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CHEST X-RAY

Transcript: Lung Cancer Normal x-ray - Small right hemithorax - Diffuse haziness - Tracheal shift to right - Blunted costophrenic angle - Lines not corresponding to fissures Tuberculosis - Homogenous density - Loss of cardiogenic angle - Loss of diaphragmatic and right cardiac silhouette CHEST X-RAY Pleural effusion Pneumonia - Airspace opacity - Lobar consolidation - Interstitial opacities - Overlap - Indistinct borders - LUL cavities - RUL infiltrate - Bilateral upper lobe disease - (nodules) - consolidation - adenopathy - pleural effusion - cavitation - calcification Pleural fibrosis Bibliography Squamous cell - large mass - atelectasis with hilar mass - lymphadenopathy KOSACK CS, E. A. Evaluation of a chest radiograph reading and recording system for tuberculosis in a HIV-positive cohort. - PubMed - NCBI En el texto: (2) Bibliografía: 2. Kosack CS e. Evaluation of a chest radiograph reading and recording system for tuberculosis in a HIV-positive cohort. - PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2017 [cited 1 March 2017]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28236438 TONKOPI E, E. A. Diagnostic Reference Levels and Monitoring Practice Can Help Reduce Patient Dose From CT Examinations. - PubMed - NCBI En el texto: (1) Bibliografía: 1. Tonkopi E e. Diagnostic Reference Levels and Monitoring Practice Can Help Reduce Patient Dose From CT Examinations. - PubMed - NCBI [Internet]. Ncbi.nlm.nih.gov. 2017 [cited 1 March 2017]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28245142 X-RAY, C. Chest x-ray: MedlinePlus Medical Encyclopedia En el texto: (3) Bibliografía: 3. x-ray C. Chest x-ray: MedlinePlus Medical Encyclopedia [Internet]. Medlineplus.gov. 2017 [cited 1 March 2017]. Available from: https://medlineplus.gov/ency/article/003804.htm BONE- white SOFT TISSUE- gray LUNG TISSUE- dark

A chest X-ray

Transcript: Benefits vs. Risks What is a chest X-ray? Features of the X-ray The equipment typically used for chest x-rays consists of a wall-mounted, box-like apparatus containing the x-ray film or a special plate that records the image digitally and an x-ray producing tube, that is usually positioned about six feet away. The equipment may also be arranged with the x-ray tube suspended over a table on which the patient lies. A drawer under the table holds the x-ray film or digital recording plate. A portable x-ray machine is a compact apparatus that can be taken to the patient in a hospital bed or the emergency room. The x-ray tube is connected to a flexible arm that is extended over the patient while an x-ray film holder or image recording plate is placed beneath the patient. Benefits No radiation remains in a patient's body after an x-ray examination. X-rays usually have no side effects in the diagnostic range. X-ray equipment is relatively inexpensive and widely available in emergency rooms, physician offices, ambulatory care centers, nursing homes and other locations, making it convenient for both patients and physicians. Because x-ray imaging is fast and easy, it is particularly useful in emergency diagnosis and treatment. Risks There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk. The effective radiation dose for this procedure varies. See the Safety page for more information about radiation dose. Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. See the Safety page for more information about pregnancy and x-ray A chest x-ray examination itself is a painless procedure. You may experience discomfort from the cool temperature in the examination room and the coldness of the recording plate. Individuals with arthritis or injuries to the chest wall, shoulders or arms may have discomfort trying to stay still during the examination. The technologist will assist you in finding the most comfortable position possible that still ensures diagnostic image quality. How as a patient, should i prepare for the procedure? Works in the procedure What are some common uses for the procedure? The chest x-ray is a very useful examination, but it has limitations. Because some conditions of the chest cannot be detected on a conventional chest x-ray image, this examination cannot necessarily rule out all problems in the chest. For example, small cancers may not show up on a chest x-ray. A blood clot in the lungs, a condition called a pulmonary embolism, cannot be seen on chest x-rays. Further imaging studies may be necessary to clarify the results of a chest x-ray or to look for abnormalities not visible on the chest x-ray. What are the benefits vs. the risks? Who interprets the results, and how do i get them? X-rays are a form of radiation like light or radio waves. X-rays pass through most objects, including the body. Once it is carefully aimed at the part of the body being examined, an x-ray machine produces a small burst of radiation that passes through the body, recording an image on photographic film or a special digital image recording plate. Different parts of the body absorb the x-rays in varying degrees. Dense bone absorbs much of the radiation while soft tissue, such as muscle, fat and organs, allow more of the x-rays to pass through them. As a result, bones appear white on the x-ray, soft tissue shows up in shades of gray and air appears black. On a chest x-ray, the ribs and spine will absorb much of the radiation and appear white or light gray on the image. Lung tissue absorbs little radiation and will appear dark on the image. Until recently, x-ray images were maintained as hard film copy (much like a photographic negative). Today, most images are digital files that are stored electronically. These stored images are easily accessible and are frequently compared to current x-ray images for diagnosis and disease management. What are the limitations of Chest Radiography? Patient experience How does the procedure work? The chest x-ray is the most commonly performed diagnostic x-ray examination. A chest x-ray makes images of the heart, lungs, airways, blood vessels and the bones of the spine and chest. An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging. What does the equipment look like? The chest x-ray is performed to evaluate the lungs, heart and chest wall. Click to view larger A chest x-ray is typically the first imaging test used to help diagnose symptoms such as: shortness of breath. a bad or persistent cough. chest pain or injury. fever. Physicians use the examination to help diagnose or

Chest X-Ray

Transcript: Adult Posterior-Anterior Chest Radiograph Protocol Brendan Leys Adult Posterior-Anterior Chest Radiograph Protocol Adult Posterior-Anterior Chest Radiograph Protocol I. Purpose A posterior-anterior (PA) radiograph of the adult chest is performed to assist in the diagnosis of disease or injury that may reside within or about the thoracic region. This region includes the heart, great blood vessels, lungs, trance, ribs, clavicles, scapulae, thoracic spine, liver, stomach and diaphragm. Providing a PA chest radiograph of the highest quality image for interpretation by a radiologist. I. Purpose HSECA Diagnostic Healthcare Professionals Programs skill book II. Distribution/Scope Request for diagnostic procedure Patient gown Simulated chest film Simulated chest cassette Directional letter markers Personal lead shielding Simulated x-ray instrument (overhead projector) Simulated x-ray board III. Equiptment/Supplies 1. Review authorized request for diagnostic procedure 2. Prepare examination area a. Area is clean b. Supplies are available c. Equipment is functioning IV. Pre-Examination Phase 3. Retrieve patient. a. Use the request for diagnostic procedure to verbally call for patient in the waiting area. b. Greet the patient as they identify themselves to you. c. Introduce yourself and explain that you will be the healthcare professional to interact with them while they are in the Diagnostic Imaging area. d. Request the patient to identify themselves using two patient identifiers (full name and date of birth). i. Confirm information with printed documentation ii. Resolve any discrepancies before proceeding e. Explain that you will be conducting the diagnostic test(s) requested by their medical provider and estimate how long the process will take. i. NOTE: The patient is implying consent if they continue to accompany you after you have explained what procedure will be taking place. 4. Escort to the changing area and provide instructions: a. Remove all jewelry from the chest area (simulation) b. Remove all clothing from the chest area (simulation) c. Provide a gown and instruct the patient to put it on with the opening in the back, tied around the neck and back. d. Instruct the patient to let you know when they are ready. IV. Pre-Examination Phase (Cont.) 1. Position the patient a. Provide lead shielding across the patient’s posterior pelvis to prevent exposing the reproductive organs to direct or scatter radiation. b. Instruct the patient to remain standing, facing the “x-ray board” so their thoracic area is flush against the surface. c. Adjust the median plane of the patient’s body so that it is perpendicular to and over the center of the prepared film and cassette. d. Place the patient’s acromion processes 3 inches below the upper cassette film border. 2. Position the equipment a. Turn on the simulated x-ray instrument and adjust the central beam of the light to the center of the prepared film and cassette. b. Turn the beam off after making appropriate adjustments c. Request the patient to remain still V. Examination Phase 3. Don your personnel protective shielding 4. Instruct the patient to take a deep breath and exhale several times to expand their lung capacity; then ask them to breathe in and hold it. 5. Observe the patient at the height of inhalations and say “HOLD IT” loudly. After observing the patient not breathing or moving, quickly activate the simulated x-ray instrument to complete the exposure (turn the beam on and off). 6. Instruct patient to breath normally; observe for any signs of distress. 7. Remove the lead shielding from the patient and yourself. 8. Remove the cassette from the instrument and place it with the patient identification card in the darkroom box for processing. Allow the patient to sit and request that they wait momentarily while the image is examined for adequacy V. Examination Phase (Cont.) 1. Escort the patient back to the changing area and inform them they can dress. a. Instruct the patient to place their gown in the appropriate laundry hamper when they are finished. b. Remind the patient to take any jewelry or personal items with them. c. Ask if the patient has any questions d. Thank the patient for using your facility/services; patient may now exit the facility. 2. Clean the area a. Check the environment for any safety hazards or clutter b. Discard any used disposable supplies c. Place any used linens in the appropriate hamper. 3. Clean equipment and replace used supplies. 4. Wash/sanitize your hands. VI. Post-Examination 1. Artifacts- anything on the final image other than the anatomy of the patient may be misinterpreted as disease or trauma. Physical artifacts are radiopaque items that block x-rays from reaching the film. Items such as metal zippers, metal sutures are obvious artifacts. Others such as dust, hair or other debris are not so obvious and may result in a false diagnosis if interpreted as a disease process. Fingerprints from improper handling of film may also cause

Chest X-Ray

Transcript: entire lung boundaries Chest X-Ray is a x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm Collapsed Lung(Pneumothorax) scanning with fovea over each part of lung Abnormal Chest X-Ray shows fibrosis, calcification, and cavitation mainly in upper left lobe Turn off stray lights, adjust room lighting, view the images in order Paient Data Routine Technique: AP/PA, exposure, radiation, supine or erect Trachea: midline or deviated, caliber, mass Lungs: look for abnormal shadowing or lucency Pulmonary vessels: artery or vein enlargement Hila: masses, lymphadenopathy Mediastinal contour: mass? width? Heart: thorax: heart width 2:1 Pleura: effusion, thickening, calcification Bones: lesions or fractures Soft tissues: (like mastectomy) Look for pneumothorax right heart border is silhouetted out caused by pneumonia Abnormal Chest X-Ray Key Notes Patient can appear to have a abnormal chest if the film is taken during expiration Patient should be examined in full inspiration Abnormal Chest X-Ray Mass vs Infiltrate upper left lobe masses Chest X-Ray Silhouette Sign Tuberculosis Lung Cancer PA Technique Ikyra Ross lung masses (irregular or abnormal shadows on the lung fields) collection of air in the space around the lungs Abnormal Opacity Scan all portions of the film Follow lung/mediastinal interfaces mass (well-defined) Process Bony structures appear to white on the film because they absorb the most radiation Hollow structures that contain mostly air such as the lungs, usually appear dark In normal chest x-rays the chest cavity is outlined on each side by white bony structures that are the ribs On the top portion is the neck and clavicles On the bottom the chest cavity is the diaphragm On the sides of the chest cavity the bones of the shoulder and arms can be easily seen Inside chest cavity the vertebral column is seen down the middle of the chest On each side of the midline is a dark area which is the lungs A white shadow in the middle of the field on top of the diaphragm more towards the left side is the heart Lateral Scanning Technique air space disease like pneumonia poorly defined opacity

Geriatric Chest X-Ray

Transcript: Pregnancy may be asked if the patient is 55 or younger (No usual for geriatric pts.) What is the exam? History questions Pathology Able to stand on their own Upright imaging Wall bucky set up Line up patient Shield Set technique Take images 1. What is the centering point for a Chest x-ray? 2. Name 2 possible diseases seen on a Chest x-ray. 3. What prep does the patient need to do for this exam? 4. What technique should be used? 5. What changes the technique? Position patient for lateral projection- Left side on board, arms above head or holding on to bars provided, keep feet straight forward, no rotation Set technique for patient Give breathing instructions and take image Make sure patient has all of their things and they are free to go Walk them back to where you got them Techniques Complete exam details May or may not be able to stand Keep in chair or cart if not Wheelchair- set up like upright on wall bucky. Cart- Use free detector Position patient Use positioning sponge for lateral Set technique Take images Eisenberg, R. L., Johnson, N. M., & Eisenberg, R. L. (2011). Respiratory System. In Comprehensive radiographic pathology, sixth edition. Frank, E. D., Long, B. W., Smith, B. J., Merrill, V., & Ballinger, P. W. (2007). Thoracic Viscera. In Merrill's atlas of radiographic positioning & procedures. St. Louis, MO: Mosby/Elsevier. Geriatric Radiography. (n.d.). Retrieved from http://www.hkrta.50g.com/Academicdoc/Geriatric.pdf Gossner, J., & Nau, R. (2013, July 1). Geriatric Chest Imaging: When and How to Image the Elderly Lung, Age-Related Changes, and Common Pathologies. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713368/ What you Need to Know About Chest Radiology. (2009). Retrieved from https://www.asrt.org/docs/default-source/patientpages/chest_papg.pdf?sfvrsn=4 1. T7 or Bottom of scapula 2. COPD, Pneumonia, CHF, ECT. 3. None 4. 90-125kVp 1-3 mAs 5. Patient size and Pathology (additive or destructive diseases) Exam Prep Chest x-rays should be shielded Why?- Limit exposure for patient. Age doesn't matter! Place around patients waist/on lap/over gonadal area without blocking anatomy of interest Hospital dependent Between 90-125 kVp Between 1-3 mAs Larger patients may need 4 mAs Smaller patients may need 0.9 mAs Pathology changes technique- Additive disease=Higher Tech Destructive disease=Lower tech Bring patient into room AIDET Use 2 identifiers to make sure you have correct patient Remove possible artifacts Position Tube and Bucky Shield Position patient for PA Chest- Upright whenever possible, Center at T7 include all of lungs, no rotation. Set technique for patient Give breathing instructions, take image Radiologist involved? Immobilization Devices ANY QUESTIONS For us? You should know this by now...... Keep a few things in mind with older patient- Communication problems may be an issue with loss of teeth or other issues, Some have trouble hearing, Repeat information if you need to, be patient they are not as fast as us sometimes, confirm their identity sometimes more than once their mental state may be altered. Make sure everyone else is out of the room! Normally, no If you see something you're unsure of call them over to look really fast Don't let patient leave if you see something Remember we can't diagnose... Leave that to the Docs Answers To observe the heart and lungs Illnesses and conditions of heart and lungs that are more common as we age Decreased oxygen levels Continuous coughing SOB Chest pain Fever Shielding Jennifer Bennett, Kelly Carnett, and Sarah Engle There are none for the patient Make sure they have all of their belongings Technologist should wipe down the room and move everything back to original place Portable- Put everything back to how it was when you got there, if patient had 3 pillows give them 3 pillows. Chest x-ray of a Geriatric patient Most common medical imaging exam Small amount of radiation Shows heart, lungs, airway, and chest wall PA and Lateral projections Upright position wanted- shows air/fluid level and depresses diaphragm Used to rule out many respiratory and heart conditions Typically are not used If patient won't stay still AMS patients Sandbags Straps Retrieving Patient (AIDET) Many different diseases can be seen with a chest x-ray Common diseases for elderly patients- Emphysema, Bronchitis, Pneumonia, Pulmonary edema, COPD, Cancer, CHF, Embolism, Aspiration, Asthma, ARDS, Atelectasis, Pneumothorax Prepare the room to meet needs of patient Determine how the images should be taken- ambulatory, wheelchair, or Cart? There is no prep for the patient to do before the exam Refrences Quiz Time! Ambulatory Patient Post Procedure instructions Indications Doing exam in a Cart is similar to a Portable chest x-ray Wheelchair or Cart Geriatric Chest X-Ray Hospital dependent, Usual questions include... Are you a smoker? SOB? Chest pain? History of COPD? Coughing? History of Cancer? How long has this been going on? Surgeries?

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