Basic Chest X-Ray Interpretation

Different tissues in our body absorb X-rays at different extents: Bone- high absorption (white) Tissue- somewhere in the middle absorption (grey) Air- low absorption (black)

Systematic CXR Interpretation IDENTIFICATION TECHNIQUE INTERPRETATION

Systematic CXR Interpretation IDENTIFICATION Correct patient Correct date & time Correct examination Right vs. Left side (gastric bubble) Comparison film.

Systematic CXR Interpretation IDENTIFICATION TECHNIQUE INTERPRETATION

Systematic CXR Interpretation TECHNIQUE Complete exam All views Entire anatomical area included.

Systematic CXR Interpretation TECHNIQUE, cont. Projection or Quality of the film: First determine is the film a PA or AP view. PA- the x-rays penetrate through the back of the patient on to the film. AP-the x-rays penetrate through the front of the patient on to the film. The width of heart & mediastinum larger on AP film. All x-rays in the ICU are portable and are AP view

Systematic CXR Interpretation TECHNIQUE, cont. Position Erect. Supine. Lateral position.

Systematic CXR Interpretation TECHNIQUE, cont. Penetration Over-penetrated dark films can obscure subtle pathologies. Under-penetrated white films may given impression of diffuse increased density.

Is the film over or under penetrated? If under penetrated you will not be able to see the thoracic vertebrae.

Systematic CXR Interpretation TECHNIQUE, cont. Adequacy (full Inspiration) Normal, erect, inspiratory CXR shows 9.5-10.5 posterior ribs. Less inspiration appears diffusely denser Diaphragms elevated causing heart & mediastinum to appear enlarged.

Systematic CXR Interpretation TECHNIQUE, cont. Rotation Determine by observing the equal distance between the medial clavicular head and the spinous process of the thoracic vertebral body.

Systematic CXR Interpretation IDENTIFICATION TECHNIQUE INTERPRETATION

Systematic CXR Interpretation Extraneous material Contrast Lines, tubes, clips All properly located? Bones Fracture, dislocation Mineralization Soft tissues Asymmetry Calcifications

Systematic CXR Interpretation Diaphragms & Below Free air Dilated bowel Abnormal position Lung fields & mediastinum Asymmetry , central mediastinum Consolidation (opacity), nodule or lesion Vascular marking. Heart Size & shape Cardiothoracic ratio

CONSOLIDATION

CONSOLIDATION

Congestive Heart Failure

TENSION PNEUMOTHORAX

Air under the diaphragm

ARTERIAL BLOOD GAS

Arterial Blood Gas Definition Blood gases is a measurement of how much oxygen (O2) and carbon dioxide (CO2) is in your blood. It also determines the acidity (pH) of your blood.

Arterial Blood Gas Why the Test is Performed ? To evaluate respiratory diseases and conditions that affect the lungs. It helps determine the effectiveness of oxygen therapy.

Arterial Blood Gas How the Test is Performed? Usually, blood is taken from an artery. The blood may be collected from the radial artery in the wrist, the femoral artery in the groin, or the brachial artery in the arm. May test circulation to the hand before taking a sample of blood from the wrist area. Insert a small needle through the skin into the artery (You can use (anesthesia) applied to the site before the test begins).

Arterial Blood Gas How the Test is Performed In rare cases, blood from a vein may be used. After the blood is taken, pressure is applied to the site for a few minutes to stop the bleeding. Watch the site for signs of bleeding or circulation problems. The sample must be quickly sent to a laboratory for analysis to ensure accurate results.

Arterial Blood Gas How to Prepare for the Test There is no special preparation. If you are on oxygen therapy, the oxygen concentration must remain constant for 20 minutes before the test.

Arterial Blood Gas How the Test Will Feel You may feel brief cramping or throbbing at the puncture site

Arterial Blood Gas Risks There is very little risk when the procedure is done correctly. Veins and arteries vary in size from one patient to another and from one side of the body to the other. Taking blood from some people may be more difficult than from others.

Arterial Blood Gas Other risks associated with this test may include: Bleeding at the puncture site Blood flow problems at puncture site (rare) Bruising at the puncture site Delayed bleeding at the puncture site Fainting or feeling light-headed Hematoma (blood accumulating under the skin) Infection (a slight risk any time the skin is broken)

Arterial Blood Gas