Chest Radiography 2/25/2010jh. CXR Different tissues in our body absorb X-rays in different amounts...
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Transcript of Chest Radiography 2/25/2010jh. CXR Different tissues in our body absorb X-rays in different amounts...
CXR
•Different tissues in our body absorb X-rays in different amounts:–Radiolucent- (see through) Black
–Radiopaque (dense) White
2/25/2010jh
Indications
• Pulmonary work up –ABG, PFT, CXR, H and P
•Diagnose Disease•Determine Therapy •Evaluate Tx •Placement of invasive lines •Determine progression of Disease
2/25/2010jh
CXR Views
•PA – the x-rays
penetrate through the back of the patient on to the film
–Standard
2/25/2010jh
CXR Views
•AP-– the x-rays penetrate
through the front of the patient on to the film
–PORTABLE
2/25/2010jh
Computed Tomography
• The use of computers with tomography results in very fine detail.
• The cost of CT is much higher than that of a conventional chest x-ray
2/25/2010jh
Angiography
• An angiography is an x-ray of an artery or arteries in the body.
• Used to determine pulmonary embolism
2/25/2010jh
Fluoroscopy
• Live X ray• An x-ray procedure that makes it
possible to see internal organs in motion.
• Fluoroscopy uses x-ray to produce real-time video images.
• Murrugun The Mystic - Sword Swallowing Fluoroscopy - YouTube
2/25/2010jh
Evaluating Chest X rays…Be systematic:
1)Check the quality of the film
2)Check position 3)Check inspiration 4)Check Technique 5)Check Name!!!6)Evaluate lung fields
2/25/2010jh
X-ray Evaluation
• Place the chest film on the view box as if the patient were facing the clinician
– i.e., the right side of the patient’s chest is on the clinician’s left,• Cardiac shadow on left side of
chest
• X-rays are often marked R or Lhttp://www.youtube.com/watch?v=qAjEJZ-mQvQ
2/25/2010jh
Quality (cont.)
• Check to see if the film over or under penetrated
• Properly penetrated chest radiograph is one which the vertebral bodies can be seen
2/25/2010jh
An under-penetrated chest x-ray does not differentiate the vertebral bodies from the intervertebral spaces
An over-penetrated film shows the intervertebral spaces very distinctly
2/25/2010jh
Quality (cont)
• Check for rotation
• Does the thoracic spine align in the center of the sternum and between the clavicles?
• Are the clavicles level?
2/25/2010jh
Verify Right and Left sides
2/25/2010jh
•Gastric bubble should be on the left.
•Heart should be on the left
Now you are ready
• Look at the diaphragm:abnormal elevation
• Margins should be sharp
(the right hemidiaphragm is usually
slightly higher than the left)
2/25/2010jh
Check the Heart
• Size
• Shape
• Silhouette-margins should be sharp
• Diameter (>1/2 thoracic diameter is enlarged heart)
Remember: AP views make heart appear
larger than it actually is.2/25/2010jh
Cardiac Silhouette
1. R Atrium2. R Ventricle3. Apex of L Ventricle
4. Superior Vena Cava5. Inferior Vena Cava6. Tricuspid Valve
7. Pulmonary Valve8. Pulmonary Trunk9. R PA 10. L PA2/25/2010jh
Finally, Check the Lung Fields
• Infiltrates
• Increased interstitial markings
• Masses
• Absence of normal margins
• Air bronchograms
• Increased vascularity
2/25/2010jh
Hyperinflation
• Often due to obstructive lung disease– Increased A/P diameter, flattening of
diaphragm, large airspace.
2/25/2010jh
Congestive Heart Failure
• Large heart
• Fluid collection in vasculature and gravity dependent portions
• Kerly’s B lines
2/25/2010jh