Question Answer
Air (low density) Black (radiolucent), passes through body and allows for more penetration
Water densities result in less exposure and therefore whitish-gray shadows on film
Bone (high density) includes ribs, clavicles, scapulae, and vertebrae. White, calcium (radiopaque) allows for less penetration patient Assessment: Chapter 9 Chest X-Rays – Test Bank Study Guide
Fat Shades of gray
Heart, diaphragm, & major vessels considered to have the density of water. Do not change in density but may change in size, shape, & position.
Lung consolidation Increase in density because of pneumonia, tumor, or collapse, that area will absorb more x-ray and appear as a white patch on the film.
Cavities and Blebs Decrease lung density absorb fewer x-ray and result in darker areas on the film.
Distance from film Important to consider, the closer the patient is to the source, the greater the magnification and distortion of objects seen.
Indications for X-Ray Assist in Dx of lung pathology, determining appropriate Tx, evaluating effective Tx, tracking the progress of lung disease, determining the position of tubes and lines.
Posteroanterior PA view into the Posterior threw to the Anterior
Lateral Side view (generally left) provides cardiac magnification and a sharper view of LLL.
Lateral decubitus view Pt laying on the right or left side to see whether free fluid (pleural effusion or blood) is present in the chest. Can help w pneumothorax (air rises and fluid drops).
Apical lordotic view Projection is made at a 45-degree tube angulation. Sometimes required for a closer look at the RML or apices of the lung.
Oblique views helpful in delineating a pulmonary or mediastinal lesion from structures that override it on the PA & lateral views.
Pneumotharax The only time you do an expiatory film.
AP Film cassette placed behind patient back, chest x-ray passe the from front (anterior) to back (posterior). Used for bedside x-ray’s.
Post procedural x-ray evaluation ETT (radiopaque strip 2 in Above carina), central (R or L subclavian or jugular vein, rest in sup vena cavae & RAtrium), swanz (check position on a daily basis in the pulmonary artery), picc, Nasogastric (stomach, small bowel), chest tube (tip of tube posterior
Procedures requiring AP film Toracentesis, Pericardiocentesis, Bronch
CTscan Computed enhancement of x-ray shadows to give clearer look @ internal anatomy.
CT scan & Lung Tumors Superior to conventional x-ray can detect nodules 2-3mm. CT helps place biopsy needle to prevent pneumo.
CT scan & interstitial lung disease Can show considerable changes even when x-ray reads normal. Used selectively because of the high cost.
CT scan & AIDS Early detection of pneumonia that occur as a result of AIDS.
CT scan & Occupational lung Helpful in identifying changes in the pleura & lung parenchyma.
CT scan & Pneumonia Restricted use because of cost but they can detect pneumonia sooner.
CT scan & Bronchiectasis Has replaced the invasive use of bronchogram. CT scan can detect early.
CT scan & COPD Emphysema shown clear and detailed. Dx consistently in the high 90%
MRI Used in the evaluation of the hilar. Can better see hilar lymph node enlargement from enlarged hilar blood vessels than is CT. Also, better at seeing chest wall invasion by lung cancer specifically Pancoast tumor or superior sulcus tumor.
Lung scanning (V/Q scan) obtained by measuring gamma radiation emitted from the chest after injected into the bloodstream or inhaled. Useful to evaluate possible P.E. Results often inconclusive and are only suggestive.
PET scan Positron emission tomography, Used to Dx and stage cancers. The compound is injected into a vein, malignant cells show >metabolic rates.
Pulmonary Angiography Used to evaluate thromboembolic disease only used if V/Q scan results are uncertain definitive dx.
X-ray interpretation (A) airways, (B) bones, © cardiac, (D) diaphragm, (E) extras.
(A) airways Tracheal mid line, carina, main stem bronchi, air bronchogram(occur with alveolar filling)
(B) bones Clavicles equal, ribs, scapulae, spine
© Cardiac Cardio-thoracic ratio 1/3 on PA ½ on AP, cardiac borders, aortic arch and vessels, cardio costophrenic angle. diaphragm
Silhouette sign Infiltrates in the lung will blur the edges of the heart or the diaphragm where the infiltrate touches them. This helps to locate w better precision where the infiltrates located.
Air bronchogram Patent airway w/ deep lung consolidation.
Compressive Atelectasis Seen in pt w/ pleural effusion, pneumothorax, hemothorax, & any space-occupying lesion.
Obstructive Atelectasis Blockage of the airway, the absence of ventilation. Tumor, aspirated foreign body, fibrosis, mucus plug, mechanical obstruction, & scaring. Trachea and heart shifts toward.
X-ray & Atelectasis Shift of the fissure toward, movement of hilar toward, the overall loss of volume, hemidiaphragm elevation.
X-ray & Pnumothorax Hyperlucency on the affected side, the shift of the mediastinal away from the air-filled pleural space. Trachea shifts away. <blood flow, <good lungs ability to oxygenate.
X-ray and Hyperinflation COPD can be read as normal if mild, mod-severe large lung volumes, depressed diaphragm, small narrow heart, enlarged intercostal spaces.
X-ray Interstitial lung disease Alveolar pattern may lead to air bronchograms as a result of alveolar spaces becoming infiltrated and denser, the air filled airway is clear and dark, the contrast between the two appear as ground glass.
X-ray & CHF 1- redistribution of pulmonary vasculature to the UL (normally in LL) 2- Cardiomegaly 3- Kerley’s B lines(1-2cm) usually seen in right base, they are pleural lymphatic vessels filled w/ fluid 4- Misc. >interstitial markpleuralplural effusion in R hemithorax, En