Densities Techniques Anatomy CXR Interpretation.

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