chest x-rays

Question 1

what medium appears black on an x-ray?

Answer 1

air

Question 2

what medium appears dark grey on an x-ray?

Answer 2

fat

Question 3

what medium appears light grey on an x-ray?

Answer 3

soft tissue

Question 4

what medium appears white on an x-ray?

Answer 4

bone/fluid

Question 5

what medium appears bright white on an x-ray?

Answer 5

metal

Question 6

what are the uses of x-rays?

Answer 6

• Identify lung pathology e.g. fluid, infection, pneumothorax
• Identify bowel pathology e.g. pneumoperitoneum
• Identify foreign objects
• Confirm placement of lines and tubes

Question 7

how do you intepret an x-ray?

Answer 7

• Details
• RIPE
• ABCDE

Question 8

what details do you need to check on an x-ray?

Answer 8

• Check patient ID
• Check date/time of image
• Any previous imaging?

Question 9

what does RIPE stand for?

Answer 9

• Rotation
• Inspiration
• Projection
• Exposure

Question 10

what do you look for in rotation?

Answer 10

• Medial aspect of each clavicle in relation to the spinous process – should be equidistant
• Spinous process vertically orientated against vertebral bodies

Question 11

what do you check for in inspiration?

Answer 11

• 5-6 anterior ribs

* Lung apices, costophrenic angles and lateral rib edges should be visible

Question 12

how can you tell if an x-ray is AP or PA?

Answer 12

• If the scapula aren’t projected on the film it’s PA

Question 13

what do you look for in exposure?

Answer 13

• Left hemidiaphragm visible to the spine

* Vertebrae visible behind the heart

Question 14

what does ABCDE stand for?

Answer 14

• Airways
• Breathing
• Circulation
• Diaphragm
• Everything else

Question 15

what do you check for with the airways?

Answer 15

• Trachea and bronchi visible – branches at the carina

* Trachea passes down right hand side of aorta

Question 16

how does an airway get pushed?

Answer 16

increase in volume or pressure on one side (ipsilateral) pushes it towards to the opposite (contralateral) side.

Question 17

what causes an airway to get pushed to one side?

Answer 17

Mass, Effusion, Tension pneumothorax

Question 18

how does an airway get pulled?

Answer 18

decrease in volume or pressure on one side (ipsilateral) pulls it towards to the same (ipsilateral) side.

Question 19

what causes an airway to be pulled?

Answer 19

collapse

Question 20

how is breathing described?

Answer 20

at zones on radiographs

Question 21

where should lung markings be visible?

Answer 21

should occupy entire field to thoracic wall

Question 22

when should pleura and pleural space be visible?

Answer 22

only in abnormality

Question 23

how should the diaphragm look?

Answer 23

higher on the right

Question 24

what things do you look for in “everything else”?

Answer 24

• Bones – fractures, lesions
• Tubes – ETT, NGT, CVC
• Artificial valves
• Pacemaker – usually left-sided
• Thoracotomy wires
• Soft tissue – effusion, haematoma, emphysema

Question 25

what are features of COPD?

Answer 25

* Hyperinflation * Flattened hemidiaphragms * Bullae