Download - Chest Imaging and Anatomy
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Chest Imaging And Anatomy Overview Imaging Methods : ain ocus
Others: Computed Tomography, MRI, Ultrasound, Nuclear
Medicine
Approach to CXR
Densities
Anatomy and approach
Technical Factors
Other Imaging Methods
CXR-Will be discussed later
Computed Tomography
MRI Ultrasound
Mainly for procedures
Computed Tomography
protocols/techniques
depending on clinicalhistory
Helical/spiral versus high
Contrast
Renal failure
Allergy
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Computed Tomography
Main further investigation for
most CXR abnormality (eg
nodule/mass) or to exclude
disease with normal CXR
Main investigation for certain
scenar os , ssec on,trauma)
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MRI
Multiple planes
No radiation
Common Indication
Pancoast tumour Brachial plexus
Cardiac
Vascular (aorta)
Usually targeted
examination (unlike
CT)
Coronal
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Nuclear Medicine
Variety of tests: functional rather than anatomic V/Q specific to chest imaging
Others: bone scan, gallium, WBC etc.
Ultrasound
Limited use in thorax (non cardiac) due to air in lungs
Assess pleural effusions
Mainly used for procedures
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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Chest Radiograph: Approach and
Normal Anatomy
THERE IS NO ONE APPROACH: BE
SYSTEMATIC
Bone and Soft Tissue including abdomen
Heart
Mediastinum-aorta, trachea
Hila
Lungs
Pleura
Normal Anatomy
Bone-CT Reconstruction
PA View
Rib IntercostalSpace
VertebralColumn
Bone Anatomy
Sternum
Rib
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Heart Size Normal is
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Cardiac Anatomy: Right Sided ChambersCardiac Anatomy: Left Sided
Chambers
SVC Aortic Arch
Right Descending
Pulmonary Artery
Left Descending
Pulmonary Ater
Lungs posteriorly
should get darker as
you go down more
inferiorlyRetrosternal
Airspace
Scapula
IVC
um
Pulmonary
Vessels
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Airway Anatomy
Trachea
Cartilage
Membranous posteriorly
Carina
Bifurcation
Bronchus
Left and right
Lobar (RUL,RML,LUL,LLL)
egmenta e t, r g t
Trachea
R +L Main
Carina
Bronchi
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
u ricates an prevents riction uring respiration
Potential Space Dont see unless abnormal
Parietal pleura: Lines chest wall, mediastinal and
diaphragmatic surfaces
Visceral pleura: Lines lungs, fissures
Parietal Pleura
Visceral pleura
Diaphragms
Normal: Sharp costophrenic sulcus
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Which is right and left diaphragm?
Approach to Chest Radiograph:
Technical Factors
Patient Identification (name and date)
Markers (Left vs right)
Assess for rotation (clavicles vs spinous process)
Penetration (thoracic spine should be visible)
Degree of Inpiration: 6th anterior or 10th posterior
Clavicles
S inous Process
Vertebral Body
Visible
6
7
Counting anterior
ribs
10
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Counting posterior ribs
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Inspiration/Expiration Images
xp rat on
Heart size appear larger
Mediastinum is wider
Pulmonary vasculature indistinct
4th Anterior
8th Posterior
Expiration Image
Inspiration: Same PatientExpiration