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

Systematic CXR
Interpretation
IDENTIFICATION
Correct patient
Correct date & time
Correct examination
Right vs. Left side (gastric bubble)
Comparison film.

Systematic CXR
Interpretation

IDENTIFICATION
TECHNIQUE

INTERPRETATION

Systematic CXR
Interpretation

TECHNIQUE

Complete exam
All views
Entire anatomical area included.

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

Systematic CXR
Interpretation

TECHNIQUE, cont.
Position
Erect.
Supine.

Lateral position.

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.

Is the film over or under

penetrated?

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

Systematic CXR
Interpretation

TECHNIQUE, cont.

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.

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.

Systematic CXR
Interpretation

IDENTIFICATION
TECHNIQUE

INTERPRETATION

Systematic CXR
Interpretation
INTERPRETATION

Extraneous material
Contrast
Lines, tubes, clips
All properly located?
Bones
Fracture, dislocation
Mineralization
Soft tissues
Asymmetry
Calcifications

Systematic CXR
Interpretation

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