Basic Chest X-Ray Interpretation

Basic Chest X-Ray
Interpretation
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)

Systematic CXR Interpretation
• IDENTIFICATION
• TECHNIQUE
• INTERPRETATION
• IDENTIFICATION
– Correct patient
– Correct date & time
– Correct examination
• Right vs. Left side (gastric bubble)
• Comparison film.
• IDENTIFICATION
• TECHNIQUE
• INTERPRETATION
• TECHNIQUE
– Complete exam
• All views
• Entire anatomical area included.

TECHNIQUE, cont.
– Projection or Quality of the film:
• First determine is the film a PA or AP view.
• 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 & mediastinum larger on AP film.
• All x-rays in the ICU are portable and are AP

view
TECHNIQUE, cont.
― Position
• Erect.
• Supine.
• Lateral position.
• TECHNIQUE, cont.
– Penetration
• Over-penetrated dark films can
obscure subtle pathologies.
• Under-penetrated white films

may given impression of diffuse
increased density.
Is the film over or under
penetrated?
• If under penetrated
you will not be able
to see the thoracic
vertebrae.
― 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.
―Rotation
• Determine by observing the equal
distance between the medial clavicular
head and the spinous process of the
thoracic vertebral body.
• IDENTIFICATION
• TECHNIQUE
• INTERPRETATION
 INTERPRETATION
 Extraneous material
 Contrast
 Lines, tubes, clips
 All properly located?
 Bones
 Fracture, dislocation
 Mineralization
 Soft tissues
 Asymmetry
 Calcifications
 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
CONSOLIDATION
CONSOLIDATION
Congestive Heart Failure
TENSION
PNEUMOTHORAX
Air under the diaphragm
ARTERIAL BLOOD GAS
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.
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.
Arterial Blood Gas
How the Test is Performed?
 Usually, blood is taken from an artery.
 The blood may be collected from the radial

artery in 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).
Arterial Blood Gas
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
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
How the Test Will Feel
You may feel brief cramping or

throbbing at the puncture site
Arterial Blood Gas
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
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

Basic Chest X-Ray Interpretation

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Basic Chest X-Ray

– Bone- high absorption (white)

– Tissue- somewhere in the middle

– Air- low absorption (black)

– Correct date & time

• Entire anatomical area included.

• PA- the x-rays penetrate through the back of the

• AP-the x-rays penetrate through the front of the

• All x-rays in the ICU are portable and are AP

• Under-penetrated white films

― Adequacy (full Inspiration)

 Lines, tubes, clips

 All properly located?

 Lung fields & mediastinum

 Asymmetry , central mediastinum

 Consolidation (opacity), nodule or lesion

 Size & shape

• Blood gases is a measurement of

• It also determines the acidity (pH) of

 To evaluate respiratory diseases and

 It helps determine the effectiveness

 The blood may be collected from the radial

 May test circulation to the hand before taking

 Insert a small needle through the skin into the

 In rare cases, blood from a vein may be used.

 After the blood is taken, pressure is applied to

 Watch the site for signs of bleeding or

 The sample must be quickly sent to a

 There is no special preparation.

 If you are on oxygen therapy, the

How the Test Will Feel

You may feel brief cramping or

 Veins and arteries vary in size from

 Taking blood from some people may

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