the chest x-ray
DESCRIPTION
The Chest X-Ray. Dr Mohamed El Safwany, MD. Intended learning outcome. The student should learn at the end of this lecture Clinical aspects of Chest X ray. Aims:. Basics Best exam results Appreciate the role radiology plays. Contents:. Densities Techniques Anatomy CXR Interpretation - PowerPoint PPT PresentationTRANSCRIPT
The Chest X-Ray
Dr Mohamed El Safwany, MD.
Intended learning outcome
• The student should learn at the end of this lecture Clinical aspects of Chest X ray .
Aims:
•Basics•Best exam results•Appreciate the role radiology plays
Contents:•Densities•Techniques•Anatomy•CXR Interpretation•Common Pathologies•Questions
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
Techniques - Projection
•P-A (relation of x-ray beam to patient)
Techniques - Projection (continued)
•A-P Supine/Erect
Techniques - Projection (continued)
•Lateral
Techniques - Projection (continued)
• Decubitus
Techniques - Projection (continued)
•Oblique
Rotation
Rotation (continued)
Penetration
Inspiration/Expiration
Anatomy
Anatomy
Lobes• Right upper lobe:
Lobes (continued)
• Right middle lobe:
Lobes (continued)
• Right lower lobe:
Lobes (continued)
• Left lower lobe:
Lobes (continued)
• Left upper lobe with Lingula:
Lobes (continued)
• Lingula:
Lobes (continued)
• Left upper lobe - upper division:
Pleura• Layers:
Parietal , visceral
Heart
Right border: Edge of (r) Atrium
3. Left border: (l) Ventricle + Atrium
4. Posterior border: Reft Ventricle
5. Anterior border: Right Ventricle
Heart (continued)
Heart (continued)
Heart (continued)
• Valves
Mediastinum
Hilum
Made of:
1. Pulmonary Art.+Veins
2. The Bronchi
Left Hilus higher (max 1-2,5 cm)
Identical: size, shape, density
Hilum
Ribs
Lateral CXR (continued)
Lateral CXR (continued)
Lateral CXR (continued)
Lateral CXR (continued)
CXR Interpretation
Technical Details
•Rotation
•Inspiration/expiration
•Penetration
Lungs:
• Lungs
• Density
• Symmetry
• Lesions
Heart•Size:
Heart •Size of heart
•Size of individual chambers of heart
•Size of pulmonary vessels
•Evidence of stents, clips, wires and valves
•Outline of aorta and IVC and SVC
Mediastinum:• Width
• Contour
• AP window
Hila:• Size
• Location
Review areas:
• Apices
• Behind the heart
• CP angles
• Below the diaphragm
• Soft tissues ( breast, surgical emphysema)
• Ribs & clavicle
•Vertebrae
Identify the lesion → localise the lesion → describe the lesion → give DD
Never stop looking, carry on with your systematic approach!!
Pathology
RUL pneumonia
RML pneumonia
RLL pneumonia
LUL pneumonia
LLL pneumonia
Consolidation on CT
Hilar m l
The Enlarged Hila
Causes:
1. Adenopathies (neoplasia, infection)
2. Primary Tumor
3. Vascular
4. Sarcoidosis
Multiple Masses
Hilar Lymphadenopathy - BL
Pleural Effusion
Pulmonary Fibrosis
?
Heart failure
Pneumothorax
RUL collapse
LLL collapse
Air under the diaphragm
Emphysema
Cervical Rib
Cavitating lesion
Hiatus hernia
Miliary shadowing
Chest Tube, NG Tube, Pulm. artery cath
Dextrocardia
Text Book
• David Sutton’s Radiology
• Clark’s Radiographic positioning and techniques
Assignment
• Two students will be selected for assignment.
Question
• Define rotation in chest X ray ?
Thank You
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