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

9. Systematic CXR Interpretation
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

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

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 over or under penetrated?
If under penetrated you will not be able to see the thoracic vertebrae.

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

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

18. Systematic CXR Interpretation
IDENTIFICATION
TECHNIQUE
INTERPRETATION

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

20. Systematic CXR 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

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 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).

35. 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.

36. 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.

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

38. 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.

39. 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)

40. Arterial Blood Gas