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20 Cards in this Set

  • Front
  • Back

Indications for CXR Examiniations

Detecting alterations of the lung

Direct to the appropriate therapy

Evaluating the effectiveness of treatment

Tube and catheter placement

Progression of lung disease

Review of the thoracic imaging : Overview

X ray beams poass through chest

After passing through chest, beams strike film

The more intense beams cause dark

Air (lungs ) is less dense = black, while x rays absorbed by more dense tissue = white

REsulting chest radiograph represents various hades of gray shadows

Review of thoracic imaging : overview

4 different tissue densities are visible on normal chest radiograph

:Air, fat, water and bone

AIr (lung) absorbs x rays least (radiolucent

Bone (ribs) absorb most x ray (radiopague)

Fat and water shoadows are different degrees of gray

Review of thoracic imaging overview

FIlm is now digital

Digital films have advantages

:Can be manipulated to enhace interpretation

:Can be stored and retrieved quickly from any location/time

:Can be copied, shared and transported quickly

:Image quality does not deteriorate over time

Radiographic views

Standard views

:Posteroanterior, traditional department film


LAnteroposterior- portable film

Special views

:Lateral decubitus

:Apical lordotic



Distance of object from xray tube

Normal distance is 6 feet

Closer to the x ray tube the greater the magnification oand distortion

Because of the tendency to scatter, the beam will spread as distance from x ray tube increases

PA chest film

PA usually dr office

Film placed against patients chest

High quality film with minimal magnification of heart shadow

Later view: usually, left lateral due to less cardiac enlargement LL and LLL

In the PA projection the diameter of the heart should not exceed black of the chest

half of the diameter

Cardiac to thoracic ratio

Measure from the midline (spine_ to the right heart border and see whether that distance will fit into the piece of the lung field to the left side of the heart

Measure at the widest point, should be no more than 1/2 the width of the thorax

AP chest film

Indications for AP portable films

:Evaluate the lung status

:Evaluate lines and tubes

:See results of invasive therapeutic maneutvers

Taken with portable x ray machine in ICU

X ray source is in front of the patient and film is behind patient

Distance from x ray source to film is 4 feet

AP cchest film

AP films are often more difficult to read because quality is not as good as PA film

Heart shadow is more magnified with AP film since heart is closer to X ray source

Rotation of patient is more likely

Lateral decubitus radiograph

The lateral decubitus radiograph is obained by having the patient lie on the left or right side rather than standing or sitting in upright position

The naming of the decubitus radiograph is determined by the side on which the patient lies

:Thus a right lateral decubitus radiograph means that the patients right side is down

Apical lordotic

45 degree angle from below looking up

Looks at right middle lobe or apical areas

Oblique views

turned 45 degrees to either side

Helps to localize abnormality

Used in lung perfusion scans

Lateral neck xray or thumb sign is for


Ap NECK is for croup, steeple


When is an expiratory film used

Can help in identifying a small pneumothorax

Upon exhalation the lung because more radiopaque

The pneumothorax remains radiolucent

Approach to reading chest film

Disciplined approach si needed

First, patient match

Second, evaluate quality of film (proper patient position, x ray penetration etc

Third systematiaclly evaluate all anotomical structures seen on film following prescribed series of steps

Approach to reading cehst film

Correct orientation of the film, the heart shadow should descent downward toward the right as the film is viewed on the view box

More approach

Rotation is determined by locating the neck of the clavicles and verifying that the spine lies equidistant between them

:Clavicles should be flat/ striaght side to side

Penetration is determined by examining the spinal column through the cardiac shadow. The vertebral bodies should just barely be distinguishable, without obvjous dark spaces between them