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PRINCIPLES OF CARDIOVASCULAR IMAGING

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CHEST RADIOGRAPHS

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Justin B. Joines

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Cedric Lefebvre

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Technology/Technique

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Chest radiographs are the most commonly performed diagnostic radiographs in emergency departments. A chest radiograph can help identify cardiovascular emergencies and other medical problems such as pneumothorax, pulmonary edema, aortic dissection, pneumonia, perforation of the gastrointestinal tract, fractures, masses, and foreign bodies (Table 3.1).

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TABLE 3.1

MEDICAL CONDITIONS AND ASSOCIATED FINDINGS ON CHEST RADIOGRAPH

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A radiograph, or “x-ray,” is customarily performed by a trained radiologic technician. The x-ray apparatus typically consists of x-ray film or a special plate that digitally records the picture and an x-ray tube. The x-ray film is positioned next to the patient while the x-ray tube is located at a distance of about 6 feet from the patient. Two views are taken for a conventional chest radiograph: a posterior–anterior (PA) view, in which the x-ray beam passes through the chest from the back, and a lateral view such that x-rays pass through the chest from one side to the other. When the clinical scenario mandates a portable radiograph at the bedside, an anterior–posterior (AP) view can be obtained with the patient in a seated position. The technician may use a lead apron to protect certain parts of the patient’s body (eg, reproductive organs) from radiation. The amount of radiation used in a chest radiograph is relatively small and confers approximately 0.1 milli-severts (1/10,000 Sv) to the patient.

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FIGURE 3.1

The conventional PA view of a chest radiograph provides an image of the lungs, heart, great vessels, mediastinum, ribs, clavicles, trachea, esophagus, spine, and diaphragms.

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FIGURE 3.2

The lateral view of a chest radiograph.

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FIGURE 3.3

For a PA view, the patient is positioned so that the chest rests against the image plate.

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FIGURE 3.4

For a lateral view, the patient is turned with one side against the image plate and arms raised above the head.

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FIGURE 3.5

An AP view is ...

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