Respond to other student’s responses with substantive comments. Substantive comments add to the discussion and provide your fellow students with information that will enhance the learning environment.The postings should be at least one paragraph (approximately 100 words) and include references.

1. References and citations should conform to the APA 6th edition.
2. Remember: Please respect the opinions of others, even if their views differ. In other words, disagree professionally and respectfully.Plagiarism is never acceptable – give credit when credit is due – cite your sources

Response1-Autumn

Two diagnostic procedures involving the assessment of the thorax and lungs are the chest x-ray and chest computed tomography (CT). A chest x-ray uses a very small dose of ionizing radiation to produce images of the inside of the chest. This diagnostic procedure can be ordered to evaluate shortness of breath, cough, fever, chest pain, injury, or to help diagnose and monitor a variety of lung conditions including pneumonia, emphysema, and cancer amongst others (Radiological Society of North America, Inc., 2018b). Because the x-ray requires no patient preparation and can be completed quickly, it is extremely useful in emergency diagnosis. A radiologist analyzes and interprets the images then sends a signed report to the physician ordering the exam. Although the chest x-ray is an extremely useful assessment and diagnostic tool, it does have its limitations. “Because some conditions of the chest cannot be detected on a conventional chest x-ray image, this examination cannot necessarily rule out all problems in the chest” (Radiological Society of North America, Inc., 2018b). Examples of this include small, early-stage cancers and pulmonary embolisms.

A chest CT is used to create cross-sectional and multi-plane images of internal organs, bones, soft tissue, and blood vessels. A chest CT is painless, noninvasive, accurate, quick and appropriate to use in emergency situations to detect internal injury or bleeding (Radiological Society of North America, Inc., 2018a). A chest CT can be used to evaluate all the same symptoms that an x-ray can, but is used to further examine abnormalities already found on conventional x-rays as well as obtain more detailed images of the chest. The chest CT is extremely effective in diagnosing early-stage lung cancer as it can detect very small nodules when they are in their most curable stage (Radiological Society of North America, Inc., 2018a). Chest CT is also beneficial in diagnosing pneumonia, tuberculosis, cystic fibrosis, inflammation or diseases of the pleura, interstitial or chronic lung disease, and congenital abnormalities (Radiological Society of North America, Inc., 2018a).

Both tests are extremely reliable and demonstrate validity, as they provide accurate imaging to their respective diagnostic capacity. More sensitive imaging can be obtained with the chest CT over the x-ray, but which to order is dependent on the diagnostic purpose and presenting patient’s clinical manifestations. Both diagnostic procedures are usable in a variety of settings and are noninvasive to the patient, however, claustrophobic patients may have a difficult time withstanding the CT as the patient lies on a narrow examination table that slides into and out of a small tunnel. These patients may require distraction or sedation prior to initiation of the exam.

References

Radiological Society of North America, Inc. (2018a). Computed tomography (CT) – chest. Retrieved from https://www.radiologyinfo.org/en/info.cfm?pg=chest…

Radiological Society of North America, Inc. (2018b). X-ray (radiography) – chest. Retrieved from https://www.radiologyinfo.org/en/info.cfm?pg=chest…

Response2-Kathleen

The clinical assessment tools that are most readily available to distinguish between acute pulmonary abnormalities include auscultation and chest x-ray. A chest x-ray (CXR) often provides the first evidence in diagnosing a respiratory disorder, for example, a pleural effusion. Because the fluid typically collects in the dependent regions, it is seen at the base of the affected lung on an upright chest x-ray, and along the lateral wall when the client is positioned on the affected side. CT scans and ultrasonography also are used to localize and differentiate pleural effusions. A CXR is fundamentally used to evaluate structures and tissues. The limited diagnostic accuracy of these tools may not allow for the accurate differentiation between conditions such as lung collapse, consolidation, and pleural effusion.

Another diagnostic procedure method is a magnetic resonance imaging (MRI). The procedure is used in diagnostics to more accurately identify abnormal masses and fluid accumulation. An MRI of the thorax is used to diagnose alterations in lung tissue more difficult to visualize by CT scan. Currently, contrast-enhanced dynamic MR imaging is the method of choice to measure perfusion non-invasively and without radiation exposure. However, so far MR perfusion imaging remained a research tool and was not broadly introduced in the clinical field. Because a major issue is the lack of standardization in technical aspects which have to be considered for a successful quantitative evaluation. Requirements to fulfill the standards are a sequence and contrast agent dose optimization and a correct selection of the arterial input function.

References:

Fenstermacher, K. & Hudson, B. T. (2015). Practice Guidelines for Nurse Practitioners (4th ed.). Saunders: Elsevier

Sourbron, S. (2010). Technical aspects of MR perfusion. Europe Journal of Radiology. (76). 304–313.

Zöllner, F., Weisser, G., Reich, M., Kaiser, S., Schoenberg, S., Sourbron, S., & Schad, L. (2013). UMMPerfusion: An open source software tool towards quantitative MRI perfusion analysis in clinical routine. Journal of Digital Imaging. 26(2). 344-352. doi:10.1007/s10278-012-9510-6

Leech, M., Bissett, B., Kot, M., & Ntoumenopoulos, G. (2015). Lung ultrasound for critical care physiotherapists: A narrative review. Physiotherapy Research International. 20(2). 69-76. doi:10.1002/pri.160

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