Patients may occasionally ask you to take a chest x-ray. Often the chest x-ray is a pre-employment requirement. If you choose to take chest x-rays for your patient, please be aware of the technical requirements. The accepted standard technique for taking a PA chest is non-grid at 72 inches, 100 to 110kVp, film size 14 x 17 in full inspiration. The central ray is approximately at T6. It is important to include the apices of the lungs and costophenic margins. The lateral chest is taken with the same technique, except for the positioning. The central ray on the lateral view should be in the axillary region. With a good technique the thoracic spine should be only slightly visualized on the PA view. The broncovasular markings should be clearly visualized, if they are not, you have over-penetrated. Normally the heart shadow is less than half the greater diameter of the thorax. If any finding appears suspicious, get a second opinion. I don't need to even discuss with you the malpractice implications if a neoplasm or even an infection is missed. If your patient is a smoker, I would recommend getting a second opinion, even if the study appears normal.
PA Chest:
Lateral Chest:
The Cardiothoracic Ratio:
This measurement is performed to determine the size of the heart and a screening for heart enlargement.
MRD = maximum transverse diameter of the right side of the heart, which is a line drawn from the midline of the spine to the most distant point of the right cardiac margin.
ML= midline of the spine
MLD = maximum transverse diameter of the left side of the heart, which is a line drawn from the midline of the spine to the most distant point of the left cardiac margin
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This article focuses on nine severe injuries that are generally not diagnosable until the third to fourth week following the date of injury, including how to diagnose these severe injuries. The discovery of any of these injuries early can make a significant difference in the case outcome.
While canes, braces and posts represent extrinsic methods for lessening adductor moment arms, an intrinsic method for lessening the development of medial knee osteoarthritis occurs when the hip abductor musculature and the iliotibial band are strong enough to create a compressive force capable of stabilizing the lateral knee.
