Based on the provided chest x-ray, the ET tube tip is located above the carina and in the proper position within the trachea. It does not appear to need adjustment. Feeding through the R/T tube would be appropriate.
4. Film Quality PA or AP view. Upright/Erect or Supine Breath : Inspiration or Expiration X-ray penetration : Under- or Over- Rotation
5. PA vs AP views PA view Scapula is seen in periphery of thorax Clavicles project over lung fields Posterior ribs are distinct Position of markers AP view Scapulae are over lung fields Clavicles are above the apex of lung fields Position of markers Anterior ribs are distinct
7. Penetration With correct exposure you should barely see the intervertebral disc through the heart If you see them very clearly the film is overpenetrated If you do not see them it is underpenetrated
11. Pitfalls to Chest X-ray Interpretation Poor inspiration Over or under penetration Rotation Forgetting the path of the x-ray beam
12. Normal Chest X-ray Cardiac Structures Position More central in younger infants and children More on the L side in older infants and teens Size CARDIO-THORACIC RATIO! Cardiac diameter : normal individuals < 15.5 cm in males; <14.5 cm in females. A change in diameter of greater than 1.5 cm between two X-rays is significant.
13. Cardio-thoracic ratio seen on postero-anterior (PA) view only >50% is considered abnormal in an adult; more than 66% in a neonate. Possible causes of a ratio greater than 50% include: cardiac failure pericardial effusion left or right ventricular hypertrophy *AP views make heart appear larger than it actually is.*
14. Normal Chest X-ray 1. Soft tissue structures Shadows, most commonly, breast 2. Bony structures Count the ribs 8 – 10 ribs should be visible on inspiration Clavicle placement at 2-3 intercostal space (if not, may be rotated)
15. Normal Chest X-ray 3. Diaphragm Contour Rounded with sharp pointed costophrenic and costocardiac angles Right diaphragm is usually 1-2 cm higher
16. Normal Chest X-ray 4. Lungs Start at the top and compare the R and L Trachea should be midline over the thoracic vertebrae and air filled Lung parenchyma becomes lighter as you go down the lung. If not, it may indicate a lower lobe or pleural effusion
29. Atelectasis Loss of air Obstructive atelectasis: No ventilation to the lobe beyond obstruction Radiologically: Density corresponding to a segment or lobe Significant loss of volume Compensatory hyperinflation of normal lungs
30. No ventilation to lobe beyond the obstruction Trapped air absorbed by pulmonary circulation Segmental/lobar density Compensatory hyper-inflation of normal lungs. Atelectasis
48. A single, 3cm relatively thin-walled cavity is noted in the left midlung. This finding is most typical of squamous cell carcinoma (SCC). One-third of SCC masses show cavitation
58. COPD: increase in heart diameter, flattening of the diaphragm, and increase in the size of the retrosternal air space. In addition the upper lobes will become hyperlucent due to destruction of the lung tissue.
61. CHF:a great deal of accentuated interstitial markings, Curly lines, and an enlarged heart. Normally indistinct upper lobe vessels are prominent but are also masked by interstitial edema.