densities techniques anatomy cxr interpretation
TRANSCRIPT
RADIOLOGY
CHEST X -RAYS
CONTENTS:•Densities•Techniques•Anatomy•CXR Interpretation
DENSITIES The 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
Routine chest radiographRoutine chest radiograph
Air — least dense; most transparent or radiolucent; unobstructed beam or air-filled densities appear blackLungs, gastric bubble, trachea, ? bifurcation of bronchi
Air — least dense; most transparent or radiolucent; unobstructed beam or air-filled densities appear blackLungs, gastric bubble, trachea, ? bifurcation of bronchi
Routine chest radiographRoutine chest radiograph
Fat — breastsFat — breasts
Routine chest radiographRoutine chest radiograph
Fat — breastsNote: breast least opaque on the lung field, moderate lateral to lung. Fully opaque over the liver.
Fat — breastsNote: breast least opaque on the lung field, moderate lateral to lung. Fully opaque over the liver.
Non-pendulous breast producing impression on the lung field.
Non-pendulous breast producing impression on the lung field.
Routine chest radiographRoutine chest radiograph
Blood: heart most opaque, hilar vessels less opaque. Opacity in the hilar vessels decreases distally.
Blood: heart most opaque, hilar vessels less opaque. Opacity in the hilar vessels decreases distally.
TECHNICALLY ADEQUATE The patient should be examined in
full inspiration. This greatly helps the radiologist to
determine if there are intrapulmonary abnormalities.
The diaphragm should be found at about the level of the 8th - 10th posterior rib or 5th - 6th anterior rib on good inspiration.
A patient can appear to have a very abnormal chest if the film is taken during expiration.
RIBS
INSPIRATION/EXPIRATION
ROTATION If there is rotation of
the patient, the mediastinum may look very unusual.
One can access patient rotation by observing the clavicular heads and determining whether they are equal distance from the spinous process of the thoracic vertebral bodies.
ROTATION
ROTATION
TECHNIQUES - PROJECTION
•P-A (relation of x-ray beam to patient)
Routine chest radiographRoutine chest radiograph
PA view – film is placed anteriorly, X-ray beam passes from posterior aspect to anterior side.
PA view – film is placed anteriorly, X-ray beam passes from posterior aspect to anterior side.
•Lateral
•Lateral Decubitus
The right is an example of a decubitus film in this case showing a mobile pleural effusion (arrows).
AP viewAP view
An AP film, enlarges the shadow of the heart and makes the posterior ribs appear more horizontal.
An AP film, enlarges the shadow of the heart and makes the posterior ribs appear more horizontal.
ANATOMY
Lung lobesLung lobes
Anteriorly most area is represented by left upper lobe
Anteriorly most area is represented by left upper lobe
Lung lobesLung lobes
In the lateral view upper lobe occupies upper and anterior portions.
In the lateral view upper lobe occupies upper and anterior portions.
Lung lobesLung lobes
Posteriorly maximum portion is occupied by lower lobe
Posteriorly maximum portion is occupied by lower lobe
LOBES• Right upper lobe:
LOBES
• Right middle lobe:
LOBES
• Right lower lobe:
LOBES
• Left lower lobe:
• Left upper lobe with Lingula:
Position of the fissurePosition of the fissure
rtlt
The level of the left diaphragm isAbout 2.5cm below the right one.
The level of the left diaphragm isAbout 2.5cm below the right one.
DIAPHRAGMDIAPHRAGM
In chest PA view, mediastinum hasTwo borders, left and right
In chest PA view, mediastinum hasTwo borders, left and right
MEDIASTINUMMEDIASTINUM
HEART
MEDIASTINAL BORDERMEDIASTINAL BORDER
Right border is formed by -Form above downwardsRight bracheocephalic vesselsAscending aorta and superimposed SVCRight atriumInferior vena cava
Right border is formed by -Form above downwardsRight bracheocephalic vesselsAscending aorta and superimposed SVCRight atriumInferior vena cava
MEDIASTINAL BORDERMEDIASTINAL BORDER
Left border is formed by -from above downwardsLeft bracheocephalic vesselsAortic archPulmonary trunkLeft atrial appendageLeft ventricle
Left border is formed by -from above downwardsLeft bracheocephalic vesselsAortic archPulmonary trunkLeft atrial appendageLeft ventricle