Podcast
Questions and Answers
Which patient position during a chest x-ray is MOST suitable for detecting small pleural effusions?
Which patient position during a chest x-ray is MOST suitable for detecting small pleural effusions?
- Lateral decubitus with the affected side dependent (correct)
- Oblique
- AP, supine
- Erect
In a well-inspired chest x-ray film, how many posterior ribs should typically be visible, at a minimum?
In a well-inspired chest x-ray film, how many posterior ribs should typically be visible, at a minimum?
- 10 (correct)
- 8
- 12
- 6
Why is it generally not recommended to assess heart size on an AP supine chest x-ray?
Why is it generally not recommended to assess heart size on an AP supine chest x-ray?
- The magnification effect caused by the AP view can make the heart look artificially larger. (correct)
- The heart appears smaller in the supine position.
- The heart is obscured by the mediastinum in this view.
- The heart is rotated in a supine position, making size assessment inaccurate.
Which of the following is NOT a typical indication for ordering a chest x-ray?
Which of the following is NOT a typical indication for ordering a chest x-ray?
During chest x-ray interpretation, what is the purpose of assessing the 'costophrenic angles'?
During chest x-ray interpretation, what is the purpose of assessing the 'costophrenic angles'?
If a chest x-ray demonstrates free air under the diaphragm, what condition is most likely?
If a chest x-ray demonstrates free air under the diaphragm, what condition is most likely?
Which technical factor is assessed by comparing the position of the spinous processes with the medial ends of the clavicles on a chest x-ray?
Which technical factor is assessed by comparing the position of the spinous processes with the medial ends of the clavicles on a chest x-ray?
When reviewing a chest x-ray, the acronym 'PA' refers to which type of patient positioning?
When reviewing a chest x-ray, the acronym 'PA' refers to which type of patient positioning?
Flashcards
Chest X-Ray
Chest X-Ray
A common radiographic exam used to examine structures within the chest, such as lungs, heart, and bones.
PA View
PA View
A standard view of the chest, where the x-ray beam passes through the patient from the back to the front.
Lateral View
Lateral View
A view taken from the side of the patient, to better localize abnormalities seen on the PA view.
Cardiothoracic Ratio
Cardiothoracic Ratio
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Pneumoperitoneum
Pneumoperitoneum
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Trachea Evaluation
Trachea Evaluation
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Diaphragm Evaluation
Diaphragm Evaluation
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Hilum
Hilum
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Study Notes
Lecture 2: X-Ray Interpretation
- Chest X-Ray is a frequently requested plain radiograph, but can be difficult to interpret. A systematic approach is crucial.
- Indications include infectious, inflammatory, or neoplastic lung pathologies, chest trauma (hemothorax, rib fracture), COPD, ILD, and cardiac pathologies.
Patient Position
- PA: Standard view.
- Lateral: Localizes abnormalities seen in the PA view.
- AP, Supine: Useful for infants and ill patients, but not ideal for assessing heart size.
- Erect: Detects gas under the diaphragm.
Additional Projections
- Oblique: Demonstrates pleural chest wall and rib abnormalities.
- Apical: Provides a clear view of lung apices, free of bone.
- Expiratory: Highlights air trapping and pneumothorax.
- Lateral Decubitus: Aids in identifying small pleural or subpulmonic effusions.
Interpretation
- Patient Information: Request forms should include name, age, sex, date, MRN, and pertinent clinical details.
- Technical Factors: Centring, patient position, marker, exposure, and degree of inspiration are critical for accurate interpretation.
- Good inspiration: At least 10 posterior and 6 anterior ribs should be visible. The base of the lungs should be clearly defined. Poor inspiration can cause a normal-sized heart to appear enlarged.
- Centring: Spinous processes and medial ends of clavicles align with the image.
- Penetration: Bodies of 1-4 thoracic vertebrae should be visible.
Key Anatomical Features
- Trachea: Position and outline are evaluated.
- Heart and Mediastinum: Shape, relative position, and any abnormalities are noted.
- Diaphragm: Outline, shape, and relative position are assessed.
- Pleura: Horizontal fissure positioning, and costophrenic/cardiophrenic angles should be reviewed.
- Lung Fields: Local or generalized abnormalities, translucency, and vascular markings are observed.
- Hidden Areas: Apices and posterior sulci receive attention for any abnormalities.
- Hilum: Density, position, and shape are notable.
- Below Diaphragm: Gas, shadows, calcification, and soft tissue densities(e.g., mastectomy).
Common Lung Patterns
- Air Space Disease: Involves filling of air spaces with fluid, exudate, blood or edema, causing opacity. Silhouette sign is typical of the loss of border definitions between structures like mediastinum, diaphragm, vs. adjacent lung.
- Atelectasis: Volume loss in a portion of the lung (e.g., lobe, segment or subsegment). It can be massive (entire lung) or less extensive. Different types include obstructive, passive, and compressive.
- Masses: Opacities suggesting cancer (primary bronchogenic carcinoma), metastasis, lymphoma, or chest wall/mediastinal tumors
- Pleural Effusion: Abnormal fluid collection. Radiographic signs include homogenous opacification, loss of diaphragm outline and no visible pulmonary/bronchial markings. Identifying the meniscus sign (concave upper border).
- Pneumothorax: Air in the pleural cavity. Radiological signs include absent lung markings, and mediastinal shift (tension pneumothorax).
- Hydro Pneumothorax: Air and fluid in pleural cavity, usually related to bronchial-pleural fistula.
- Rib Fractures: Commonly involve the 4th-10th ribs. Fractures of the 1st-3rd ribs are often associated with high-energy trauma. A flail chest can occur with three or more contiguous ribs in at least two places fracturing and resulting in rib floating.
- Clavicle Fractures: Common (5% of all fractures), typically in the mid-shaft.
Pulmonary Tuberculosis (TB)
- Tuberculosis (TB) can present in primary or secondary forms in an x-ray.
- Primary TB usually occurs in children and may present as consolidation or lymphadenopathy.
- Secondary TB presents in adults, often with cavitary lesions, pleural effusion, and possible lymphadenopathy.
- Miliary TB involves hematogenous dissemination of the bacilli and presents with millet-sized nodules.
Other Topics
- Cardiothoracic Ratio: Normal ratio, under 50%, in PA upright radiographs.
- Abdominal Radiograph: Evaluations often involve assessing for bowel obstruction (small or large), perforation, calculi (stones), foreign bodies, and meconium failure in infants.
- Standard Projections: AP supine, PA erect, KUB views, and additional variations for specific cases like lateral decubitus, PA prone, or oblique, are common.
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