INDEX

Abscess, 92 fi rst radiographic abnormalities, Absorption 81 coeffi cient, 7 infi ltrates, 153–154 of scatter, 9 mortality rates, 81 Acute lung injury (ALI), 79–81, 83 radiographic appearance of, Acute , 73, 76, 81–83 151. See also Myocardial recovery phase, 85 infarction severe, 83 Acute respiratory distress Adenopathy, 18 syndrome (ARDS) Adhesive atelectasis, 90 case studies, 152–158 AIDS patients, 65, 141 characteristics of, 50, 60, 70, Air alveolograms, 137, 140 78–79 Air bronchograms, 18, 60–61, co-existing pneumonia, 157–158 63–64, 79, 82–85, 90–93, 138, CT scans, 83–84 142, 153–154 defi ned, 80COPYRIGHTEDAir cysts, MATERIAL 55 diagnosis, 80–81 Air-fl uid levels, 44 etiologies, 80, 82–83 Air space density, 78 exudate phase of, 81–82 Air to tissue ratio, 47

ICU Chest Radiology: Principles and Case Studies, by Harold Moskowitz Copyright © 2010 John Wiley & Sons, Inc. 171 172 INDEX

Airway obstruction, 21 development of, 60, 63 Alignment, grid-x-ray beam, 9, 11 effusion distinguished from, 92 Allergic pneumonitis, 128 etiologies, 25, 90 Alveoli incidence of, 90 air conditions, 46 left lung, 170 capillary membrane, 82–83 lobar, 93, 120 consolidation, 65 lower lobe, 120, 129 densities, 16, 78, 155–156, 158 obstructive, 90–91 distension of, 50, 83 passive, 90–92 edema, 71–72, 75–76 peripheral subsegmental, 93 overinfl ation of, 50 plate-like, 93 Aneurysms, 19, 89 pneumonia associated with, Angel wings, 75–76 93–94, 163 Angiograms radiographic appearance of, coronary, 166 93–94 selective pulmonary, 114 treatment of, 77 Angiography, 88, 160, 166 upper lobe, 151 Angle of acceptance, 11–12 Atomic number, 7 Angulation, 11 Atrial septal defect (ASD), 125 Anterior posterior (AP) position, 8 Atria, 19, 77, 92, 125 Aorta, 19, 42, 52, 115 Auricle, 77 Arch of the aorta, 19 Automatic processing, 12 , 28, 37 Artery(ies) Bacteria common carotid, 52 Cryptococcus, 68 coronary, 19 Klebsiella pneumonia, 63–64 innominate, 52 Legionella, 58 mammary, 115 Pneumocystis carinii pneumonia, pulmonary, 19, 36–37, 42, 70, 77, 65, 141 113–115, 164 Pseudomonas, 63 subclavian, 42, 52, 72–73 Staphylococcus aureus, 57–58, 88, Aspergillus, 58, 68 119 Aspiration, tube placement and, 26, Streptococci, 88 34 Balloon pumps, intra-aortic, 22, 37, , 74 41–43 Atelectasis Barotrauma adhesive, 90 case studies, 126–133 basilar, 61 defi ned, 46 case studies, 121, 129, 161–170 impact of, 81 cicatricial, 90, 92–93 interstitial emphysema, 54–55 compressive, 90, 92, 112 pneumomediastinum, 52, 55 CT scan, 66, 92, 167 pneumonia, 126 INDEX 173

pneumothorax (PTX), 47–52 Bypass surgery positive end expiratory pressure cardiac, 110, 116 (PEEP) ventilation, 46–47, mammary artery, 115 83–84 positive pressure ventilation Calcifi cations, 18 (PPV), 46 Candida pneumonia, 58 secondary, 83 Capillary pressure, 72 subcutaneous emphysema, 55–56 Carcinoma tension pneumothorax, 50, 53–54 of the breast, 140 ventilator-induced, 50 bronchogenic, 31 Basement membrane, 70, 83 of the colon, 138 Bat wings, 75–76, 146 of the lungs, 123 Bilateral confl uent densities, 84 Cardiac asthma, 74 Bipolar catheter, 43 Cardiac border, 18–19, 95–96, 110, Bipolar pacemaker, 43–45 136, 139, 150, 162, 168 Bleeding, see Hemorrhage Cardiac catheterization, 47, 111 thoracotomy tubes, 33 Cardiac contour, 16 variceal, 38 Cardiac shadow, 16–17, 19, 72, Blood 94–95, 131 fl ow, 50, 73 Cardiac silhouette, 52, 72 oxygenation, infl uential factors, Cardiogenic , 46 70–71, 77, 82 transfusions, 80 , 8, 72, 74, 113, 150, Bony structures, 7, 18. See also 166 specifi c types of vertebrae Cardiopulmonary status, 5 Breathing guidelines Cardiothoracic ratio, 72 expiration, 6, 17 Cardiovascular collapse, 50 inspiration, 6, 8, 15, 17 Carina, 21–23, 26, 77 negative-pressure, 53 Case studies Bronchi acute respiratory distress characteristics of, 18 syndrome, 152–158 major, 52 atelectasis, 161–170 right main stem, 23 barotrauma, 126–133 upper lobe, 77 pneumonia, 134–144 Bronchial intermedius, 165 pulmonary edema, 145–151 Bronchieatasis, 85 pulmonary embolus, 152–160 Bronchiectosis, 89 tubes, lines, and catheters, Bronchopneumonia, 63–65 109–125 Bronchopulmonary fi stula, 31 Catheters Bronchoscopy, 59, 91, 96 bipolar, 43 Bucky, defi ned, 10 case studies, 113–114 Bucky, Gustav, 10 central venous, 26–30 174 INDEX

Catheters (cont’d) Congestive , 71, 77–78, knotting of, 38 81 location of, 9, 14 Congestive myopathy, 146–147 placement of, 27 Connective tissue, 54 Swan-Ganz, 36–38, 70, 92, 113, Consulting physician, 13 115, 117–118, 120 Contrast, 7, 13, 66 triple lumen, 27 Contusions, pulmonary, 60 Central venous catheters Conventional radiography, 12–13 complications of, 27, 29–30 Coronary angiography, 166 indications for, 26 Coronary arteries, 19 misplacement of, 28–29 , 146–147, placement from left side, 29 166 placement from right side, Costophrenic sulcus, 18, 51–52, 26–28 121 venous anatomy, 27 Critically ill patients Cephalization, 73, 75, 78, 146 breathing, 6, 17 Cervical vertebrae, 18 challenges of, 5 Chemical processing, 12 dialysis for, 27 Chest tissue, interstitial, 51 immunocompromised, 58 Chest tube, 53, 55–56. See also immunodepressed, 87 Thoracotomy tubes mechanical ventilation, 21, 26, 46, Chronic obstructive lung disease, 50, 58, 91 77, 118, 121, 130, 132 positioning of, 6, 8, 16, 47, 54, 61, Chronic obstructive pulmonary 77 disease (COPD), 17, 71–72, quality of care, 14 135–136 size of, 8 Clavicles, 16, 28 Cross-hatched grids, 11 Coalescence, 154–155 Cross-table lateral view, 48 Common carotid artery, 52 Cuffi ng Communications peribronchial, 75 clinical-radiologist, 14 perivascular, 73–74, 77, 146 consulting physicians, 13 Cytomegalovirus (CMV), 65 physician-radiologist, 14 recordkeeping guidelines, 7, 14 Decubitus view, 48, 77 team conferences, 14 Deep sulcus sign, 121, 130 Computed tomography (CT) scan, Defi brillators, 43–45, 111–112 3, 34, 65–66, 78, 83, 88–89 Density Computer radiography, 12–13 abnormal, 18 Computerized tomography measurement of, 7 angiogram (CTA), 88 signifi cance of, 5, 7–8, 14, 68, 78, Congestion, 149 83–84, 93, 95, 110, 117, 120, 139 Congestive failure, 150–151 triangular, 86–87 INDEX 175

Developer solutions, 12 malposition of, 25 Diabetes, 58 placement of, 20–23, 36, 58–59, Dialysis patients, 27 140 Diaphragm, 18, 47, 50, 91, 94, 96, postintubation x-ray, 25 117, 122 removal of, 118 Digital radiography, 12–14 Esophageal gastric junction, 138

Dmax, 7 Esophagus, 25, 52, 116, 1 40 Dmin, 7 Exit beam, 9 Dobhoff tubes, 34–35, 138 Expiratory fi lm, 17, 30 Draining tubes, 116 Exposure Drug abuse, 87, 144 distance and, 9 Drug toxicity, 70 grids and, 13 Dynamic range, 13 infl uential factors, 8 signifi cance of, 15–17 Echocardiogram (ECG), 41, 144 Edema, pulmonary. See Pulmonary Fat embolism, 87 edema Feeding tubes. See Nasogastric Effusion (NG) tubes atelectasis distinguished from, 92 Fiber optic bronchoscopy, 59 pleural, 36, 75, 77, 91, 96, 112 pulmonary emboli, 87 atrial, 125 Emboli, septic, 30, 66–67, 87–88, ventricular, 111 144 Fibrosis, 18, 77, 93, 118, 127, 147 Emphysema Film etiologies, 25, 34 AP, 77, 94 interstitial, 54–55 contrast, 7, 13, 66 mediastinal, 51, 129, 137, 155 conventional systems, 12 subcutaneous, 46, 55–56, 67, 84, daily, 25 132 expiratory, 17, 30 Endobronchial obstruction, 91 fogging of, 12 , 68, 87–88, 144 follow-up, 8 , 43, 68, 87–88, 144 high resolution, 7, 14 Endothelial damage, 28, 37 lateral, 33–34, 44 Endotracheal tubes (ETTs) low resolution, 7 case studies, 110, 129–130, 132, PA, 75, 77 142–143, 146, 154, 156, 168–169 processing, see Processing complications from, 24–26, 118 approaches daily fi lms of, 25 quality of, 4–6, 9–10 displacement of, 25 noise, 7, 13 extubation, 23 resolution, types of, 7, 13–14 improper placement of, 23 spatial resolution, 7, 13 infl ation of, 24 system speed, 8 176 INDEX

Focused grid strips, 11 pulmonary edema, 70 Follow-up fi lms, 8 shift of structures, 94 Fungal diseases, 65 Heimlich tube, 136 Gallstones, 18 Hematoma, 28, 33 Gas exchange, 21 Hemidiaphragm, 17, 49, 60, 62, 91, Gas gangrene, 44 124, 129, 136, 138–139, 162, Gastrointestinal (GI) tract, 164 166, 168 Goodpasture syndrome, 89 Hemithorax, 47, 124, 163–164 Grafts, 18 , 44 Gram negative pneumonias, 57–58, Hemorrhage 61 indications of, 39, 60, 79 Great vessels, 52 intrapulmonary, 113 Grid ratio, 10–12 pulmonary, 87, 89 Grids Herniation, 164, 167 alignment and, 9, 11 Hiatal hernia, 167 angulation, 11 High resolution, 7, 14 computerized radiography and, Histoplasmosis, 65, 68 13 Homeostasis, 72 conventional, 10 Hospital information system (HIS), cutoff, 9, 11 14 ideal, 11 Hyaline membrane objections to, 9 disease, 155 scatter and, 11–12 implications of, 82–83 signifi cance of, 8–9 Hydrostatic pulmonary edema, types of, 9–11 69–71, 79 width of, 11 Hyperinfl ation, 23 Hypertension Hampton hump, 86–87 pulmonary, 18, 70–71, 73 Head, in endotracheal tube venous, 77 placement, 22–23 Hypoxia, 81 Health hazards, 12 Heart, see specifi c parts of heart ICU anatomy ancillary personnel, 12 cardiac output, 36 patients in, see Critically ill cardiac size, 18, 26, 75–76 patients cardiac valves, 19 personnel, roles of, 6 cardiovascular collapse, 50 physician, 14 chamber enlargement, 18–19, rounds in, 14 146, 150 Image characteristics of, 52 acquisition systems, 14 density of, 7 degradation factors, 10 enlarged, 44, 92 manipulation of, 13 INDEX 177

navigation, 13 end-diastolic pressure, 73–74 postprocessing, 13 enlargement of, 77 quality, infl uential factors, 12–13 failure of, 70–71 receptor, 8 size of, 75 sharpness, 7–8 Lesions, nodular, 65, 67 transmission, 13 Level measurement, 13 Immunocompromised patients, 58 Linear grids, 11 Immunodepressed patients, 87 Lines Immunosuppressant therapy, 58 case studies, 109–112 Impaction, mucoid, 91 Kerley, 71, 74–75, 149 Infected endocarditis, 87 picc, 27 Infection, 25, 29–30, 44, 54, 58–59, removal of, 6 87 replacement of, 111 Intensive care unit. See ICU Loculated hydropneumothorax, 33 Information fl ow, 14 Lucency, 55, 121 Injury edema, 70 Lungs Interpretation of images, 14. acini of, 65, 95 See also Misinterpretation anatomy of, 70 Intra-aortic balloon pumps basilar, 135 (IABPs), 22, 37, 41–43 carcinoma of, 123 Intraventricular cardiac collapse of, 90–92, 94–96, 116– defi brillator (ICD), 111–112 117, 162, 164, 168 , 42, 118, 156 CT scans, 93–94 density of, 7–8 Jejeunal tube, 59 fi elds, 18 interstitium, 72 Kerley lines, 71, 74–75, 149 left, 92–93, 157, 162, 164, 169–170 Kidneys lower lobe, 17, 35, 93, 91–94, 96, dialysis, 27 116–117, 135, 153, 162–163, renal failure, 70 165, 168

Kilovolt potential (KVp), 8 lymphatics of, 72, 74–75, 149 middle lobe, 94–95, 147, 157 Laser beams, 12 overexpanded, 47 Lateral fi lms, 33–34, 44 partial collapse, 116, 168 Lateral view, 48, 75 pulmonary hemorrhage, 89 Lead strips reexpansion of, 77 functions of, 9 right, 92, 94–96, 153–154, 157, height and space between, 10–11 165, 168 Leaky lung syndrome (LLS), 79 stiff, 46, 50, 156 Left ventricle tracheal tube placement, 23 borders, 19 upper lobe, 91–92, 94, 151, 153, 157 dysfunction, 41 volume of, 46, 54, 162 178 INDEX

Lympathic system, 72, 74–75, 149 Neurogenic pulmonary edema, 70 Lymph nodes, 18 Neurovascular bundle, 32 Lymphoma, 65 Nodules, pulmonary, 66–68 Lymphoprolypherative disorders, 68 Noise, 7, 13 Noncardiac pulmonary edema, 70, Magnifi cation factor, 19 78–79 Mediastinitis, 30 Noncardiogenic pulmonary edema, Mediastinum 77, 79 characteristics of, 9–10, 18, 41, 46 Nosocomial pneumonia, 57–59, 61, shadow, 16 135 shift in, 50, 53, 64, 91, 94, 96, 162, 164, 170 Obstructions, types of, 18, 21, 90–91 upper, 95, 1 16 Oligemia, 86 widening, 28, 36 Opacity, implications of, 60, 82–83, Mendelson syndrome, 80 87–88, 93, 154, 157, 162, 164 Metastatic disease, 67 Oropharyngeal colonization, 57–58 Methicillin resistance, 58, 119 Overexposure, 13 Milliampere second (mAs), 8 Overhydration, 78 Misinterpretation, sources of, 6, 17 Overpenetration, 16 , 62, 115 Oxygen saturation, 83, 109 Monitors, types of, 14 Mucormycosis, 58 Pacemakers, 43–45, 111, 147 Mucus plugging, 90–91, 162 PA fi lm, 75, 77 Multiorgan failure, 81 Pancreatitis, 80, 154–155 Myocardial disease, 71 Parallel grid strips, 11 Myocardial infarction, 113 Patent ductus arteriosis, 125 Myocardium, 44, 71, 113 Patient care guidelines. See Critically ill patients Nasogastric (NG) tubes PEEP ventilation. See Positive end abnormal position of, 34 expiratory pressure (PEEP) case studies, 122, 140 ventilation complications of, 34–35 Perforation, 28, 36, 39, 44 placement of, 22, 34, 36, 116, 122, Pericardial tamponade, 28, 44 140 , 54, 116 Neck Perihilar alveolar edema, 76 air tracking in, 51, 131 Permeability pulmonary edema, 70, cervical vertebrae, 18 79 soft tissues, 52, 133 Pharynx, 24–25, 34 Necrosis, 156 Phosphor materials, 12 Necrotizing entrocolitis, 122 Photons, 7, 9 Nerve injury, phrenic, 92 Photo-timing devices, 8 Network display devices, 14 Picc lines, 27 INDEX 179

Picture-archiving computerized mortality rates, 57 system (PACS) nodular, 143–144 defi ned, 12 nosocomial, 57–59, 61, 135 digital system combined with, pulmonary edema with, 77 13–14 right-sided, 65–66, 137–140 Pixel size, 13 round, 61–62 Plasma oncotic pressure, 72 secondary, 81 Pleura staphylococcal, 142 adhesions, 50, 52 treatment of, 72–73, 139 fl uid evacuation from, 32 upper lobe, 61, 64, 127, 137 mediastinal, 52 Pneumonitis, 79 parietal, 47 , 54 Pneumocytes Pneumothorax (PTX) type I, 70 air leak from, 55 type II, 70, 82–83, 155 case studies, 127–128, 136 Pneumomediastinum, 26, 36, 52, 54 characteristic radiologic features, Pneumonectomy, 124 49–52, 85 Pneumonia CT scan, 127 aspiration, 25, 39, 61, 70, 135, 140 defi ned, 46 atelectasis associated with, 93–94, detection of, 48–49 163 development of, 84 basilar, 138 etiologies, 23, 25–28, 30–31, 39, bilateral, 64, 140 46–48, 56, 92, 116, 127–128 bronchopneumonia, 63–65 large, 67 case studies, 124, 126–128, left-sided, 48 134–144 right-sided, 127 cavitary, 61 small, 14, 48–51, 56 classifi cation of, 63 tension, 50, 53–54 classic silhouette sign, 60 treatment of, 77 common pathogens of, 57–58 Portable chest radiograph consolidative, 139 benefi ts of, 3 development of, 50, 58–59, 70, 82 reading, 15–19 diagnosis, 57, 59–60, 78 teamwork, 6 eucenephalic, 128 technical quality of, 5–6 etiologies, 65, 124, 141 techniques, 6–14 interstitial, 63, 65 Ports, for dialysis, 27 left-sided, 64–66, 136 Positioning of patient lobar, 63, 165 anterior posterior (AP), 8 lower lobe, 61–63, 124, 126–127, decubitus, 48, 77 136, 139 erect, 61 methicillin resistance, 58 right anterior oblique, 16 middle lobe, 139 rotation, 77 180 INDEX

Positioning of patient (cont’d) CT scans, 88–89, 160 signifi cance of, 6 diagnosis, 88–89 supine, 6, 47, 54, 61, 77 effusions, 87 Positive end expiratory pressure etiologies, 86–88 (PEEP) ventilation, 46–47, 50, infi ltrates, 87 83–84 predisposing factors, 86 Positive pressure ventilation (PPV), Pulmonary infarction, 37, 60, 66, 87, 46, 50 113 Postprocessing, 13 Pulmonary vascular permeability, Principles of ICU chest radiology 81 acute respiratory distress Pylorus, 116, 138 syndrome, 80–85 air space diseases, 66–68 Quality of care, 14 atelectasis, 90–96 barotrauma, 46–56 Radiation catheters, see Catheters dosage, 12 lines, see Lines low-energy, 13 portable chest technique, 5–14 primary, 9 pneumonia, 57–66 scatter, see Scatter radiation pulmonary edema, 69–79 Radioisotope perfusion scan, 88 pulmonary embolus, 86–89 Radiologist reading a portable chest functions of, 6, 13 radiograph, 15–19 ICU, 8 tubes, see Tubes rounds with, 14 Processing approaches, 12–13 Radiolucencies, 55 Protocols, 14 Radionucleotide scan, 88 Pulmonary artery pressure, 36, 70 Radio-opaque tubes, 27 Pulmonary capillary wedge Ratio pressure, 36, 70 air to tissue, 47 Pulmonary edema cardiothoracic, 72 bilateral, 77 grid, 10–12 case studies, 145–151 Reading guidelines of portable characteristics of, 50, 71–75 chest radiograph classic patterns of, 75 evaluation of, 15–18, 77 diagnosis, 78–79 systematic approach, 15, 18–19 etiology, 60, 69–72, 75, 78 Recordkeeping guidelines, 7, 14 unilateral, 76–77 Resolution Pulmonary embolus high, 7, 14 bilateral, 89 low, 7 case studies, 159–160 spatial, 7, 13 characteristics of chest Respirators, 26, 47, 127. See also radiograph, 86 Ventilation INDEX 181

Respiratory collapse, 50 Stomach, 25, 39–40, 122–123, 138, Respiratory failure, 20–21 140, 167–168 Respiratory therapy, 96 Storage devices, 14 Retroperitoneum, 52 Storage phosphor-computed Revascularization surgery, 148 radiography, 12–13 Ribs/rib cage, 7, 16, 18–19, 27 Stricture, 24 Right anterior oblique position, 16 Subpleural blebs, 50 Right ventricle, 45 Supine radiograph, 6, 47, 54, 61, 77 Rotation of patient, 15–16 Surgical complications, 54, 62 Ruptures, 37, 39, 41, 52, 54, 113 Swan-Ganz catheters, 36–38, 92, 113, 115, 117–118 Sagittal reconstruction, 119 Scapula, 18 Teamwork, 6, 14 Scarring, 118, 147 Technologist Scatter fraction, 10 role of, 6, 8 Scatter radiation training strategies, 7 control of, 11–12 Temperature control, 12 decreasing effects of, 13 Tension pneumothorax, 50, 53–54 defi ned, 9 Thickness, signifi cance of, 7. as health hazard, 12 See also Density image degradation and, 13 “Third spaces,” 79 impact of, 5, 9–10 Thoracentesis, 47, 139 Scrolling, 13 Thoracic outlet, 117 Sengtaken-Blakemore tubes, 38–41 Thoracic spine, 16 Sensitometric fi lm strips, 12 Thoracic vertebrae, 16–18 Sepsis, 30, 66–67, 70, 80, 83, 87–88, Thoracotomy tubes 144 complications from, 32–33 Septal thickening, 71, 77 malfunction of, 32–33 Shock, 41, 70 parenchymal placement of, 33 Shoulders, 18 placement of, 30–31, 33 Shunting, 54 Thorax, 72 Silhouette sign, 52, 60, 72, 95 Thrombosis, 113 Sinusitis, 25 Thymus, 52 Skinfolds, 48–49 Tissue Soft tissue, 18, 44, 51, 55, 132–133 connective, 54 Spatial resolution, 7, 13 density of, 14 Spine, 16 interstitial, 51 Spinous process, 16 soft, 18, 44, 51–52, 55, 132–133 Starling equation, 72 Trachea Sternal dehiscence, 118 characteristics of, 52 Sternum, infection in, 118 injury to, 52 Steroid therapy, 58 overdistention of, 156 182 INDEX

Trachea (cont’d) cardiac, 19 rupture, 25 mitral, 62, 115 shift of structures, 94, 170 prosthetic, 120 Tracheobronchial injuries, 52 tricuspid, 67, 87–88, 114 Tracheobronchial tree, 34 Valvular disease, 71 Tracheostomy Vanishing tumor, 147 indications for, 35, 126 Variceal bleeding, 38 tubes, 26, 58 Vascular pedicle, 19, 26, 54, 77, 79 Transtracheal bronchoscopy, 59 Vascular pedicle width (VPW), 72 Trauma, physical impact of, 54 Vasculature, lower lobe in lung, 17 Triglycerides, 87 Veins Triple lumen catheters, 27 axillary, 18, 27 Tube-fi lm distance, 9 azygous, 29, 77 Tuberculosis, 65, 68, 89 brachiocephalic, 27 Tubes esophageal, 38 case studies, 109–112 femoral, 27 coiling, 110 jugular, internal, 27, 36, 47, 113, displacement of, 25 117, 162 endotracheal (ETT), 20–26, 36, pulmonary, 18, 70–71, 73 58–59, 110, 118, 140, 143 subclavian, 27, 47 nasogastric (NG), 22, 34–36, 116, Vena cava 132, 140 inferior, 75 location of, 14 superior, 27–29, 52, 72, 77, 94, placement of, 21–22, 26–27, 112, 142, 162 30–31, 33–34, 36, 116, 122, 140 Venous anatomy, thoracic, 27. removal of, 6, 23, 118 See also Veins Sengtaken-Blakemore, 38–41 Venous pressure, 27, 77. See also thoracotomy, 30–34 Wedge pressure tracheostomy, 26, 58 Venous system, see Veins x-ray, 6, 8–9 central, see Central venous Tumors, 65, 89, 92, 109, 147, 165, 170 system Twiddlers syndrome, 45 pulmonary, 70 Ventilation, mechanical, 21, 26, 46, Ulceration, 24 50, 58, 91 Ultrasound applications, 3, 165 Ventilator, positive-pressure Underexposure, 13 mechanical, 21 Underpenetration, 16 Ventricular aneurysms, 19 Upright position, 6 Ventricular septal defect (VSD), 125 Valves Vocal cord damage, 24 aortic, 115 Voice-recognition recording artifi cial, 120 system, 14 INDEX 183

Volume status, signifi cance of, 46, postintubation, 25 54, 77, 79, 162, 170 primary beam, 11 tube, see X-ray tube Wedge pressure, 36, 70, 113 X-ray tube Window measurement, 13 current, 8 -fi lm distance, 8–9 X-ray function of, 6 examination, benefi ts of, 3 image receptor, distance from, grid, 8–11 8