CVR - X-rays

Question 1

What do the different colours in an X-ray show?

Answer 1

White = bone
White/grey = water
Grey = fat
Black = air
White = metal

Question 2

What are the types of X-ray views you can have?

Answer 2

AP = anteroposterior
- a beam passes through the chest from front to back. portable CXRs performed at bedside
PA = posteroanterior
- a beam passes through the chest from back to front. the patient must stand whilst CXR is taken

Question 3

When checking a patients X-ray, what approach should you take?

Answer 3

Check:
 - patients name, DOB. hospital no
 - note X-ray time and date
 - note the view/ projection (AP, PA or lateral)
Exposure:
 - overexposed = black
 - under expossed = white
State of inspirtaion:
 - count the ribs
 - on full inspiration, midpoint of right hemidiaphragm lies between 5-7 ribs anteriorely and 8-10 ribs posteriorely

Question 4

What is the ABCDE approach with X-rays?

Answer 4

Airways
Bones
Cardiac
Diaphragm
Everything
 - exposure
 - lung fields
 - soft tissue
 - lines/airways

Question 5

On an X-ray, what do you look at for the airways?

Answer 5

Can the trachea be seen, and is it central?

Question 6

On an X-ray, what do you look at for the bones and soft tissues?

Answer 6

• Clavicular level
• Rib markings (fractures)
• Identify the scapula borders
• Vertebral and spinous processes
• Breast shadows
• Surgical emphysema under the skin

Question 7

On an X-ray, what do you look at for the cardiac section?

Answer 7

Heart:

1. Position
   - extended slightly to midline
2. Size
   - in right ventricular hypertrophy, the heart is enlarged
   - a rounded heart mat indicate pericardial effusion
3. Heart borders
   - Lt lower lobe = left hemidiaphragm
   - Rt lower lobe = right hemidiaphragm
   - Lt upper lobe = aortic arch
   - Rt upper lobe = right upper mediastinum

Question 8

On an X-ray, what do you look at for the diaphragm section?

Answer 8

The diaphragm should be level with 6th rib anteriorely
Should be domed shaped and smooth
Flattened diaphragm is caused by hyperinflation
Tenting is caused by excess gas in the stomach, paralysed hemi-diaphragm

Question 9

On an X-ray, what do you look at for the ‘everything else’ section?

Answer 9

• Snowstorm appearance indicates acute respiratory distress syndrome
• Unilateral white out caused by lung collapse or large pleural effusion
• Chest drains, tracheostomy, ECG leads

Question 10

Describe the following lung volume definitions:

• Tidal volume
• Inspiratory reserve volume
• Expiratory reserve volume
• Residual volume
• Minimal volume

Answer 10

• Tidal volume = vol of air inhaled/exhaled in one breath
• Inspiratory reserve volume = max amount of air inspired on top of normal tidal inspiration
• Expiratory reserve volume = max amount of air exhaled following normal tidal expiration
• Residual volume = vol of air remaining in the lung after a maximal expiration
• Minimal volume = amount of air that would remain if the lungs had collapsed

Question 11

What is FEV1?

Answer 11

Forced expiratory vol in 1 second
The volume of air that the patient is able to exhale in the first second of forced expiration starting from full inspiration

Question 12

What is FVC?

Answer 12

Forced Vital Capacity

The total volume of air that the patient can forcibly exhale in one breath after full inspiration