Chest Imaging

Question 1

Chest Exposure Factors and Rationale

Answer 1

**110-125 kVp **- need low contrast imaging to see small attenuation differences between structures
**400 mA **- allows for short exposure times
0.02-0.1s - minimise chance of involuntary movement artefact
Grid - reduces scatter radiation - lots of matter

Question 2

Chest projections

Answer 2

PA
- patient stands facing erect bucky
- hands on hips or hug bucky to clear scapula from image
- lean forward and push shoulders into bucky so chest in contact with the IR
- instruct patient to hold breath and take x-ray
- beam collimated to size of IR, include top of shoulders
- 180 cm FRD
- centre midline

**Lateral **
- hands above head, typically left side touching IR or side with most pathological feature
- patient leaning slightly forwards to bring thorax vertically
- centre midway between sternum and posterior ribs anteroposteriorly

AP Erect (Trauma)
- IR placed behind back
- posterior aspect of chest in contact with IR
- arms abducted and internally rotated as much as possible
- caudal tube angle 5 degrees
- centre middle of thorax

AP Supine (Trauma)
- chin raised
- arms abducted and internally rotated as much as possible
- IR placed beneath chest
- caudal tube angle 5 degrees
- 200cm FRD

Question 3

Rib projections

Answer 3

Rib View
- use oblique projection whose name describes the area of interest
- erect is preferred
- 45 degrees to IR
- arm on affected side is raised and placed over head, other arm by side
- centre midway between vertebral column and lateral border of ribs laterally; midway between superior aspect of first rip and costal margin

Question 4

Suspected Aortic Dissection

Answer 4

when wall of aorta is split and pressure of blood forces its way through layers of aorta
- critical

Question 5

Projections for Suspected Aortic Dissection and why

Answer 5

PA - if possible or can be done with other trauma views, to see if the pathology is present
Lateral - orthogonal view

Question 6

Radiographic appearance of suspected aortic dissection

Answer 6

• widened mediastinum
• globular heart
• loss of counter of aortic knucle
• can sometimes be difficult to identify

Question 7

Suspected pulmonary embolism

Answer 7

when blood clot (embolus) is caught into pulmonary artery

Question 8

Projections for suspected pulmonary embolism and why

Answer 8

PA - full view of the chest, see where there could be possible embolism
Lateral - orthogonal viewing

Question 9

Radiographic appearance of suspected pulmonary embolism

Answer 9

• the lung appears to be dying off due to blood clot
• part of the lung is more white
• uneven density of the lung

Question 10

Heart Failure

Answer 10

Fluid in the lungs when blood not pumped efficiently

Question 11

Projections for heart failure and why

Answer 11

Erect AP - patient unlikely to stand, visualise all anatomy of thorax

Question 12

Radiographic appearance of Heart failure

Answer 12

• hazy appearance in x-ray
• heart appears big due to muscle not working efficiently

Question 13

Heart Valve Disease

Answer 13

issue with the heart valve, normally replaced surgically

Question 14

Projections of heart valve disease and why

Answer 14

PA - can be done post op to see positioning of the heart valve

Question 15

Radiographic appearance of heart valve disease

Answer 15

• artifical heart valve if post op
• wires from surgery in the heart

Question 16

Congenital Heart Disease

Answer 16

occuring in infants, structural problems with the heart that are present at birth, such as BIG heart

Question 17

Projections of congenital heart disease

Answer 17

PA - see the thorax anatomy

Question 18

Radiographic appearance of congenital heart disease

Answer 18

• heart appears big
• all chest anatomy

Question 19

Pneumonia (2 types)

Answer 19

Infection in the lungs; presence of pus, dead WBC accumulate and become pus
LOBAR = pneumonia isolated to one lobe or one part of lung
BRONCHO = widespread across the lung

Question 20

Projections for Pneumonia and why

Answer 20

PA - see what type of pneumonia it is and how widespread
LAT - orthogonal imaging, see the depth of the infection

Question 21

Radiographic appearance of pneumonia

Answer 21

Lobar - spotty appearance in one part of lung
Broncho - spotty appearance all across the lung

Question 22

Pleural Effusion

Answer 22

occurs outside of lung in pleural space and there is fluid (fluid in the lung)

Question 23

Projection of pleural effusion and why

Answer 23

PA erect - fluid levels can only be seen when erect or sitting

Question 24

Radiographic appearance of pleural effusion

Answer 24

• meniscus of fluid level
• fluid in pleural space looks more dense than fluid in lungs

Question 25

Cancer

Answer 25

uncontrolled growth and spread of abnormal cells primary - site of OG tumour secondary - OG tumour in another site but spreads throughout body

Question 26

Projections of cancer and why

Answer 26

PA - see where the cancer has spread to or where it is in the lung

Question 27

Radiographic appearance of cancer

Answer 27

hazy spots in the lung, in clusters

Question 28

Pneumothorax

Answer 28

Lung collapses from external pressure; air in pleural cavity

Question 29

Projections of pneumothorax and why

Answer 29

PA - see where the pneumothorax is in the lung and to to identify what kind, and severity of it (closed, open, tension)

Question 30

Radiographic appearance of pneumothorax

Answer 30

- uneven density in the lung - part of the long appears darker and there is a line that shows the edge of lung and air

Question 31

Fractured Ribs

Answer 31

fracture in the ribs

Question 32

Projections of fractured ribs and why

Answer 32

depending on where there is rib pain (upper or lower), do PA and lateral to generally assess RIB views - to see anterior and posterior ribs , facing in and then out

Question 33

Radiographic appearance of fractured ribs

Answer 33

- fracture in the rib