XRAY questions
what is the most common view used for he critically ill patient?
AP
What causes the x-ray film to be black or white?
An unexposed x-ray film is housed in a lightproof cassette, sandwiched between two phosphorescent screens. X-rays hit the phosphorescent screens, the screens give off light, and the light exposes the film. Heavy light exposure (e.g., through radiolucent lung) precipitates much silver, which causes the film to be black. Little light exposure (e.g., through radiodense bone) precipitates little silver, which causes the film to be white. Film is now being replaced by sophisticated digital receptors that offer many advantages; however, the basic image formation remains the same. Digital data are more flexible; data can be transmitted, stored, and processed to alter contrast and brightness.
The BEST determination of a Silhouette Sign would be comparing which of the following: Contrasting the P-A from the lateral view. Areas that have like radio densities. The opposite extremes of radio dendities. Contrasting the P-A with the A-P view.
Areas that have like radio densities.
When observing the hilar region within the lungs we will find it:
Around the fissures of the lungs.
If a Sihouette Sign is determined on the CXRay the characteristics would be:
Blunting and disappearing of local or diffuse features like the heart, aorta, trachea and diaphragm.
When approaching the A-P or P-A view, the reader should take which approach to evaluating the two different films?
Both should be viewed from the front (anterior).
Which imaging has the best contrast discrimination?
CT
A pseudo-silhouette sign of the diaphragm may occur on a perfectly penetrated CXR.
F
An image parallel to the patient's lateral plane is a(n) oblique image.
F
CT scanner is expressed in Hounsfield units and calibrated so pure water is(-)800 HU.
F
Conventional radiograph distinguish four basic densities; air, water, fat, metal.
F
During CT the patient is supine on a mobile table that passes through a cylinder tunnel or gantry.
F
Loculated pericardial infection would be heterogeneous and of low echogenicity.
F
On the lateral CXR, the heart normally obscures the right diaphragm anteriorly.
F
The Silhouette Sign is a normal sign that depict the adjacent anatomical structures clearly.
F
Though MRI scans are more graphic and detailed, they are less common because of the amount of radiation that passes through the patient?
F
Lobar PNA is often due to infection.
F, bacterial
On CT-scan axial view, what do the lines from the medial view hilum that extend uninterrupted to the outer edges parietal lining represent?
Fissures between lobes.
How does contrast enhance the CT taken of the patient?
It has a fluorescent iodine structure that "light up" vessels.
What importance role does the azygos fissure play in lobar anatomy?
It has little importance to the reader.
What does the fissure of the left lung separate?
LUL and LLL
When doing a left lateral image the _______________ of the patients position is MOST commonly pressed against the cassette.
Left
On the lateral, which is routinely taken with the [right/left] side against the cassette, a right-sided nodule appears [larger/smaller] than an identical left-sided nodule
Left and larger
The first step in observing a chest x-ray is to:
Locate all anatomical features.
What has a radiopaque line that is seen along the carina via the esophagus that lies behind but can be identified by further travel to the abdomen.
OG tube
The fissures of the right lung separate?
RUL and RML RLL and RML
What does the term "Scattered" refer to?
Scattered occurs due to photon beams being deflected away from the receptor.
If pleural fluid enters a fissure, the fissure thickens.
T
PET scans rely on the injection of an isotope joined to a carrier.
T
Fluid is bright on
T2
The Posterior-Anterior (P-A) view is MOSTLY preferred due which of the following:
The affects of gravity on fluid.
If a patient is turned slightly to the left, the right heart border may not be seen because?
The heart border is obscured the dense spine
Computed Tomography is most commonly used for detailed images and this is achieved by which of the following technology?
The images are taken in slices as the patient passes through the tube.
A normally exposed CXRay can be identifiable by which following rule:
The vertebrae should be seen behind the heart shadow.
How is (SS) best controlled?
Thin plated metal and wooden strips that create a grid to reach the receptor.
What is the importance of scanning the liver and stomach when viewing a CXR?
To distinguish between upper abdominal pathology from pulmonary pathology.
Why is the lateral view beneficial in radiological interpretation?
To identify potential lesions behind the heart or near the diaphragm.
Many times, people will find their own way to read CXR's but a formal approach would start with?
abdomen and move upwards
When the lung is consolidated and the bronchi contain air, the dense lung delineates the air filled bronchi. Visualization of air in the intrapulmonary bronchi on a chest roentgenogram is called the air bronchogram sign. The presence of the air bronchogram indicates ______
alveolar consolidation
because bronchi have very thin walls, contain air, and are surrounded by air filled alveoli, the intraparenchymal bronchi ____ visible on a normal CXR
are not
MRI and US permits evaluation of dynamic physiologic process such as
blood flow, and cardiac motion
When observing the most common axial position of the CT-scan the film or view will appear:
circular slides
he Posterior-Anterior (P-A) view is done in the _____________ position
erect
radiography and CT use x rays. By convention, the synthesized CT image of the normal lung is black due to the lung being radiodense.
f
to visualize the bronchi, we used to instill an opaque material iodinated oil into the bronchial lumen. The positive contract bronchogram is seldom performed now because patients ____ having thick oily goop dumped into their bronchi
hated
Loculated pericardial infection would be heterogeneous and of ____________ echogenicity.
high
US of a pericardial effusion would be expected to be?
homogeneous
What would the CXR appear like if it is overexposed?
hyper-radiolucent
The reader most times prefer the CXR to be executed during INSPIRATION/EXPIRATION.
inspiration
All of the following are considered radio densities found in the thorax EXCEPT: soft tissue integumentary fat bone
integumentary
The alveoli are vessels, lymphatics, bronchi, and connective tissue. This support framework is known collectively as the ____________ of the lung
interstisium
What is usually inserted through the left femoral artery ascending up to the aortic knob and terminates just below this structure. The radiopaque tip should terminate just beyond the left subclavian artery.
intra-aortic ballon pump
How do fissures and septums help the reader identify a disease process?
it will create the border for a localized consolidated lobe.
During expiration lung markings become more crowded making the lungs appear
larger
It is often difficult to detect a lesion located behind the heart, near the mediastinum, or near the diaphragm on the PA view. The _____________ view generally shows such a lesion, so we use it routinely
lateral
When a patient turns from the straight PA to the right anterior oblique position, different anatomic structures move in different directions. In the right anterior oblique, the left pectoralis muscle or breast (anterior structure) moves [medially/laterally], and the left scapula (posterior structure) moves [medially/ laterally], relative to the thorax. The opposite occurs in the left anterior oblique.
laterally and medially
One of the most common lines seen during CXR?
lead lines
The bifurcation of the trachea is the carina and the RIGHT/LEFT mainstem will have a sharper angle where foreign objects will not most likely fall into.
left
Under penetration the CXR will appear
light
What are the fissures of the left lung?
major
What fissures can be seen by the axial view of a CT scan?
major
What are the fissures of the right lung? accessory minor septum major
minor and major
The denser the tissue the MORE/LESS it will absorb giving it a DARKER/LIGHTER appearance to the reader.
more and lighter
the best approach in order to evaluate fissures would be the:
parallel View
Once the CXR has been processed all of the following may be the biggest challenges for successful interpretation EXCEPT: Patient positioning. Exposure during expiration. Pleural fluid blunting. Over or underexposed film.
pleural fluid blunting
The two linings that wrap around the entire lungs within the thorax is known as the:
pleural lining
All of the following reasons are important to reading CXR lobar anatomy EXCEPT: Pre and post intubation. Postural drainage Radiation therapy Bronchoscopy planning
pre and post intubation
A tumor is typically
radiodence
What would a CXR appear like if it is underexposed?
radioopeque
The term used to identify structures or disease processes is:
superimposed
On a CT the bronchi are normally visible through much of the lung
t
________________________ runs obliquely downward from approximately the level of the fifth thoracic vertebra to the diaphragm
the major fissure
What is the general difference between the right lung and the left lung overall?
the right is bigger than the left in size due to other anatomical structures.
When viewing the anterior aspect of the axial positioning for CT-scanning the first thoracic structure to be seen would be:
the thymus
There are people that have a left minor fissure between the lingula and the rest of the upper lobe on the left.
true
The interlobar fissure or septum is the space between the lobes where the ____________ pleural surface touches.
visceral
The two linings that wrap around the entire lungs within the thorax is known as the: Hilar lining. Visceral lining. Diaphramatic lining. Pleural lining.
visceral lining and pleural lining
Soft tissue and air density are involved in the air bronchogram and silhouette sign. If an air-filled bronchus is to be seen, it must be surrounded by ____________ density. Conversely, if a pulmonary vessel is to be seen, it must be surrounded by _________. Not seeing the lung vessels is a variation of the silhouette sign.
water (soft tissue), increased (air)
The linear making seem in the lungs are basically blood vessels, which are
water density (soft tissue)
During expiration in unilateral air trapping, a normal deflated lung appears
whiter
