Chest X-ray - Tubes
Principles

Key points

  • Check the patient details, date and time
  • Systematically look at the whole image
  • Look for unexpected pathology
  • Two images are not routinely required because the three-dimensional location of a device can be determined by a combination of radiological and clinical observations

It is essential to be systematic when checking the position of a medical device on an X-ray.

Patient details

Start by checking you are looking at the correct image. Check the name, patient identity details and date.

It is particularly important to check the time the image was acquired, as those who have medical devices placed often have several images acquired on the same day.

Patient details

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Patient details

  • Check the patient identity details
  • Check the image is the most recent by checking both the date and time

Image adequacy

Chest X-rays performed to determine medical device position are often performed using different radiographic parameters from those used to acquire diagnostic X-rays. Patients are also often more unwell, and so achieving good quality images can be more technically challenging.

If an image is of suboptimal quality but adequately demonstrates the position of the medical device, then there is usually no need to repeat the image.

The 'inadequate' X-ray

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The 'inadequate' X-ray

  • This X-ray was performed to check the position of a chest drain used to treat a pneumothorax
  • Conventionally this X-ray would be considered inadequate for diagnostic purposes as it does not include the costophrenic angles
  • The chest drain position is shown clearly
  • The image does not need to be repeated to include the costophrenic angles

Systematic approach

Although images may be of reduced diagnostic quality compared to conventional chest X-ray images, they must still be checked systematically for the presence of pathology.

The unexpected pathology

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The unexpected pathology

  • Chest X-ray performed to assess central venous catheter position
  • The catheter is in a good position
  • Systematic assessment of the image shows a left pneumothorax and pneumoperitoneum (free gas) - both potentially life-threatening abnormalities

2D v 3D?

It is not possible to determine the exact location of a medical device in three dimensions using a single X-ray image alone. However, as it is clinically evident where a tube has entered the body, only one image is usually required to confirm its internal position.

2D v 3D?

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2D v 3D?

  • The balls represent the location of three medical devices
  • The entry points of the orange and green devices would be evident clinically, and so only the Posterior-Anterior (PA) image is required in order to determine their superior/inferior and medial/lateral location within the chest
  • It would also be evident clinically that the red device is not in the body at all
  • Therefore, a lateral view is not routinely required