On a standard Xray study of the chest, which of the following are the most common two views? I. Posterior-anterior II. Anterior-posterior III. Lateral IV. Apical lordotic a. I and III b. I and IV c. II and III d. II and IVa. I and II
When the posterior-anterior (PA) view is compared w/ the anterior-posterior (AP) view: a. heart shadow on the PA view is larger b. heart shadow on the AP view is larger c. apices are more easily visualized on the AP view d. PA view is often a portabb. the heart shadow on the AP view is larger
Which of the following has the greatest radiodensity? a. air b. fat c. water d. boned. bone
A possible nodular anomaly is present in the right upper lobe on a PA film, but partially obscured by the clavicle. What view might show the anomaly better? a. AP projection b. Lateral projection c. Apical lordotic projection d. L. anterior oblique prc. Apical lordotic projection
During full inspiration, the hemidiaphragms on an adult chest film should be: a. at the C5 vertebra b. at the level of the 12th rib c. at the L4 vertebra d. at the level of the 10th ribd. at the level of the 10th rib
When evaluating a PA film of the chest, you note that the right costophrenic angles are blunted. What does this suggest? a. pneumothorax b. presence of an infiltrate in the right lower lobe c. presence of atelectasis in the right base d. presence ofd. presence of a pleural effusion on the right
When evaluating a PA film of the chest, you note that in the upper lobe there is a 1 cm wide sliver along the lateral margin, descending from the apex, merging w/the ribs at the 3rd rib. This narrow sliver is very black & devoid of vascular markings. Thisa. pneumothorax
For evaluating the position of an ET tube on an AP chest film, the tip of the ET tube should rest: a. at the carina b. at the 4th rib space c. at a point 2-3 cm above the carina d. just above the claviclesc. at a point 2-3 cm above the carina
When viewing a V/Q scan, you note ventilation to be even on all views. On the perfusion scan, you note absence of perfusion in the right apical posterior segment. This finding suggests: a. pulmonary infiltrate b. atelectasis in the right apical posterioc. a possible pulmonary embolus
A pulmonary angiogram is used to: a. image the ventilation of the lung b. image the perfusion of the lung c. image the lymph system of the lung d. none of the aboveb. image the perfusion of the lung
Trachea shift from midlinePneumothorax Hemothorax Significant Atelectasis
Concave Superior InterfacePleural Effusion
Obliterated Costophrenic AnglesPleural Effusion
Reticulogranular or Granular PatternARDS IRDS
Flattened DiaphragmCOPD Significant Air-Trapping
Ground Glass or Honeycomb PatternARDS IRDS
Scattered Patchy InfiltratesARDS
Fluffy InfiltratesPulmonary Edema
Plate-like or Patchy InfiltratesAtelectasis
Wedge-shaped InfiltratesPulmonary Embolus
Butterfly or BatwingPulmonary Edema
Air BronchogramPneumonia
what would a normal chest x-ray show?trachea is midline, bilateral radiolucency, with sharp costophrenic angles
what can cause a loss of airway patency?foreign body obstruction, edema such as croup or epiglottitis or allergic reaction, tracheal spasms, internal or external compression or a trauma leading to air leak
where should the tip of the ETT be positioned on chest x raybelow the vocal cords and no closer than 2cm or 1 inch above the carina. which is also the same level of the aortic knob or aortic arch. (if above the clavicle it is to high.)
where should the pacemaker be positioned?in right ventricle
where should the pulmonary artery catheter appearin the right lower lung field
where should the central venous catheter be placed?in the right or left subclavial or juhular vein and should rest in the vena cava or right atrium of the heart
where should a chest tube be located ?in the pleural space surrounding the lung
where should the nasogastric tubes and feeding tubes be located?in the stomach 2-5 cm below the diaphragm
croup or laryngotracheobronchitis will look like what on a x ray of the neck?a steeple sign , picket fence or a pencil point
epiglottitis will show what on a lateral neck x ray?supraglottic narrowing with enlarged and flattened epidlottis and swollen aryepiglottic folds. this is known as thumb sign
besides croup and epiglottitis what will cause airway narrowingedema,secreations, tumors, aspiration of a foreign body
what is raidiolucent on a chest x ray?Air it is a dark pattern which in normal in the lungs
what is radiodense/opacity on a chest x ray?its solid or fluid it is a white pattern which is normal for bones and organs
what diagnosis would you have if your chest x ray had infiltrates?atelectasis
what diagnosis would you have if your chest x ray had a consolidation?pneumonia or pleural effusion
what diagnosis would you have if your chest x ray showed hyperlucencyCOPD or asthma attack
what dose a increase in vascular markings mean?CHF
if vascular markings are absent this would meanpneumothorax
how would pulmonary edema show up on a chest x ray ?fluffy infiltrates might have a butterfly/ batwing pattern
how would atelectasis show up on chest x ray?patchy or platelike infiltrates
how would ARDS or IRDS show up on chest x ray ?ground glass appearance, honeycomb pattern, diffuse bilateral radiopacity
how would pleural effusion show up on chest x ray?concave superior interface/border or basilar infiltrates with meniscus
Air (low density)Black (radiolucent), passes through body and allows for more penetration
Waterdensities 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
FatShades of gray
Heart, diaphragm, & major vesselsconsidered to have the density of water. Do not change in density but may change in size, shape, & position.
Lung consolidationIncrease 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 BlebsDecrease lung density absorb fewer x-ray and result in darker areas on the film.
Distance from filmImportant to consider, the closer the patient is to the source, the greater the magnification and distortion of objects seen.
Indications for X-RayAssist 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 viewinto the Posterior threw to the Anterior
LateralSide view (generally left) provides cardiac magnification and a sharper view of LLL.
Lateral decubitus viewPt 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 viewProjection is made at a 45-degree tube angulation. Sometimes required for a closer look at the RML or apices of the lung.
Oblique viewshelpful in delineating a pulmonary or mediastinal lesion from structures that override it on the PA & lateral views.
PneumotharaxThe only time you do an expiatory film.
APFilm 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 evaluationETT (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 filmToracentesis, Pericardiocentesis, Bronch
CTscanComputed enhancement of x-ray shadows to give clearer look @ internal anatomy.
CT scan & Lung TumorsSuperior to conventional x-ray can detect nodules 2-3mm. CT helps place biopsy needle to prevent pneumo.
CT scan & interstitial lung diseaseCan show considerable changes even when x-ray reads normal. Used selectively because of the high cost.
CT scan & AIDSEarly detection of pneumonia that occur as a result of AIDS.
CT scan & Occupational lungHelpful in identifying changes in the pleura & lung parenchyma.
CT scan & PneumoniaRestricted use because of cost but they can detect pneumonia sooner.
CT scan & BronchiectasisHas replaced the invasive use of bronchogram. CT scan can detect early.
CT scan & COPDEmphysema shown clear and detailed. Dx consistently in the high 90%
MRIUsed 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 scanPositron emission tomography, Used to Dx and stage cancers. The compound is injected into a vein, malignant cells show >metabolic rates.
Pulmonary AngiographyUsed 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) airwaysTracheal mid line, carina, main stem bronchi, air bronchogram(occur with alveolar filling)
(B) bonesClavicles equal, ribs, scapulae, spine
© CardiacCardio-thoracic ratio 1/3 on PA ½ on AP, cardiac borders, aortic arch and vessels, cardio costophrenic angle. diaphragm
Silhouette signInfiltrates 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 bronchogramPatent airway w/ deep lung consolidation.
Compressive AtelectasisSeen in pt w/ pleural effusion, pneumothorax, hemothorax, & any space-occupying lesion.
Obstructive AtelectasisBlockage of the airway, the absence of ventilation. Tumor, aspirated foreign body, fibrosis, mucus plug, mechanical obstruction, & scaring. Trachea and heart shifts toward.
X-ray & AtelectasisShift of the fissure toward, movement of hilar toward, the overall loss of volume, hemidiaphragm elevation.
X-ray & PnumothoraxHyperlucency 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 HyperinflationCOPD can be read as normal if mild, mod-severe large lung volumes, depressed diaphragm, small narrow heart, enlarged intercostal spaces.
X-ray Interstitial lung diseaseAlveolar 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 & CHF1- 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