Based on the provided chest x-ray, the ET tube tip is located above the carina and in the proper position within the trachea. It does not appear to need adjustment. Feeding through the R/T tube would be appropriate.

1. Basic Interpretation of Chest Radiography By Dr. ChiaKok King

2. Five Radiographic Opacities Air Fat Soft tissue Bone Metal least opaque to most opaque most lucent to least lucent Black to White

3. Radiographic Opacities & Contrasts Air Air Fat Mineral oil Water Water Bone Tums Metal ???

4. Film Quality PA or AP view. Upright/Erect or Supine Breath : Inspiration or Expiration X-ray penetration : Under- or Over- Rotation

5. PA vs AP views PA view Scapula is seen in periphery of thorax Clavicles project over lung fields Posterior ribs are distinct Position of markers AP view Scapulae are over lung fields Clavicles are above the apex of lung fields Position of markers Anterior ribs are distinct

6. Inspiration vs Expiration

7. Penetration With correct exposure you should barely see the intervertebral disc through the heart If you see them very clearly the film is overpenetrated If you do not see them it is underpenetrated

8. Penetration

9. Rotation

11. Pitfalls to Chest X-ray Interpretation Poor inspiration Over or under penetration Rotation Forgetting the path of the x-ray beam

12. Normal Chest X-ray Cardiac Structures Position More central in younger infants and children More on the L side in older infants and teens Size CARDIO-THORACIC RATIO! Cardiac diameter : normal individuals < 15.5 cm in males; <14.5 cm in females. A change in diameter of greater than 1.5 cm between two X-rays is significant.

13. Cardio-thoracic ratio seen on postero-anterior (PA) view only >50% is considered abnormal in an adult; more than 66% in a neonate. Possible causes of a ratio greater than 50% include: cardiac failure pericardial effusion left or right ventricular hypertrophy *AP views make heart appear larger than it actually is.*

14. Normal Chest X-ray 1. Soft tissue structures Shadows, most commonly, breast 2. Bony structures Count the ribs 8 – 10 ribs should be visible on inspiration Clavicle placement at 2-3 intercostal space (if not, may be rotated)

15. Normal Chest X-ray 3. Diaphragm Contour Rounded with sharp pointed costophrenic and costocardiac angles Right diaphragm is usually 1-2 cm higher

16. Normal Chest X-ray 4. Lungs Start at the top and compare the R and L Trachea should be midline over the thoracic vertebrae and air filled Lung parenchyma becomes lighter as you go down the lung. If not, it may indicate a lower lobe or pleural effusion

17. Anatomy

18. Anatomy

20. Radiopacity

22. Alveolar space filled with inflammatory exudate

23. Interstitium and architecture remain intact

24. The airway is patent

25. Radiologically:

26. A density corresponding to a segment or lobe

27. Air bronchogram, and

29. Atelectasis Loss of air Obstructive atelectasis: No ventilation to the lobe beyond obstruction Radiologically: Density corresponding to a segment or lobe Significant loss of volume Compensatory hyperinflation of normal lungs

30. No ventilation to lobe beyond the obstruction Trapped air absorbed by pulmonary circulation Segmental/lobar density Compensatory hyper-inflation of normal lungs. Atelectasis

32. Fluid in interlobar fissures

34. Kerley B lines (Interstitial edema)

35. Cardiomegaly

36. Dilated prominent upper lobe vessels

38. ARDS Congestion Interstitial and alveolar edema Collapsed or distended alveoli Bilateral

39. Pneumothorax

40. Right side tension pneumothorax

41. Left Sided Pneumothorax

42. Pleural effusion

43. Right Side Pleural Effusion

44. RLL Pneumonia

45. ????????????

46. Fracture of posterior rib #7

47. ?????????????????????

48. A single, 3cm relatively thin-walled cavity is noted in the left midlung. This finding is most typical of squamous cell carcinoma (SCC). One-third of SCC masses show cavitation

49. Right Squamous Cell Carcinoma

50. ???????????????

51. Right Middle and Left Upper Lobe Pneumonia

52. ????????????

53. Cavitation : cystic changes in the area of consolidation due to the bacterial destruction of lung tissue. Notice air fluid level.

54. Cavitation

55. ????????????

56. Tuberculosis

57. ??????????

58. COPD: increase in heart diameter, flattening of the diaphragm, and increase in the size of the retrosternal air space. In addition the upper lobes will become hyperlucent due to destruction of the lung tissue.

59. Chronic emphysema effect on the lungs

60. ????????

61. CHF:a great deal of accentuated interstitial markings, Curly lines, and an enlarged heart. Normally indistinct upper lobe vessels are prominent but are also masked by interstitial edema.

62. 24 hours after diuretic therapy

64. Chest wall lesion: arising off the chest wall and not the lung

66. Pleural effusion: Note loss of left hemidiaphragm. Fluid drained via thoracentesis

68. Lung Mass

69. The Enlarged Hila Causes:1. Adenopathies (neoplasia, infection)2. Primary Tumor3. Vascular4. Sarcoidosis

72. Small Pneumothorax : LUL

74. Right Middle Lobe Pneumothorax: complete lobar collapse

75. Post chest tube insertion and re-expansion

77. Metastatic Lung Cancer: multiple nodules seen

79. Tuberculosis

80. Pleural Effusion

81. Pulmonary Fibrosis

82. Cavitating lesion

83. Miliary shadowing

84. 5. 65 yo male admitted for sepsis. CHF or ARDS?

85. 12. Is the central line correctly positioned?

86. 13. Does ET tube need to be advance or pulled back? Arrow shows location of carina

87. 14. OK for R/T feeding?