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Radiology Essence
Basics of Chest X-ray Interpretation
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Radiology Essence
Basics of Chest X-ray Interpretation
Samyajyoti Das,
Subhajit Datta
(2015-16 batch MBBS students
Agartala Government Medical College)
EDUCREATION PUBLISHING (Since 2011)
www.educreation.in
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INTRODUCTION
This book is mainly intended for the students appearing in the
post-graduate medical admission tests around India along with all
the undergraduate students who wish to learn Radiology in a better
way. This book will give them a basic idea regarding the chest x-
ray interpretation and its use in different subjects of MBBS course.
Radiology is one of the subjects, which is not taught to a great
detail in under graduation but forms a significant part in a doctor‘s
life. More over with the changes in the patterns of questions
towards the clinical side in different competitive exams,
knowledge of radiological signs has become critical. More
importantly with proper radiological knowledge, early diagnosis of
the disease can save a patient‘s life.
This book is a humble attempt to provide you with one high yield,
comprehensive textbook to help you improve your diagnosis skills
in the field of Radiology.
The book is structured into normal chest x-ray, Quality and Tubes
in chest x-ray, Abnormalities along with Golden facts, Special
signs and Multiple choice questions. This book is written in a way
that once you go through this book, you have a comprehensive idea
about the subject and are able to answer majority of the questions
in Radiology. In today‘s competitive world every subject and every
question makes a difference with limited time available to the
students.
Although, we have given our best effort to make this book a
complete yet concise account of the subject. We request all our
readers and critics to kindly inform us about any deficiency
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regarding the book. Any suggestion to improve the book quality
will be most welcome.
Samyajyoti Das
SubhajitDatta
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ACKNOWLEDGEMENTS
We are grateful to our mentor Dr. Kishan Rao B, MBBS Third
year PGT in General Surgery at Agartala Government Medical
College for his constant support, advice and constructive criticism.
To all our teachers who always showed us the right way in our life
and taught us whatever we know.
To all our colleagues and seniors for their support, cooperation and
suggestions for betterment of the book and lastly to all our friends
who are in ‗Radiology Essence‘ group.
To Dr. Graham Lloyd-Jones FRCR, consultant radiologist at
Salisbury District Hospital UK, and editor of the website
www.radiologymasterclass.co.uk for his support in giving
permission for use of materials from the site.
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THIS BOOK IS DEDICATED TO
Our Beloved Late Grandparents for their blessings.
To our parents Mr.Asim Das and Mrs.Dipa Das
Mr.Bivash Chandra Datta and Mrs.Sikha Datta
For being a constant source of encouragement and inspiration
throughout.
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viii
FOREWORD
Radiography is often regarded as the ―third eye of a doctor‖. Thus
it is imperative on the part of a medical student to know at least the
basics of radiography and its interpretation.
Armored with its knowledge we can diagnose many clinical
conditions. Although important, it is rarely taught in medical
colleges as a routine in its curriculum.
Elation reigns over all emotions as we inform you about our
brother Samyajyoti Das and Subhajit Datta who have authored a
book on Basic Interpretation of Chest x-ray Radiograph. Being
very talented and intelligent students, they have dedicated this
humble effort to help others. Samyajyoti has already written
another book named "Language of Healthcare" to help students
communicate with the patients and is also a core member of the 28
"The White Army" Whatsapp groups which helps thousands of
medical students all over India to study better. Subhajit is creating
awareness about disease prevention among common people
through his Facebook page ―MEDTALK‖.
Understanding the concepts and then writing a book on it requires
enormous courage and confidence. Hope this book caters to the
needs of all medical students to learn radiology in an easier and
better way. Also I wish Samyajyoti and Subhajit all the success in
life and expecting more contributions from them in the field of
medicine.
-Dr. Kishan Rao B.
Third year M.S, General Surgery
Agartala Government Medical college
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TIPS FROM THE AUTHORS
Know the normal things thoroughly. May it be pulse, breath
sounds, heart sounds, bowel sounds or in this case Radiographs.
Read as many Normal radiographs as possible to know what is
Normal and, therefore what is Abnormal.
In Under Graduate level, if we can diagnose the condition it is
excellent. But we should be able to tell whether it is normal or
abnormal. We can‘t learn all abnormal because they are thousands
but normal is one. So let us learn that easy yet effective way.
Always follow a particular systemic approach.
We should know the proper anatomy because ―Eye doesn't see
what mind doesn't know.‖
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ABBREVIATIONS AND COMMON
TERMS USED IN RADIOLOGY
AAS - Acute Abdominal Series
ABC - Automatic Brightness Control
ABD - Abdomen
ADC - Analog-to-Digital Converter
AEC - Automatic Exposure Control
ALARA - As Low As Reasonably Achievable.
AP - Antero-Posterior
APR - Anatomical Programmed Radiography
BAS - Barium Swallow
BE - Barium Enema
CAT - Computed Axial Tomography
CCD - Charge Coupled Device
CHD - Coronary Heart Disease
CINE - Cinematographic
CPR - Cardio-Pulmonary Resuscitation
CR - Computed Radiography
CT - Computed Tomography
CTDI - Computed Tomography Dose Index
CXR - Chest x-ray
DDR - Direct Digital Radiography
DECUB - Decubitus
DICOM - Digital Imaging and Communication in Medicine
DSA - Digital Subtraction Angiography
EBCT - Electron Beam Computed Tomography
ECG - Electro Cardiogram
EPI - Echo Planar Imaging
ESR - Electron Spin Resonance
FPR - Fluoroscopy Programmed Radiography
GI - Gastrointestinal
IV - Intravenous
IVP - Intravenous Pyleogram
IVU - Intravenous Urogram
LAO - Left Anterior Oblique
LCD - Low Contrast Detail, Liquid Crystal Display
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LCR - Low Contrast Resolution
LPO - Left Posterior Oblique
LSF - Line Spread Function
MAMMO - Mammography, Mammogram
MDCT - Multi-Detector Computed Tomography
MRA - Magnetic Resonance Angiography
MRI - Magnetic Resonance Imaging
MRS - Magnetic Resonance Spectroscopy
MSCT - Multi-Slice Computed Tomography
PA - Postero-Anterior
PTCA - Percutaneous Transluminal Coronary Angioplasty
QA - Quality Assurance
QC - Quality Control
R&F - Radiography and Fluoroscopy
RAD - Radiation Absorbed Dose
RAO - Right Anterior Oblique
RPO - Right Posterior Oblique
SONO - Sonogram, Sonography
SPR - Scan Projection Radiograph
TCDD - Threshold Contrast Detail Detectability
TOMO - Tomography, Tomogram
UGI - Upper Gastrointestinal Series
US - Ultrasound, Ultrasonography
Abdo:-abdomen
AbdoE&S:-abdomen erect and supine (lying face upwards)
Angio:-angiogram (shows blood vessels)
Arthrogram:-this is a contrast study to view the joint cavity.
AP:-antero-posterior view
AXR:-abdominal X-ray
Barium:-a substance opaque to X-rays
BaE:-barium enema
BaSw:-barium swallow
BaM:-barium meal
BaFT:- barium follow through
Ca:- cancer
CB (WNCB):- core biopsy (wide needle core biopsy).
Small samples of tissue area unit taken employing a special needle
Contrastmedia:- the substance injected into spaces to outline them
as it is radio-opaque.Often called 'dye' but it is colourless
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CC:- cranio-caudal view.
#Often employed in diagnostic technique for the read taken
from on top of to below
CXR:- chest x-ray
Dopplerinultrasound:- the Doppler principle is used to detect and
measure flow in vessels
ERCP:-endoscopic retrograde cholangio-pancreatogram.
#Using a side-viewing endoscopic examination, the common
bile and pancreatic ducts are cannulated and contrast medium
is injected to outline the ducts
FFD:-focus film distance
FNA (c):- fine-needle aspiration cytology. Cells are taken by a fine
needle
HSG:- hystero-salpingogram.
An investigation to examine the uterine cavity and therefore the
fallopian tubes
IAM:- internal auditory meatus.
The point within the skull wherever the nerves enter the internal
ear
IVP:- intravenous pyelogram (same as IVU).
Contrast media is injected into a vein and is excreted by the
excretory organ, outlining the urinary system
IVU:- intravenous urogram (same as IVP)
KUB:- kidneys, ureters and bladder
LAT:- lateral view
LO:-lateral oblique view (often called oblique/obl view)
Mammo:- mammogram
MCU (G):- micturating cysto-urethrogram.
#It is an investigation in which the urinary tract is examined by
direct needle puncture before insertion of drainage catheter.
NOF:- neck of femur
ObstreticAFI:- amniotic fluid index
CRL:-crown rump length (measurement of fetus)
ET:- endometrial thickness (of the uterine cavity)
FH:-fetal heart
MSD:-mean sac diameter (measurement of fetal sac)
PA:- postero-anterior view
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PCN:-Percutaneous nephrostomy. Investigation of the urinary tract
by direct needle puncture, often before insertion of a drainage
catheter
PNS:-postnasal space
PT (H)C:- Percutaneous transhepatic cholangiogram.
Investigation of the biliary system within the liver via direct needle
puncture
Protogram:-Investigation of the rectum. Defaecating proctogram is
conducted during defaecation
RLat:-right lateral (or L Lat - left lateral) view
SIJs:-Sacro-iliac joints
Csp:-cervical spine
Lsp:-lumbar spine
LSsp:-lumbo-sacral spine
Tsp:-thoracic spine
SXR:-Skull X-ray
Tib&Fib:-tibia and fibula
TMJ:-temperomandibular joint
TVscan:- transvaginal ultrasound scan
Urodynamics :-The study of bladder function
US:- ultrasound
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Contents A FORTUNATE ACCIDENT……………………………………….…….…….1 FEW IMPORTANT DISCOVERIES IN RADIOLOGY………….….…....3 HOW X-RAY IS CHANGING THE WORLD?..................................4 BASICS OF CHEST X-RAY IN A NUTSHELL…………….…………….…..7 NORMAL ANATOMY OF CHEST X-RAY……………….….…………….22
1. Trachea and major bronchi……………………….……………..23 2. Hilar structures……………………………………………….……….24 3. Lung zones…………………………………………………….….……..27 4. Pleura and its spaces …………………………………...……..29 5. Lung lobes and fissures…………………………………………….31 6. Costophrenic recesses and angles…………………………….35 7. Diaphragm………………………………………………………………..38 8. Heart size and contours…………………………………………….40 9. Mediastinal contours……………………..………………………...42 10. Soft tissues………………………………………………………..……..45 11. Bones……………………………………………………………….………48
APPROACH TO QUALITY OF CHEST X-RAY………………………….….54 1. Inclusion……………………………………………………………………54 2. Projection……………………………………………..…………………..55 3. Rotation…………………………………………………………………….59 4. Inspiration and lung volume………………………………………62 5. Penetration……………………………………………………………….66
CHEST X-RAY: TUBES……………………………………………………………….70 1. ET Tubes – Position………………………………………………………72 2. NG Tubes – Position……………………………………………………..80 3. Position of CV catheters………………………………………………..87 4. Chest Drains – Position………………………………………………….97
APPROACH TO ABNORMALITIES ASSOCIATED WITH CHEST X-RAY………………………………………………………………….……………….103 1. Displacement of trachea………………………………………………103 2. Abnormalities associated with hila……………………………….105 3. Abnormalities associated with lungs……………………………..108 4. Abnormalities associated with pleura and its spaces……..113 5. Abnormalities associated with lobes, fissures and 6. Contours………………………………………………………………………..119 7. Abnormalities associated with diaphragm……………………..126 8. Cardiac contour and pulmonary oedema………………………..131
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9. Abnormalities associated with mediastinum……………………….137 10. Abnormalities associated with soft tissues………………………...141 11. Abnormalities associated with bone………………………..…………144 GOLDEN FACTS OF RADIOLOGY………………………………………………..148 Radiological Appearance of Heart in Various
Diseases…………………………………………………………………………………..150 SIGNS OF CHEST X-RAY RADIOLOGY…………………………………........153 MULTIPLE CHOICE QUESTIONS REGARDING CHEST X-RAY
RADIOLOGY……………………………………………………………………………..161 ANSWER TO THE QUESTIONS……………………………………………………184 REFERENCE………………………………………………………………………………189
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1
A FORTUNATE ACCIDENT
German physicist Wilhelm Conrad Röentgen was studying the
process of electric current passing through a gas at an extreme low
pressure (in the year 1895).
Figure: Wilhelm Conrad Röentgen
He noticed that when he passed high voltage electricity through a
fluorescent tube, it started to glow; he then covered the tube with a
black paper and repeated the experiment.
To his great surprise, he observed that a plate coated with ‗barium
platinocyanide‘ in his lab was emitting fluorescence
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Radiology Essence
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So he came to a conclusion that an unknown ray was emitted by
the tube which could penetrate the black paper and caused glowing
of the plate.
As the source of the ray was unknown, he proposed the name ‗X
ray‘ for his new discovery.
Later, he took an X ray image of his wife‘s hand.
In the year 1901, he got the first ever Nobel Prize as a physicist for
his discovery.
It was indeed very sad that later he died of an epithelial cell
carcinoma.
X RAYS are invisible ELECTROMAGNETIC
RADIATION having wavelength of 10 Å to 0.01 Å
travelling at the speed of light.
X rays are a pure form of energy emitted due to collision of
electrons with tungsten atoms.
Modern X ray plates are made up of an emulsion-gelatin,
containing radiation sensitive silver halide crystals in a
flexible transparent blue tinted base.
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FEW IMPORTANT DISCOVERIES IN
RADIOLOGY
Antoine Henri Bacquerel:-Radioactivity
Charles Dotter:-Image guided medical procedures; Father of
Interventional Radiology
David E. Kuhl:-Positron Emission Tomography (PET)
Ernest Rutherford:-Alpha/beta particles, neutrons; Father of
Nuclear Physics
Godfrey Hounsfield:-Computed Tomography (CT) scan
Ian Donald:-Ultrasonography (USG); Father of Obstetric
Ultrasound.
John Caffey:-Father of Pediatric Radiology
*****
DID YOU KNOW?
Roentgen Didn‘t Patent X-Ray.
Roentgen Was Colour Blind.
X-Rays Were Used Within Weeks By European
Surgeons After Its Discovery To Find Bullets And
Other Objects. From A Year After That X-Ray Was
Used To Detect Fractured Bones In United States.
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