clinical application of the chest radiograph overview · 3 chapter 1 – anatomy of the respiratory...
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CHAPTER 1 – Anatomy of The Respiratory System
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Chapter 10 Clinical Application of the
Chest Radiograph
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Overview
Physics related to radiographs Standard and special views Techniques for interpreting the chest film Common pathologic abnormalities seen on
chest x-ray films
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Production of the Radiograph
X-rays: __________ ______ that radiate from a tube
that an electric current has passed through Tube made of a cathode attached to low-
voltage electron source (transformer) End of cathode wire is inside the vacuum-
sealed tube As electrons flow through the wire they
strike the anode
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CHAPTER 1 – Anatomy of The Respiratory System
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Indications for CXR Examination
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Radiographic Views
Standard views __________________ __________________
Special views ____________ ______________ ____________ ______________ ____________ ____________
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Anteroposterior View
___________ __________ __________ Film cassette placed _________________ X-ray beam moves from ______________
(anterior to posterior) 4 feet from beam’s origin More magnification artifact than PA chest x-ray
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Anteroposterior View (cont’d)
Indications for AP portable films _____________________________________
_____________________________________
__________________________________________________________________________
__________________________________________________________________________
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Postprocedural CXR Evaluation
________________ _______________ Thin radiopaque strip along entire length of
ETT Inferior tip of ETT ___ ___ ____ cm above the
carina Accidental placement in right mainstem or
esophagus must be recognized • ________________________ • ________________________ • ___________________________
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Postprocedural CXR Evaluation (cont’d)
_______________ ____________ ___________________ Placed in R or L subclavian vein or jugular vein Tip just above confluence of SVC and RA Accidental lung puncture must be recognized
• AP chest film required before initiating fluid therapy
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Postprocedural CXR Evaluation (cont’d)
________________ ______________ ___________________ Tip at the right midlung near the hilum Catheter is sutured into place if chest film
demonstrates proper position of catheter tip Accidental rupture of inflatable balloon may
rupture pulmonary artery • Area of pulmonary infarction on CXR
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Postprocedural CXR Evaluation (cont’d)
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Postprocedural CXR Evaluation (cont’d)
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________________________
________________________
________________________ After transtracheal biopsy or needle aspiration
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Computed Tomography
Mathematical modeling of tissues ______________ beams pass through tissue Slice of body equivalent to a slice of bread
_____________ _______ _________________________________
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Computed Tomography (cont’d)
Lung tumors Differentiate _______________ __________
or ___________________ As small as 2 to 3 mm
______________ _________________ _________________ Superior to conventional CXR
AIDS Early detection of pneumonias, abscesses, and
cavities
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Computed Tomography (cont’d)
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Magnetic Resonance Imaging
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Radionuclide Lung Scanning
_________ radiation emitted from the chest after radiopharmaceuticals injected into the bloodstream and inhaled into the lung
Evaluation of suspected_______________ ___________________ Normal ventilation and abnormal perfusion
Pneumonia and atelectasis _____________________________________
_____________________________________
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Positron Emission Tomography
Also called PET scan Determines metabolic activity of tissues Tumors and areas of infection have high
metabolic activity = _____ __________ Evaluation of ____________________
_______________________________
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Pulmonary Angiography
To evaluate _______________________ _________________________________
Performed after V/Q lung scanning is ______________________
Injection of contrast medium into _______________ ______________
CT angiography has reduced frequency of conventional angiography
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Evaluation of the Chest Radiograph
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Determine Quality of the Film
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Interpretation
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Silhouette Sign and Air Bronchogram
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Limitations of the Chest Radiograph
Small lesions may not be seen Often normal in patients with significant
respiratory symptoms ____________
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Clinical and Radiographic Findings in Lung Diseases
A H I C P C
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Atelectasis
Compressive atelectasis ____________________________________
____________________________________
If severe: __________ _______________ Obstructive atelectasis
___________________________________ Postoperative atelectasis
_________________________ CXR: lung volume loss, mediastinal shift
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Pneumothorax
Often causes atelectasis Tension pneumothorax
M T P
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Hyperinflation
Obstructive lung disease I L F
CXR neither sensitive nor specific for COPD Provides
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Interstitial Lung Disease
Substance activates patient’s immune system = ______ or _________________ Months to years
S Large hilar and paratracheal lymph nodes
A Calcified ___________ or ________________
___________________
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Interstitial Lung Disease (cont’d)
End-stage pulmonary fibrosis H
Bronchiectasis Large
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Congestive Heart Failure
Redistribution of pulmonary vasculature Engorgement of ________________________
________________________ Fluid collection in ____________ portions
of the lungs Increased cardiothoracic (C/T) ratio (>0.5)
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Congestive Heart Failure (cont’d)
Kerley’s B lines Right base, <1 mm thick, 1 to 2 cm long,
horizontal Miscellaneous signs
Increased ________________________ and/or _______________________________
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Pleural Effusion
Usually >_____ ml of fluid Small volume effusion:
Blunting of the _________________________ Small meniscus sign Partially ______________________________
____________________ Large volume effusion
_____________________________________ Complete obscuring of the ________________
__________ with _______________ __________________
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Consolidation
M L H A
See Figures 10-17 and 10-18
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Summary
Dense body tissue appears white on CXR (_______________); air-filled body tissue appears black (_________________)
Increasing ventilator pressures may indicate a ___________________ and should prompt an order for a CXR
CT scans show ____________ information using x-rays, but provide more detail and more specific information about _________________
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Summary (cont’d)
MRI uses a strong ________ _________ rather than x-rays to provide images of the body
V/Q lung scans helpful only if normal or highly suggestive for ____________ __________________
PET scan uses radioactively tagged sugar water injection to demonstrate _____________________ active tissue
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Summary (cont’d)
CXR interpretation requires evaluation of: Proper Proper Proper Systematic review of
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Summary (cont’d)
____________ ________ allows one to know whether a pulmonary opacity is touching the heart or diaphragm rather than residing in lung tissue anterior or posterior to those tissues
_____ __________________ suggest fluid in the lung tissue surrounding patent airways