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APDx Ch.9

WillWallace APDx Ch.9

Air (low density) Black (radiolucent), passes threw body and allows for more penetration
Water Water densities result in less exposure and therefore whitish-gray shadows on film
Bone (high density) includes ribs, clavicles,scapulae, and vertebrae. White, calcium (radiopaque) allows for less penetration
Fat Shades of gray
Heart, diaphragm, & major vessels considered to have the density of water. Do not change in density but may change in size, shape, & position.
Lung consolidation Increase in density because of pneumonias, tumor, or collapse, that area will absorb more x-ray and appear as a white patch on the film.
Cavities and Blebs Decrease lung density absorb fewer x-ray and result in darker areas on film.
Distance from film Important to conceder, the closer the the patient is to the source, the greater the magnification and distortion of objects seen.
Indications for X-Ray Assist in Dx of lung pathology, determining appropriate Tx, evaluating effective Tx, tracking the progress of lung disease, determining position of tubes and lines.
Posteroanterior PA view into the Posterior threw to the Anterior
Lateral Side view (generally left) provides cardiac magnification and a sharper view of LLL.
Lateral decubitus view Pt laying on the right or left side to see whether free fluid (plural effusion or blood) is present in the chest. Can help w pnumothorax (air rises and fluid drops).
Apical lordotic view Projection is made at a 45 degree tube angulation. Sometimes required for closer look at the RML or apicies of the lung.
Oblique views helpful in delineating a pul or mediastinal lesion from structures that override it on the PA & lateral views.
Pneumotharax The only time you do an expiatory film.
AP Film cassette placed behind pt back, chest x-ray passes from front (anterior) to back (posterior). Used for bedside x-ray's.
Post procedural x-ray evaluation ETT (radiopaque strip 2 in Above carina), central (R or L subclavian or jugular vein, rest in sup vena cavae & RAtrium), swanz (check position on a daily basis in the pul artery), picc, Nasogastric (stomach, small bowel), chest tube (tip of tube posterio
Procedures requiring AP film Toracentesis, Pericardiocentesis, Bronch
CTscan Computed enhancement of x-ray shadows to give clearer look @ internal anatomy.
CTscan & Lung Tumors Superior to conventional x-ray can detect nodules 2-3mm. CT helps place biopsy needle to prevent pnumo.
CTscan & interstitial lung disease Can show considerable changes even when x-ray reads normal. Used selectively because of high cost.
CTscan & AIDS Early detection of pneumonias that occur as a result of AIDS.
CTscan & Occupational lung Helpful in identifying changes in the pleura & lung parenchyma.
CTscan & Pneumonia Restricted use because of cost but they can decect pneumonia sooner.
CTscan & Bronchiectasis Has replaced invasive use of bronchogram. CTscan can detect early.
CTscan & COPD Emphysema shown clear and detailed. Dx consistently in the high 90%
MRI Used in the evaluation of the hilar. Can better see hilar lymph node enlargement from enlarged hilar blood vessels than is CT. Also, better at seeing chest wall invasion by lung cancer specifically Pancoast tumor or superior sulcus tumor.
Lung scanning (V/Q scan) obtained by measuring gamma radiation emitted from chest after injected into bloodstream or inhaled. Useful to evaluate possible P.E. Results often inconclusive and are only suggestive.
PET scan Positron emission tomography, Used to Dx and stage cancers. Compound is injected into a vein, malignant cells show >metabolic rates.
Pulmonary Angiography Used to evaluate thromboembolic disease only used if V/Q scan results are uncertain definitive dx.
X-ray interpretation (A) airways, (B) bones, © cardiac, (D) diaphragm, (E) extras.
(A) airways Tracheal mid line, carina,main stem bronchi, air bronchogram(occur with alveolar filling)
(B) bones Clavicles equal, ribs, scapulae, spine
© Cardiac Cardio-thoracic ratio 1/3 on PA ½ on AP, cardiac borders, aortic arch and vessels, cardio phrinic angle. diaphragm
Silhouette sign Infiltrates in the lung will blur the edges of the heart or the diaphragm where the infiltrate touches them. This helps to locate w better precision where the infiltrates located.
Air bronchogram Patent airway w/ deep lung consolidation.
Compressive Atelectasis Seen in pt w/ pleural effusion, pneumo, hemo, & any space-occupying lesion.
Obstructive Atelectasis Blockage of airway, absence of ventilation. Tumor, aspirated forign body, fibrosis, mucus plug, mechanical obstruction, & scaring. Trachea and heart shifts toward.
X-ray & Atelectasis Shift of the fissure toward, movement of hilar toward, overall loss of volume, hemidiaphragm elevation.
X-ray & Pnumothorax Hyperlucency on the affected side, shift of the mediastinal away from the air-filled pleural space. Trachea shift away. <blood flow, <good lungs ability to oxygenate.
X-ray and Hyperinflation COPD, can be red as normal if mild, mod-severe large lung volumes, depressed diaphragm, small narrow heart, enlarged intercostal spaces.
X-ray Interstitial lung disease Alveolar pattern may lead to air bronchogramsas a result of alveolar spaces becoming infiltrated and denser, the air filled airway is clear and dark, the contrast between the two appear as ground glass.
X-ray & CHF 1- redistribution of pul vasculature to the UL (normally in LL) 2- Cardiomegaly 3- Kerley's B lines(1-2cm) usually seen in right base, they are pleural lymphatic vessels filled w/ fluid 4- Misc. >interstitial markings, plural effusion in R hemithorax, En
Created by: MK602