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Chapter 15. Imaging Studies

In general, follow this principle: Obtain plain films before obtaining films that require contrast. Each hospital has its own guidelines for patient preps. Consult the radiology department before ordering any x-ray that requires a prep. Examinations that require no specific bowel preparation are routine CXR, flat and upright abdominal films, cystograms, C-spines, skull series, extremity films, CT scans of the head and chest, and many others.

Studies that usually require preps such as enemas, laxatives, or oral contrast agents or those that require that the patient be NPO before the examination include upper GI series, small-bowel follow-through (SBFT), barium enema, IVP, and others. IV contrast studies are discussed below.

Chest

Chest X-Ray (Routine):

Includes posteroanterior (PA) and lateral chest films. (PA means the film is placed in front of the patient with the beam coming from the back.) Evaluation of pulmonary, cardiac, and mediastinal diseases and traumatic injury. See How to Read a Chest X-Ray, and Figures 15–1 and 15–2.

Figure 15–1.
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Structures seen on a posteroanterior (PA) chest x-ray. 1 = first rib; 2–10 = posterior aspect of ribs 2–10; AK = aortic knob; APW = aortopulmonary window, BS = breast shadow (labeled only on right); C = carina; CA = colonic air; CPA = costophrenic angle, DA = descending aorta; GA = gastric air; LHB = left heart border (Note: Most of the left heart border represents the left ventricle; the superior aspect of the left heart border represents the left atrial appendage.); LPA = left pulmonary artery; RC = right clavicle (left clavicle not labeled); RHB = right heart border (Note: The right heart border represents the right atrium.); RHD = right hemidiaphragm (left hemidiaphragm not labeled); RPA = right pulmonary artery; T = tracheal air column.

Figure 15–2.
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Structures seen on a lateral chest x-ray. A = aorta; CPA = posterior costophrenic angle; LHD = left hemidiaphragm; PHB = posterior heart border (Note: The posterior heart border represents the left atrium superiorly and left ventricle inferiorly; the anterior heart border is not clearly defined on this film but represents the right ventricle.); RA = retrosternal airspace; RHD = right hemidiaphragm; RMF = right major fissure (left major fissure and minor fissures not well visualized on these films but can occasionally be seen); S = scapula; T = tracheal air column.

Expiratory Chest:

Visualization of small pneumothorax

Lateral Decubitus Chest:

Allows small amounts of pleural effusion or subpulmonic effusion to layer out; as little as 175 mL of pleural fluid can be detected

Lordotic Chest:

Evaluation of apices and lesions of the ...

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