural effusions and pneumothorax Signup and view all the answers

What is the importance of patient positioning in a chest x-ray?

To ensure proper rotation and angulation Signup and view all the answers

What is the purpose of a lateral view?

To detect abnormalities in the posterior lungs Signup and view all the answers

What is the characteristic of a portable AP view?

All x-rays in the ICU are portable and AP view Signup and view all the answers

What is an indication of good inspiratory effort on an X-ray?

9 posterior ribs are visible. Signup and view all the answers

What does it indicate if fewer ribs are apparent above the hemi-diaphragm on an X-ray?

The patient has restricted lung volumes. Signup and view all the answers

How can you check for rotation on a chest X-ray?

By checking if the thoracic spine aligns in the center of the sternum and between the clavicles. Signup and view all the answers

What is the significance of the mid-clavicular line of the diaphragm on an X-ray?

It indicates the level of the 6th or 7th rib. Signup and view all the answers

What is an indication of poor inspiratory effort on an X-ray?

Less than 9 posterior ribs are visible. Signup and view all the answers

What happens if more ribs are apparent above the hemi-diaphragm on an X-ray?

The patient has a large inspiratory volume or is hyper-inflated. Signup and view all the answers

What is the significance of the anterior end of the 6th or 7th rib on an X-ray?

It indicates good inspiratory effort. Signup and view all the answers

What is the purpose of checking for rotation on a chest X-ray?

To ensure that the X-ray is taken in the correct position. Signup and view all the answers

What is the ideal position of the mediastinal shadow?

Slightly to the left of center and in contact with the diaphragm Signup and view all the answers

What is the normal range for the cardiothoracic index?

One-third to one-half Signup and view all the answers

What is the significance of the cardiophrenic angle?

It is the intersection of the heart shadow and the hemi diaphragm Signup and view all the answers

What is the normal position of the hila?

1 to 2 cm higher on the left side of the mediastinum Signup and view all the answers

What is the significance of the sternoclavicular joints?

They should be at the same distance from the spines of the thoracic vertebrae Signup and view all the answers

What is the significance of the aortic arch?

It is a normal structure seen on an AP view Signup and view all the answers

What is the significance of the trachea?

It should be midline Signup and view all the answers

What is the significance of the diameter of the heart?

It should be about half the thoracic diameter Signup and view all the answers

What is the significance of dividing the lungs into zones on a Chest X-ray?

To pay more careful attention to each smaller area Signup and view all the answers

What is the normal appearance of the lung markings on a Chest X-ray?

Black with lung markings Signup and view all the answers

What is the location of the pleural spaces on a Chest X-ray?

Around the entire edge of the lung Signup and view all the answers

What is the normal shape of the diaphragm on a Chest X-ray?

The right hemidiaphragm is higher than the left Signup and view all the answers

What is the significance of the costophrenic angles on a Chest X-ray?

They should be well defined Signup and view all the answers

What is the purpose of examining the lung fields on a Chest X-ray?

To look for any opacities that may indicate pathology Signup and view all the answers

What is the normal appearance of the margins of the diaphragm on a Chest X-ray?

Sharp Signup and view all the answers

What is the importance of checking for air bronchograms on a Chest X-ray?

To identify the presence of consolidation Signup and view all the answers

What is a characteristic finding in a pneumothorax?

Visceral pleural line Signup and view all the answers

What is the term for the filling of alveoli with fluid, pus, blood, or cells?

Consolidation Signup and view all the answers

What is the term for a white homogeneous opacity that obliterated the costophrenic angle and rises to the axilla?

Pleural effusion Signup and view all the answers

What is the term for an air-filled bronchus surrounded by opacified lung?

Air bronchograms Signup and view all the answers

What is the term for a collection of air in the pleural space?

Pneumothorax Signup and view all the answers

What is the term for a dark area on a chest x-ray?

Radiolucent Signup and view all the answers

What is the term for a lighter area on a chest x-ray?

Opacity Signup and view all the answers

What is the term for a collapsed lung?

Atelectasis Signup and view all the answers

Study Notes

Chest Radiology

Chest radiography (CXR) is a common diagnostic tool used to evaluate symptoms, screen for lung cancer, and monitor medical devices.
Indications for CXR include evaluation of symptoms, screening for lung cancer, pre-employment and pre-surgery, and placement of devices and tubes.

Technical Aspects of Chest Radiography

A systematic approach to reading a CXR involves evaluating the quality of the film, patient position, and orientation.
The chest X-ray should be viewed with the patient's right side on the right and left side on the left, with the aortic knob and gastric bubble on the left.
The heart should be two-thirds to the left, and the patient position should be PA, AP, lateral, or decubitus view.

Assessing CXR Technical Quality

Inspiratory effort: 9-10 posterior ribs should be visible, and the thoracic intervertebral disc space should be visible.
Penetration: the film should not be over or under penetrated, allowing for clear visibility of thoracic vertebrae.
Positioning/rotation: medial clavicle heads should be equidistant from the spinous process.

Systematic Approach to Reading CXR

Evaluate the airway, trachea, and carina.
Check the bone structures, including ribs, scapulae, clavicles, and vertebrae.
Evaluate the heart size, shape, and silhouette, and check for cardiophrenic angles.
Assess the hilar region and diaphragm shape, height, and margins.
Examine the lung fields, including infiltrates, interstitial markings, nodules, and masses.
Evaluate the pleural spaces and lung zones.

Lung Findings

Radiolucent areas: pneumothorax, cysts/bulla, air bronchograms.
Opacities: infiltrates, atelectasis, nodules or mass, consolidation/pneumonia.
Other lung findings: bronchitis, pneumothorax, consolidation/pneumonia, pleural effusion, and mass.

Specific Lung Conditions

Pneumothorax: black jet opacity, visceral pleural line, collapsed lung, and possible mediastinal shift.
Consolidation/pneumonia: caused by filling of alveoli with fluid, pus, blood, or cells; may be diffuse or isolated to segments or lobes of the lung.
Pleural effusion: white homogeneous opacity, obliterating costophrenic angle, and rising to axilla.

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