XRays

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X-Rays Michael R. Jackson
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Neonatal Chest X-Rays in Clinical
Diagnosis Michael R. Jackson RRT-NPS
CPFT Brigham Womens Hospital, Boston, MA
Diligent Study
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Neonatal Chest Radiography Michael R. Jackson
RRT-NPS CPFT Brigham Womens Hospital, Boston,
MA
Diligent Study
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Neonatal Chest Radiography Michael R. Jackson
RRT-NPS CPFT Brigham Womens Hospital, Boston,
MA
Diligent Study
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Neonatl Chest Radiography Michael R. Jackson
RRT-NPS CPFT Brigham Womens Hospital, Boston,
MA
Diligent Study
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Method
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• Identification
• Name date
• Technique
• View appropriate complete
• Patient position (upright, supine)
• markers placed clavicles centered
• AP PA Lateral, oblique, decubitus tube
  angulation
• Ventilatory phase (insp., exp., forced exp.)

• Technical qualities (eg. Lordotic film)
• Penetration
• Visualize dorsal inter-vertebral disk spaces
• Serial consistency?
• Artifact (e.g. motion)
• Canalization of airways

R oblique
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• Mediastinum sail wave sign
• In normal position?
• Heart large (thymus effect in kids)
• Aortic arch on left?
• Clear heart borders?
• Major airways normal?
• Hila Pulmonary Vessels
• Normal hila size position?
• Vessels normal caliber definition?
• Lung
• Densities?
• Air bronchogram?
• Positive silhouette (homogeneous tissue) sign?
• Area behind heart normal?
• Kerley lines thickened interlobular septa
• Spine sign
• Hyperaeration or atelectasis

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• Systematic Analysis
• Bones, soft tissue, diaphragm
• a. Bones (configuration, breaks, notches,
  destruction)
• b. Soft tissue (amount, breast tissue,
  masses, SQ air, adipose)
• c. Diaphragm (position, shape, angles,
  subdiaphragmatic abnormalities?)
• 2. 4 PS
• Plastic
• Pump
• Pleura
• Parenchyma

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• Chest Wall
• Tissues indicate nutrition
• Congenital rib spine changes
• Spine sternum intact on lateral view
• Diaphragm
• Outlines intact positive silhouette sign
• Domes in normal position?
• Pleura
• Sharp costophrenic angles
• Pneumothorax?
• Fissures in normal position?
• Ctd

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Heart Size
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• Illusions
• Skin folds
• Rotation from desired posture

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HELIUM_NEON LIGHT
www.sprawls.org/resources/DIGRAD/module.htm
www.sprawls.org/resources/DIGRAD/module.htm
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Features of Digital Image DisplayAmerican
College of Radiology Standards for Teleradiology
2006

• Bright high resolution (1023 lines/60Hz) monitor
• Gray scales maximized
• 6 bits 64 gray 8 bits 256 gray 12 bits
  4,096 gray
• low reflections controlled ambient light
• Accurate choice of patient, demographics image
  sequence
• Adjust window, zoom, pan rotation maintain
  viewer orientation
• Assess linear measurements Hounsfield units for
  CT
• Image compression ration, cropping, Matrix size
  Bit depth display

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Contrast
Brightness
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1,023 lines/60 Hz monitor
Digital

• Reduced rad exposure
• Edge enhancement
• Magnification
• Windowing capable

msrcol.org
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RDS TTN Pneumonia Pulm Edema Atelectasis Seve
re BPD PIE
Grainy Streaky Patchy Fluffy Hazy Bubbly Dot
ty
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ratlung
SD
PIE
BPD
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23 YEAR OLD MALE IN RESPIRATORY DISTRESS WITH
LATE SEQUELAE OF BPD OF INFANCY
Jeannine Busick M.S. RRT., Steve Morrison RRT-NPS
RPFT, Truman Read RRT, Michael R. Jackson RRT-NPS
CPFT, Paul F. Nuccio, RRT, FAARC. Department of
Respiratory Care, Brigham and Womens Hospital,
Boston, Massachusetts.
Introduction Late pulmonary sequelae of
bronchopulmonary dysplasia (BPD) may underlie
disease processes that we care for in
adulthood. Case Summary This 23-year-old male,
a former NICU patient from 1983, re-presented and
was admitted to our medical ICU with significant
shortness of breath. Initially, he was managed on
BIPAP however, worsening respiratory status,
specifically severe hypoxemia, required
intubation and mechanical ventilation. Despite
antibiotics, systemic steroids, anticoagulation,
diuretics, and nitirc oxide, his oxygenation
remained mechanically ventilated for 59 days. On
day 28 he developed sepsis and perihilar
infiltrates. Set pressures never exceeded 23 cm
H2O with sustained PEEP of 4 cm H2O. The patient
was discharged after 191 days on 1/8 lpm O2 and
Alupent. Childhood health history includes BPD,
six pneumonias during early childhood, severe
persistent asthma, obesity, and ADD.
Environmental history includes 16 years of
second hand smoke exposure, smoking ¼ pack year,
work installing sheet metal ductwork and
insulation. 
status remained tenuous and ETCO2 remained
elevated. Tests for alpha-1-antitrypsin and lung
cultures were negative. Radiographic chest
imagery revealed diffuse scattered interstitial
markings manifest on CT. Lung biopsy findings
were consistent with known sequelae and
remodeling of bronchopulmonary dysplasia. PMH
This patient was born at 28 weeks gestation
weighing 650 g. He had mild respiratory distress
syndrome and was. extubated on day 2 on day 10
he was re-intubated for apnea and
Discussion Late pulmonary sequelae of BPD in
adolescents and young adults may include airway
obstruction, hyper-reactivity, and
hyperinflation. In this case the patient has
evidence of a significant obstructive airway
component, as evidenced by pulmonary function
testing prior to this most recent admission and
emphysematous changes evident from CT.
Additionally, he has a history of hyper-reactive
airways. Although, no single element of this
patients medical history can be demonstrated to
stem directly from his BPD in infancy, the
conglomeration of diagnoses and repeated lung
injuries are illustrative of a potential course
of pulmonary sequelae following BPD of infancy.
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