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The Chest X-Ray

For: Nottingham SCRUBS 26th August 2006

Presented by: Matthew

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Aims:Basics

Best exam resultsAppreciate the role radiology plays

? Instil an interest in radiology

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Contents:

Densities

Techniques

Anatomy

CXR Interpretation

Common Pathologies

Questions

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DensitiesThe big two densities are:

(1) WHITE - Bone(2) BLACK - Air

The others are:

(3) DARK GREY- Fat

(4) GREY- Soft tissue/water

And if anything Man-made is on the film, it is:

(5) BRIGHT WHITE - Man-made

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Techniques - ProjectionP-A (relation of x-ray beam to patient)

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Techniques - Projection (continued)

A-P Supine/Erect

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Techniques - Projection (continued)Lateral

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Techniques - Projection (continued)

Lateral Decubitus

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Techniques - Projection (continued)

Oblique

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Orientation

Orientation

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Rotation

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Rotation (continued)

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Penetration

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Inspiration/Expiration

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Anatomy

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Anatomy

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Anatomy

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Lobes Right upper lobe:

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Lobes (continued) Right middle lobe:

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Lobes (continued) Right lower lobe:

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Lobes (continued) Left lower lobe:

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Lobes (continued) Left upper lobe with Lingula:

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Lobes (continued) Lingula:

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Lobes (continued) Left upper lobe - upper division:

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Pleura Layers:

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Heart

Right border: Edge of (r) Atrium

3. Left border: (l) Ventricle + Atrium

4. Posterior border: Reft Ventricle

5. Anterior border: Right Ventricle

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Heart (continued)

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Heart (continued)

H

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Heart (continued)

Valves

M di ti

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Mediastinum

Hil

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Hilum

Made of:

1. Pulmonary Art.+Veins

2. The Bronchi

Left Hilus higher (max 1-2,5 cm)

Identical: size, shape, density

Hilum

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Hilum

Ribs

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Ribs

Soft tissue & bones

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Soft tissue & bones

Lateral CXR

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Lateral CXR

Lateral CXR ( ti d)

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Lateral CXR (continued)

Lateral CXR ( ti d)

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Lateral CXR (continued)

Lateral CXR (continued)

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Lateral CXR (continued)

Lateral CXR (continued)

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Lateral CXR (continued)

CXR Interpretation

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CXR Interpretation

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Technical Details

Type

Orientation

RotationInspiration/expiration

Penetration

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Lungs:

Lungs Density

Symmetry

Lesions

Heart

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Heart

Size:

Heart

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HeartSize of heart

Size of individualchambers of heart

Size of pulmonary

vessels

Evidence of stents, clips,

wires and valves

Outline of aorta and IVC

and SVC

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Mediastinum: Width

Contour AP window

Hila: Size

Location

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Review areas:

Apices Behind the heart

CP angles

Below the diaphragm Soft tissues ( breast, surgical emphysema)

Ribs & clavicle

Vertebrae

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Identify the lesion localise the lesion describe the lesion give DD

Never stop looking, carry on with your

systematic approach!!

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Pathology

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RUL pneumonia

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RML pneumonia

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RLL pneumonia

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LUL pneumonia

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LLL pneumonia

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Consolidation on CT

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Hilar m l

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The Enlarged Hila

Causes:

1. Adenopathies (neoplasia, infection)

2. Primary Tumor

3. Vascular

4. Sarcoidosis

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Multiple Masses

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Hilar Lymphadenopathy - BL

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Pleural Effusion

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Pulmonary Fibrosis

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?

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Heart failure

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Pneumothorax

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RUL collapse

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LLL collapse

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Air under the diaphragm

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Emphysema

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Cervical Rib

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Cavitating lesion

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Hiatus hernia

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Miliary shadowing

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Chest Tube, NG Tube, Pulm. artery cath

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