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20 Cards in this Set

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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


:Lateral


LAnteroposterior- portable film


Special views


:Lateral decubitus


:Apical lordotic


:oblique


:Expiratory


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

Epiglottitis


Ap NECK is for croup, steeple

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