CHAPTER 1 – Anatomy of The Respiratory System
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 lowvoltage electron source (transformer)
End of cathode wire is inside the vacuumsealed 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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CHAPTER 1 – Anatomy of The Respiratory System
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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CHAPTER 1 – Anatomy of The Respiratory System
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Postprocedural CXR Evaluation
(cont’d)

_______________ ____________
___________________
  Placed
in R or L subclavian vein or jugular vein
just above confluence of SVC and RA
  Accidental lung puncture must be recognized
•  AP chest film required before initiating fluid therapy
  Tip
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CHAPTER 1 – Anatomy of The Respiratory System
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CHAPTER 1 – Anatomy of The Respiratory System
Postprocedural CXR Evaluation
(cont’d)

________________ ______________
___________________
  Tip
at the right midlung near the hilum
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
  Catheter
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Postprocedural CXR Evaluation
(cont’d)
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CHAPTER 1 – Anatomy of The Respiratory System
Postprocedural CXR Evaluation
(cont’d)
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
________________________

________________________

________________________
  After
transtracheal biopsy or needle aspiration
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CHAPTER 1 – Anatomy of The Respiratory System
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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CHAPTER 1 – Anatomy of The Respiratory System
Computed Tomography (cont’d)
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Magnetic Resonance Imaging
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CHAPTER 1 – Anatomy of The Respiratory System
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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CHAPTER 1 – Anatomy of The Respiratory System
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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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CHAPTER 1 – Anatomy of The Respiratory System
Determine Quality of the Film
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Interpretation
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CHAPTER 1 – Anatomy of The Respiratory System
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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CHAPTER 1 – Anatomy of The Respiratory System
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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CHAPTER 1 – Anatomy of The Respiratory System
Pneumothorax


Often causes atelectasis
Tension pneumothorax
  M
  T
  P
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CHAPTER 1 – Anatomy of The Respiratory System
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

S

A
  Large
to years
hilar and paratracheal lymph nodes
  Calcified
___________ or ________________
___________________
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CHAPTER 1 – Anatomy of The Respiratory System
Interstitial Lung Disease (cont’d)

End-stage pulmonary fibrosis

Bronchiectasis
  H
  Large
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CHAPTER 1 – Anatomy of The Respiratory System
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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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CHAPTER 1 – Anatomy of The Respiratory System
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 _________________________
meniscus sign
  Partially ______________________________
____________________
  Small

Large volume effusion
  _____________________________________
  Complete

obscuring of the ________________
__________ with _______________
__________________
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CHAPTER 1 – Anatomy of The Respiratory System
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Consolidation




M
L
H
A
See Figures 10-17 and 10-18
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CHAPTER 1 – Anatomy of The Respiratory System
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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CHAPTER 1 – Anatomy of The Respiratory System
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
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