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Overview

Imaging Methods

CXR: Main Focus

Others: Computed Tomography, MRI,Ultrasound, Nuclear Medicine

Approach to CXR

Densities

Anatomy and approach

Technical Factors

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Other Imaging Methods

CXR-Will be discussed later

Computed Tomography

MRI

Ultrasound

Mainly for procedures

Nuclear Medicine

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Computed Tomography

Numerous

protocols/techniques

depending on clinicalhistory

Helical/spiral versus high

resolution

Contrast

Renal failure

Allergy

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Computed Tomography

Role of CT

Main further investigation

for most CXR abnormality(eg nodule/mass) or to

exclude disease with

normal CXR

Main investigation for

certain scenarios (PE,

dissection, trauma)

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MRI

Multiple planes No radiation

Common Indication

Pancoast tumour Brachial plexus

Cardiac

Vascular (aorta)

Usually targetedexamination (unlike

CT)

Coronal

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Ultrasound

Limited use in thorax (non cardiac) due to

air in lungs

Assess pleural effusions

Mainly used for procedures

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Chest Radiographs

PA (posterior to anterior) and Lateral (left)

Minimizes magnification of heart (heart closest to film)

Portable (nearly always AP)

Supine or Erect

Specialized Views

Lordotic

Lateral decubitus (for effusions, pneumothorax)

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Normal Anatomy

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Bone-CT Reconstruction

PA View

Clavicle

Rib Intercostal

SpaceVertebral

Column

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Heart Size Normal is

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Right

Atrium

Right

Ventricle

Axial CT Image

Right atrium forms

right heart border

Right ventricle forms

Anterior heart border

R L

Cardiovascular: Heart

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Axial CT Image

Left atrium forms

Part of posterior

heart border

Left ventricle forms

Left and posterior

heart border

R L

Cardiovascular: Heart

Left

Atrium

Left

Ventricle

Cardiac Anatomy: Right Sided

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Cardiac Anatomy: Right Sided

Chambers

C di A L f Sid d

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Cardiac Anatomy: Left Sided

Chambers

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SVC Aortic Arch

Right Descending

Pulmonary Artery

Left Descendin

Pulmonary Ater

Lungs posteriorly

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Lungs posteriorly

should get darker as

you go down more

inferiorlyRetrosternalAirspace

Scapula

IVC

Pulmonary

Vessels

Hilum

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Airway Anatomy

Trachea

Cartilage

Membranous posteriorly

Carina

Bifurcation

Bronchus

Left and right

Lobar (RUL,RML,LUL,LLL)

Segmental (8 left, 10 right)

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Lung Anatomy

Lobes are separated by fissures Right

Upper Lobe

Middle Lobe

Lower Lobe

Left

Upper Lobe (includes lingula)

Lower Lobe

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Pleura and Fissures Pleura

Lubricates and prevents friction during

respiration

Potential SpaceDont see unless abnormal

Parietal pleura: Lines chest wall,

mediastinal and diaphragmatic surfaces

Visceral pleura: Lines lungs, fissures

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Parietal Pleura

Visceral pleura

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A h t Ch t R di h

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Approach to Chest Radiograph:

Technical Factors

Patient Identification (name and date)

Markers (Left vs right)

Assess for rotation (clavicles vs spinousprocess)

Penetration (thoracic spine should be

visible) Degree of Inpiration: 6th anterior or 10th

posterior

Clavicles

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Clavicles

Spinous Process

Vertebral Body

Visible

6

7

Counting anterior

ribs

10

11

Counting posterior ribs

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Inspiration/Expiration Images

Expiration

Heart size appear larger

Mediastinum is wider

Pulmonary vasculature indistinct

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4th Anterior

8th Posterior

Expiration Image

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