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Chest X-RayBasics of reading a Chest radiograph Initial assessment Lines/Tubes Approach (ABCDE tools)

Terms in this set (23)

○Initial assessment
○Lines/Tubes
○Approach (ABCDE tools)
●Name the 3 Basics of reading a Chest radiograph
○Pneumonia
●Pathology review on Chest X-ray (ADD PICS)
○Atelectasis
●Pathology review on Chest X-ray (ADD PICS)
○Pulmonary edema
●Pathology review on Chest X-ray (ADD PICS)
○Heart Failure
●Pathology review on Chest X-ray (ADD PICS)
○Pneumothorax
●Pathology review on Chest X-ray (ADD PICS)
○Pleural effusion
●Pathology review on Chest X-ray (ADD PICS)
○COPD
●Pathology review on Chest X-ray (ADD PICS)
◈CXR PA view: 3 days (2 view)

◈CXR PA/Lat: 18 days (3 view)

◈Helical CT: 2-3 years
◈Compare dose to normal background radiation you get everyday (3mSv/year)

CXR PA view: ____?
CXR PA/Lat: ____?
Helical CT: ____?
○Airway
○Breathing -- Pulmonary Vasculature, Lungs, Pleura,
Hila
○Circulation -- Heart, Mediastinum-aorta, trachea
○Densities -- Bone and Soft Tissue including abdomen
○Everything Else
●How to Review the Chest Image (ABCDE)
1. patient and technique - always first
-who, what, why, where, when...
-quality
-patient positioning
-how much radiation the technician used
2. Look for Line and Tubes
3. then review the image (ABCDE)
3 steps to systematically looking at a chest x-ray
PA - when patient comes down to the radiology department
- posterior to anterior
AP - portable exam
-shoot radiation from anterior to posterior
-issues: everything is enlarged
2 Standard chest x-ray exams ordered
Rotation - medial ends of clavicle equidistant from spinous process
Penetration - discs of thoracic spine should be visible
-ensuring technician uses enough penetration to get through the soft tissue
Inspiration - diaphragm at 10-11 posterior ribs on the left
-VERY IMPORTANT, pt has to take a deep breath in
-need to be able to see 10 posterior ribs
3 techniques to be used when performing a chest x-ray
1. cardiac monitor wires
2. oxygen tubing
3. NG (nasogastric tube) or (Endotracheal Tube)
5 examples of lines and tubes to look for before checking our ABCDEs
5 cm
how many cm does an endotracheal tube need to be from the carina?
Malpositioned endotracheal tube
this is an example of ?
left lung has no air, no heart border
-lung collapse
-Atelectasis (at-uh-LEK-tuh-sis) is a complete or partial collapse of the entire lung or area (lobe) of the lung

**could be Bad pneumonia, or pneumonectomy
look at image on the Right!
what has happened?
what is a sign/defining characteristic?
1. Trace down the trachea to the carina - is it straight & midline
-spinous process "dots" should be in the trachea
-medial clavicle position of trachea
-is there shift of the trachea?
-anything filling the chest can push the trachea away
2. look at the bronchi - is it narrowing or cutoff
-can you see any foreign bodies
What are the 2 techniques to checking the airway (A)
1. Both lungs well expanded and similar in volume
■10 posterior ribs?
2. Look at each lung separately, then compare.
3. Look at the margins into the costophrenic angles (where the lung ends at a point)
4. Look at the hemidiaphragms - have to be able to see differentiation, clean line
-if we can't see them, first sign of pleural effusion (fluid is sitting in there)
5. Cardiac borders are well-defined
-if we lose borders good indication of pnuemonia
5 Steps to Evaluate the lungs
● Assessment of the heart positioning and size
● Need to measure cardiac width then thoracic width
● Should be less than 50% of thoracic width
● Upper mediastinal contour
● Don't want aortic arch or trunk to be enlarge
● Hilar structures - find the dark triangles
Circulation (C) : 3 things to Evaluate the Heart and Mediastinum
○ Ribs for any fracture or bone lesions
○ Shoulders (acromioclavicular and glenohumeral joints)
○ Clavicles
○ Vertebral bodies (height loss)
● Evaluate all the osseous structures (D) - look at 4 things (there are more, but just what was on his slide
slightly bigger
on a portable AP chest x-ray, the heart can be ________ ________
atelectasis
collapsed lung; heart, trachea, and other structures move toward it
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