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Primary Care RadiologyX-Ray Initial Evaluation

WorkshopChest X-Ray Interpretation

Delwin B Jacoby, DNP, APRN, FNP-C, PNP-C, AGN-CUniversity of Kentucky College of Medicine, Department of Pediatrics,

Division of Genetics & MetabolismBaby Health Service

The author has no conflict of interest nor financial interest regarding any

content within this presentation.

Conflict of Interest Statement

This talk is presented in memory of

Robert Becher… father, husband, friend

Primary Care Radiology - ObjectivesUpon completion of this presentation the learner will

be able to:1. Review the basic physics and historical perspectives

associated with radiographic examination.2. Identify the 4 basic radiographic densities and their

significance.3. Discuss the importance of multiple views in

radiologic interpretation.4. Identify normal radiographic anatomy of the chest

and common plain bones.5. Interpret common radiographic findings

encountered in primary care such as lung infiltrates, masses, common fractures, foreign bodies and others.

Wilhelm Roentgen

German physicist

1895

Discovered “x-rays”

Early X-ray - Bertha Roentgen

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Electromagnetic Spectrum 4 Basic Densities on Radiograph

Fat

BoneAirAir

Soft Tissue

Air – absorbs little radiation –black

Fat - gray, darker than muscle

Bone – most dense thus white

Water (Soft tissue/blood) – gray, but lighter than fat.

Remember – where different densities intersect an

interface will exist

Chest Films - Projections

• PA Upright vs Supine• Lateral• AP

Ideal is PA and lateral - Upright

PA vs AP View – Chest X-Ray

PA vs AP View - Chest X-Ray Chest x-ray – Ordering the Film

•Remember – Give the radiologist a brief history.

•Order the type of study with desired views

•Remember – The radiologist is a consult, specialist, colleague and friend.

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Chest X-rays• Remember – x-rays are a 2 dimensional

view of a 3 dimensional object,so ………………………… “1 view is 1 too few.”

Technical Considerations• Exposure

• Overexposed – film too dark• Underexposed – film too light• Perfect –thoracic vertebra should be seen (should see 4

spinous processes)

• Good Inspiration• 6 anterior ribs• 10 posterior ribs

• Rotation• T-spine center of sternum• Clavicles level

Steps in Chest X-Ray Interpretation1. Identify correct pt, correct

view, correct date.2. View x-ray as if the patient is

standing and looking at the provider.

3. Check exposure.4. Chest inspiration.5. Check rotation.

Radiographic Anatomy – Chest PA

Radiographic Anatomy – Lateral Chest Radiographic Anatomy

1. Trachea2. Right main stem bronchi3. Left main stem bronchi4. Left pulmonary artery5. Right Pulmonary artery6. Right Pulmonary artery7. Vertebra8. Aortic knob9. Manubrium of sternum10. Superior vena cava11. Carina12. Right atria cardiac border13. Vertebrae14. Left ventricle cardiac border15. Left hemi-diaphragm16. Right hemi-diaphragm17. Right- Liver17. Left - Stomach

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Practice the Anatomy Practice the Anatomy

Practice the Anatomy ABC’s of Chest X-Ray Interpretation

• A – Airway• B – Bones• C – Cardiac• D – Diaphragm• E – Edges• F – Fields• G – Guts• H – Hilum• I - Interpretation

Normal Normal

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Normal Chest

Lung Radiographic Anatomy

Lung Radiographic Anatomy Infiltrate

Infiltrate Infiltrate

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Pneumothorax Pneumothorax

Pneumothorax Pneumothorax

Pleural Effusion Pleural Effusion

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Pleural Effusion Pleural Effusion

Pleural Effusion Foreign Body

Mass Chest Chest Mass

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Chest Mass Barrel Chest

Atelectasis

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