1 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

2 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Chapter 4 Radiologic Assessment

3 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Production of a Chest X-Ray Radiodensity –Areas of low density appear dark –Areas of high density appear white –Air is least radiodense – appears black –Water is more dense than air – appears gray –Fat is more dense than water – appears light gray –Bone is the most radiodense – appears white

4 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. X-Ray Views of the Chest Posterior – anterior view (PA) Anterior – posterior view (AP) Lateral view Apical lordotic view Lateral decubitus Left anterior oblique Lateral neck

5 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. The Normal Chest Radiograph Must distinguish normal structures from abnormal Should be approached with a consistent method Use an outside in or inside out approach Determine if patient is rotated Determine penetration (exposure)

6 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. The Normal Chest Radiograph Evaluate areas outside the chest wall Evaluate the ribs Evaluate the sternum Evaluate the spinous process Evaluate the pleural space Evaluate the lung fields

7 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Common Abnormalities on the Chest Radiograph Extrapulmonary air –Pneumothorax –Subcutaneous emphysema –Pneumomediastinum Changes in Lung Volume –Mediastinal shift –Hyperinflation –Atelectasis –Consolidation

8 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Common Abnormalities on the Chest Radiograph Fluid abnormalities –Pleural effusion –CHF –Pulmonary edema –Pulmonary infiltrate Foreign objects –artificial airways, chest tubes, central catheters, feeding tubes, nasogastric tubes, and surgical clips or staples

9 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Ventilation – Perfusion Scanning Compares lung ventilation with lung perfusion A radioactive gas is inhaled while lungs are scanned Detects obstruction to pulmonary circulation

10 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Pulmonary Angiography Considered by some authorities to be more definitive in detecting pulmonary emboli A pulmonary artery catheter is inserted into the pulmonary artery and radiopaque contrast material is injected into the pulmonary artery; as the contrast medium passes through the pulmonary circulation, the chest is imaged radiographically

11 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Computed Tomography of the Chest Can depict many pathologic changes in greater detail than is possible with conventional chest radiography