bbbbbbasic chest x-ray interpretation.ppt

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1. Basic Chest X-Ray
Interpretation

2. Different tissues in our body
absorb X-rays at different extents:
–Bone-high absorption (white)
–Tissue-somewhere in the middle
absorption (grey)
–Air-low absorption (black)

4. Systematic CXR Interpretation
•IDENTIFICATION
•TECHNIQUE
•INTERPRETATION

5. Systematic CXR Interpretation
•IDENTIFICATION
–Correct patient
–Correct date & time
–Correct examination
•Right vs. Left side (gastric bubble)
•Comparison film.

6. Systematic CXR Interpretation
•IDENTIFICATION
•TECHNIQUE
•INTERPRETATION

7. •TECHNIQUE
–Complete exam
•All views
•Entire anatomical area included.
Systematic CXR Interpretation

9. TECHNIQUE, cont.
–Projection or Quality of the film:
•First determine is the film a PAor APview.
•PA-the x-rays penetrate through the back of the
patient on to the film.
•AP-the x-rays penetrate through the front of the
patient on to the film.
The width of heart & mediastinumlarger on AP film.
•All x-rays in the ICU are portable and are AP
view
Systematic CXR Interpretation

10. TECHNIQUE, cont.
―Position
•Erect.
•Supine.
•Lateral position.
Systematic CXR Interpretation

12. Systematic CXR Interpretation
•TECHNIQUE, cont.
–Penetration
•Over-penetrated dark films can
obscure subtle pathologies.
•Under-penetrated white films
may given impression of diffuse
increased density.

13. Is the film overor under
penetrated?
•If under penetrated
you will notbe able
to see the thoracic
vertebrae.

14. •TECHNIQUE, cont.
―Adequacy (full Inspiration)
•Normal, erect, inspiratory CXR shows
9.5-10.5 posterior ribs.
•Less inspiration appears diffusely
denser
•Diaphragms elevated causing heart &
mediastinum to appear enlarged.
Systematic CXR Interpretation

16. Systematic CXR Interpretation
•TECHNIQUE, cont.
―Rotation
•Determine by observing the equal
distancebetween the medial clavicular
head and the spinous process of the
thoracic vertebral body.

18. Systematic CXR Interpretation
•IDENTIFICATION
•TECHNIQUE
•INTERPRETATION

19. INTERPRETATION
Extraneous material
Contrast
Lines, tubes, clips
All properly located?
Bones
Fracture, dislocation
Mineralization
Soft tissues
Asymmetry
Calcifications
Systematic CXR Interpretation

20. INTERPRETATION
Diaphragms & Below
Free air
Dilated bowel
Abnormal position
Lung fields & mediastinum
Asymmetry , central mediastinum
Consolidation (opacity), nodule or lesion
Vascular marking.
Heart
Size & shape
Cardiothoracic ratio
Systematic CXR Interpretation

23. CONSOLIDATION

24. CONSOLIDATION

25. Congestive Heart Failure

26. TENSION
PNEUMOTHORAX

29. Air under the diaphragm

31. ARTERIAL BLOOD GAS

32. Arterial Blood Gas
Definition
•Blood gases is a measurement of
how much oxygen (O2) and carbon
dioxide (CO2) is in your blood.
•It also determines the acidity (pH) of
your blood.

33. Arterial Blood Gas
Why the Test is Performed?
To evaluate respiratory diseases and
conditions that affect the lungs.
It helps determine the effectiveness
of oxygen therapy.

34. Arterial Blood Gas
How the Test is Performed?
Usually, blood is taken from an artery.
The blood may be collected from the radial
arteryin the wrist, the femoral artery in the
groin, or the brachial artery in the arm.
May test circulation to the hand before taking
a sample of blood from the wrist area.
Insert a small needle through the skin into the
artery
(You can use (anesthesia) applied to the site before the test
begins).

35. How the Test is Performed
In rare cases, blood from a vein may be used.
After the blood is taken, pressure is applied to
the site for a few minutes to stop the bleeding.
Watch the site for signs of bleeding or
circulation problems.
The sample must be quickly sent to a
laboratory for analysis to ensure accurate
results.
Arterial Blood Gas

36. How to Prepare for the Test
There is no special preparation.
If you are on oxygen therapy, the
oxygen concentration must remain
constant for 20 minutes before the test.
Arterial Blood Gas

37. How the Test Will Feel
You may feel brief cramping or
throbbing at the puncture site
Arterial Blood Gas

38. Risks
There is very little risk when the
procedure is done correctly.
Veins and arteries vary in size from
one patient to another and from one
side of the body to the other.
Taking blood from some people may
be more difficult than from others.
Arterial Blood Gas

39. Other risks associated with this
test may include:
Bleeding at the puncture site
Blood flow problems at puncture site (rare)
Bruising at the puncture site
Delayed bleeding at the puncture site
Fainting or feeling light-headed
Hematoma (blood accumulating under the skin)
Infection (a slight risk any time the skin is
broken)
Arterial Blood Gas

40. Arterial Blood Gas