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

9. 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

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

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. • 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

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

20.  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
Systematic CXR Interpretation

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. 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

36. 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

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

38. 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

39. 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

40. Arterial Blood Gas