Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- 8 Managing the airway
- 9 Tracheostomy
- 10 Venous access
- 11 Invasive haemodynamic monitoring
- 12 Pulmonary artery catheter
- 13 Minimally invasive methods of cardiac output and haemodynamic monitoring
- 14 Echocardiography and ultrasound
- 15 Central nervous system monitoring
- 16 Point of care testing
- 17 Importance of pharmacokinetics
- 18 Radiology
- SECTION 3 System Management in Cardiothoracic Critical Care
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
18 - Radiology
from SECTION 2 - General Considerations in Cardiothoracic Critical Care
Published online by Cambridge University Press: 05 July 2014
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- 8 Managing the airway
- 9 Tracheostomy
- 10 Venous access
- 11 Invasive haemodynamic monitoring
- 12 Pulmonary artery catheter
- 13 Minimally invasive methods of cardiac output and haemodynamic monitoring
- 14 Echocardiography and ultrasound
- 15 Central nervous system monitoring
- 16 Point of care testing
- 17 Importance of pharmacokinetics
- 18 Radiology
- SECTION 3 System Management in Cardiothoracic Critical Care
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
Summary
Introduction
The portable chest radiograph is the primary imaging modality on the critical care unit. Daily physical examination of sedated, intubated patients may be difficult and new or rapidly evolving changes in cardiorespiratory status may only be appreciated on chest radiography.
The routine chest radiograph
The efficacy and accuracy of the portable antero-posterior (AP) chest radiograph in assessing cardiopulmonary or pleural complications in critical care and its role in detecting malpositioned monitoring devices have been evaluated in many studies. Although undoubtedly the chest radiograph is valuable in the assessment of complications after intervention or change in clinical status, the role of the ‘routine’ daily radiograph is more controversial. Although not specifically recommending against routine radiography, one should emphasize the value of more targeted investigations.
Technical considerations
Technique
Optimal radiographic technique is essential to maximize the efficacy and accuracy of bedside radiography. The AP chest radiograph should be obtained with the patient upright using a film-to-focus distance (FFD) of 1.8 m and 5 degrees caudal angulation of the x-ray beam. In supine patients, the FFD should be 1.1 m with a perpendicular x-ray beam. Consistency in technique and positioning is critical for optimal evaluation on serial examinations. Whenever possible, care should be taken to remove extrinsic tubing and objects from the patient's chest before exposure.
- Type
- Chapter
- Information
- Core Topics in Cardiothoracic Critical Care , pp. 127 - 134Publisher: Cambridge University PressPrint publication year: 2008