Chest Radiography

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CXR

•Different tissues in our body absorb X-rays in different amounts:–Radiolucent- (see through) Black

–Radiopaque (dense) White

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CXR

–Densities• Bone• Water• Fat• Air

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Indications

• Pulmonary work up –ABG, PFT, CXR, H and P

•Diagnose Disease•Determine Therapy •Evaluate Tx •Placement of invasive lines •Determine progression of Disease

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CXR Views

•PA – the x-rays

penetrate through the back of the patient on to the film

–Standard

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CXR Views

•AP-– the x-rays penetrate

through the front of the patient on to the film

–PORTABLE

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CXR Views

• Lateral Decubitus – Evaluate fluid in pleural space

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Pleural Effusion

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Croup (AP neck)

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www.uptodate.com/.../croup_steeple_sign.jpg

Epiglottitis (Lateral)

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waent.org

Other Evaluations

•CAT Scans

•V / Q scans

•Angiography

•Fluoroscopy

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Computed Tomography

• The use of computers with tomography results in very fine detail.

• The cost of CT is much higher than that of a conventional chest x-ray

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Angiography

• Done to evaluate the patient suspected of having a pulmonary embolism

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Angiography

• An angiography is an x-ray of an artery or arteries in the body.

• Used to determine pulmonary embolism

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Fluoroscopy

• Live X ray• An x-ray procedure that makes it

possible to see internal organs in motion.

• Fluoroscopy uses x-ray to produce real-time video images.

• Murrugun The Mystic - Sword Swallowing Fluoroscopy - YouTube

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Evaluating Chest X rays…Be systematic:

1)Check the quality of the film

2)Check position 3)Check inspiration 4)Check Technique 5)Check Name!!!6)Evaluate lung fields

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A – AirwaysB – BonesC – Cardiac (silhouette)D – Diaphragm

E – ETT

F – Fissures

G – Gastric

H – Hilum

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X-ray Evaluation

• Place the chest film on the view box as if the patient were facing the clinician

– i.e., the right side of the patient’s chest is on the clinician’s left,• Cardiac shadow on left side of

chest

• X-rays are often marked R or Lhttp://www.youtube.com/watch?v=qAjEJZ-mQvQ

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Film Quality

• Was film taken under full inspiration?

-10 ribs should be visible

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Quality (cont.)

• Check to see if the film over or under penetrated

• Properly penetrated chest radiograph is one which the vertebral bodies can be seen

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An under-penetrated chest x-ray does not differentiate the vertebral bodies from the intervertebral spaces

An over-penetrated film shows the intervertebral spaces very distinctly

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Quality (cont)

• Check for rotation

• Does the thoracic spine align in the center of the sternum and between the clavicles?

• Are the clavicles level?

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Verify Right and Left sides

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•Gastric bubble should be on the left.

•Heart should be on the left

Verify Left and Right

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Now you are ready

• Look at the diaphragm:abnormal elevation

• Margins should be sharp

(the right hemidiaphragm is usually

slightly higher than the left)

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Check the Heart

• Size

• Shape

• Silhouette-margins should be sharp

• Diameter (>1/2 thoracic diameter is enlarged heart)

Remember: AP views make heart appear

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Cardiac Silhouette

1. R Atrium2. R Ventricle3. Apex of L Ventricle

4. Superior Vena Cava5. Inferior Vena Cava6. Tricuspid Valve

7. Pulmonary Valve8. Pulmonary Trunk9. R PA 10. L PA2/25/2010jh

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Check the Costophrenic angles

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Margins should be sharp

Loss of Sharp Costophrenic Angles

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Finally, Check the Lung Fields

• Infiltrates

• Increased interstitial markings

• Masses

• Absence of normal margins

• Air bronchograms

• Increased vascularity

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Air Bronchogram

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Atelectasis

• Can be compressive or obstructive

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Pneumothorax

• When air enters the pleural space.– Either from chest wall or from lung

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Hyperinflation

• Often due to obstructive lung disease– Increased A/P diameter, flattening of

diaphragm, large airspace.

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Interstitial Lung disease

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Congestive Heart Failure

• Large heart

• Fluid collection in vasculature and gravity dependent portions

• Kerly’s B lines

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Congestive heart failure

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Pleural Effusion

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Consolidation

• Copious mucus production that fills the lung tissue.

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