Approach to reading a chest radiograph
An initial assessment is done to ensure that the radiograph belongs to the patient. According to Moskowitz (2011), once the initial assessment is done, the technical quality of the radiograph is determined. This entails assessing parameters such as rotation of the patient, exposure of the film and inspiratory effort of the patient. Moskowitz (2011) notes that rotations may in most cases symbolize abnormalities in the cardiac contour and can result in erroneous diagnoses. To make certain that the patient is not rotated the position of the medial ends of the clavicles needs to be equidistance from the spinous process. Good exposure of the film is indicated by the clear visibility of the thoracic vertebrae and the assessor can see through the cardiac shadow to see structures in the lower left lobe of the lung (Moskowitz, 2011).
Once the technical aspects have been checked and evaluated, the first thing to assess is the soft tissues beginning in the neck area where checking is done for any signs of masses and vascular calcification. This is then followed by a check of the shoulders, then the axilla and finally the abdomen. A search for lymph nodes and calcifications is done in the axilla. According to Moskowtiz (2011), in the abdomen a search of free air and intestinal obstruction is carried out. The bony structures of the neck and cervical vertebral column are then checked. This is then followed by an evaluation of the scapula and the shoulders (Moskowtiz, 2011). Ribs are evaluated individually starting from the posterior then finishing at the anterior. The diaphragms are then evaluated. An evaluation of the costophremic sulcus helps to determine the presence of fluids (Moskowtiz, 2011). After this is done, the lung fields are then checked to ensure that the pulmonary veins and bronchi are normal. The heart is then assessed as the last thing for any abnormalities.
Abdominal radiograph
As with the chest radiograph, the technical quality of the film has to be assessed first. This is then followed by identification of lines such as postsurgical drains and urinary catheters, which provide evidence for the presence of intraperitoneal gas (Hussain, Latif and Hall, 2010). Gas patterns in the bowel are assessed to determine their level of abnormality. The sizes of the soft tissue organs such as the liver and the kidneys are checked (Hussain, Latif and Hall, 2010). The film is then evaluated for any presence of calcification densities that may indicate the presence of gallstones (Hussain, Latif and Hall, 2010). The bones of the vertebral column are then checked. The last check is done on the periphery structures such as at the base of the lungs (Hussain, Latif and Hall, 2010).
Radiograph of the bone
The first approach involves checking that the radiograph is for the correct patient. The alignment of bones is then checked followed by checking the joint spacing and integrity of the bone cortex. Finally, abnormalities are checked in the soft tissues of the bone area.
Information that would be included in describing a fracture
According to Erkonen and Smith (2010), information that would be used in describing a fracture would include whether the fracture is a simple or closed fracture or whether it is a compound or open fracture. Furthermore, the fractures can be described using a variety of terms such as non-displaced, spiral, angulated or distracted.
Describe the difference between the radiograph findings of a mall bowel obstruction versus a large bowel obstruction
Large bowel obstructions are characterized by colonic distention, collapsed distal colon and dilatation of the large bowel to a diameter or width of about 6cm (Gel and Jones). In a small bowel obstruction, there is the presence of small bowel distention, the presence of more than two air-fluid levels with widths of about 2.5 cm (Silva, Pimenta and Guimaraes, 2009).
Describe the difference between radiograph findings of pneumonia and pleural effusion
According to Gel and Jones, pleural effusion radiographic findings using a lateral decubitus films may show little amounts of fluid layering next to the dependent parietal pleura. According to Schwartz (2007), radiographic findings of pneumonia may be indicated by the presence of focal airspace filing and patchy airspace filling.
References
Erkonen, W., & Smith, W. (2010). Radiology 101: The basics and fundamentals of imaging (3rd, Ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
Goel, D., & Jones, A. (n.d.). Large bowel obstruction | Radiology Reference Article | Radiopaedia.org. Retrieved June 30, 2015, from http://radiopaedia.org/articles/large-bowel-obstruction
Goel, D., & Jones, J. (n.d.). Pleural effusion | Radiology Reference Article | Radiopaedia.org. Retrieved June 30, 2015, from http://radiopaedia.org/articles/pleural-effusion
Hussain, S., & Latif, S. (2010). Rapid Review of Radiology. London: Manson Publishing.
Moskowitz, H. (2011). I.C.U. Chest Radiology: Principles and Case Studies. Hoboken: John Wiley & Sons.
Schwartz, D. T. (2008). Emergency radiology: Case studies. New York: McGraw-Hill Medical.
Silva, A., Pimenta, M., & Guimaraes, L. (2009). Small Bowel Obstruction: What to Look For. RadioGraphics. Retrieved June 30, 2015, from http://pubs.rsna.org/doi/full/10.1148/rg.292085514
