SWATI VARA Contents How Xrays work Radiation Indications DR ABCDEFGHI Common conditions References How do Xrays work Xrays are electromagnetic waves Bone fat muscles and tumours ID: 539681
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Slide1
CHEST X-RAYS
SWATI VARASlide2
Contents
How X-rays work
RadiationIndications DR. ABCDEFGHICommon conditionsReferencesSlide3
How do X-rays work?
X-rays
are electromagnetic wavesBone, fat, muscles and tumours absorb X-rays at different levels
Dense structures = white e.g. boneAir filled = black e.g. lungsFluid = shades of greySlide4
Radiation
A
single chest x-ray exposes the patient to about 0.014 mSv – equivalent to three days of natural background radiationA mammogram exposes a woman to 0.4 mSv – equivalent to ~7 weeks of natural background radiationBenefit of detecting breast cancer outweighs the risk of problems from radiation exposure
A CT scan of the abdomen and pelvis exposes a person to about 10 mSv; this goes up to 20 mSv if the test is done twice (once with and once without contrast) – equivalent to 3 years and 7 years natural background radiation respectively Slide5
Indications for a CXR
Difficulty breathing
Persistent CoughSuspected infectionChest injuryChest painSigns of suspected lung cancer/lung diseaseSuspected heart failureCONTRAINDICATIONS
Pregnancy – take more of the radiation doseSlide6
IRMER
Ionising radiation medical exposure regulation
Before requesting an X-ray, must comply with IRMER regulations
RCR
Royal college radiologists have guidelines on requesting X-raysSlide7
First and foremost…
IDENTIFY THE PATIENT
NAME, D.O.B, M/FFILM TYPEDate and timeType of film - AP or PASlide8
2) Technical assessment
RIPE
R= RotationFind the spinous processes and medial end of the clavicles I= InspirationX-ray taken during inspirationSign of full inspiration = diaphragm is at level of 6th rib anteriorly P= Posture/picturePosture = Patient should be standing so that gas rises and fluid sinks
Picture = Vertebrae should be visible through the heartE= ExposureIf OVER-EXPOSED – structures will look dark and difficult to see the lung markingsIf UNDER-EXPOSED – structures will look pale and hard to see soft tissueSlide9
A=Airways: Tracheal deviation? Look for the carina
B=Bones and soft tissues: Ribs – 7 in midclavicular line, 8/9 posteriorly
Fractures, dislocations?Change in density – if white= bone metastases, if dark= osteoporosisLymph nodes, swellings?C=CardiacNormal site and size – no more than 50% cardiothoracic ratioBorders – Right atrium, Left atrium and ventricleVessels – calcification?Slide10
D=Diaphragm
Normal level: R. side slightly higher than left
Appearance: smooth and dome shapedAngles: cardiophrenic and costophrenicE= Effusions & edgesLung apices and basesBehind the heart
Under the diaphragmPericardial effusion/pleural effusionSlide11
F= Fields
Divide into zonesUpper = above 2
nd ribMiddle = between ribs 2-4Lower = 4th rib to diaphragmAny asymmetry?G= GasesGas under L. hemidiaphragm – normal
Gas under R. hemidiaphragm PneumoperitoneumBowel herniation through ruptured diaphragmSlide12
H = Hilum and mediastinum
L. hilum higher by ~ 2cmNormal hilum levels T6-T7
Changes in density and size?Mediastinum – Hodgkins lymphoma – mediastinal massI= InstrumentsPacemakersMetal workChest drainsCVP linesNG tubeECG electrodesSlide13
Common conditions
Pneumothorax
Pleural effusion
Pneumonia
Pericardial effusion
Pulmonary fibrosis
Lung
tumourSlide14
Pneumothorax
Abnormal collection of air/gas in pleural space
Lung collapses so the edges are visibleCausesSpontaneous – e.g tall males, Marfan syndromeSecondary to chronic lung disease – e.g. asthma, COPDIatrogenic – central line insertion, lung biopsy, mechanical ventilationInfections – pneumonia
TraumaTENSION PNEUMOTHORAX – requires immediate treatment!!Slide15
Pleural effusion
A collection
of fluid in the pleural spaceCauses:Exudates (high protein) e.g. infection and malignancyTransudates (low protein) –e.g. cardiac, renal and hepatic failure,
pancreatitisEmpyemaCan be a sign of underlying disease so investigate this!
Meniscus appearance and blunting of
c
ostophrenic
angleSlide16
Pericardial effusion
Abnormal fluid present in pericardial space
Causes:TraumaInflammationMalignancyAutoimmune conditionsCan lead to cardiac tamponade
Water bottle shaped heartSlide17
Pneumonia
Symptoms:
DyspnoeaProductive coughHaemoptysisFeverPleuritic chest painSigns:Local consolidation – coarse crackles, bronchial breathing and increased vocal resonanceSlide18
References
Au-Yong I, Au-Yong A, Broderick N. On-call x-rays made easy. Edinburgh: Churchill Livingstone/Elsevier; 2010.
Kumar PJ, Clark ML. Clinical medicine. 5th ed. Edinburgh: Saunders; 2002.Longmore JM. Oxford Handbook of clinical medicine. 9th ed. Oxford: Oxford University Press; 2014.NHS. Radiation. 29/01/2015; Available at: http://www.nhs.uk/Conditions/Radiation/Pages/Introduction.aspx. Accessed 09/23, 2015.