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NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Mar 28, 2015

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Page 1: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

© OFCP

NORMAL CHEST X RAY

Page 2: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

How to obtain a good quality chest radiography (1)

3  aspects are very important for good quality:

• The penetrating power of the x-ray beam

(adjustment of x-ray tube voltage )• The x-ray tube current (milliampere)• The exposure time adjustment

Page 3: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

How to obtain a good quality chest radiography (2)

• The adjustment of the x-ray tube voltage controls the contrast: the difference of density levels of the different organs and tissues in the thorax

• The x-ray tube current and the exposure time controls the intensity of x-ray beams

Page 4: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

How to obtain a good quality chest radiography (3)

Adjustment of voltage

Exposure time

High voltage: a range of 100 /120 kV: optimal contrast between lungs and bones, and good visualisation of mediastinum and vessels

<0.05 seconds: decrease of motion artefact caused by the beating of the heart or respiratory movement

Page 5: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

How to obtain a good quality chest radiography (4)

A long distance between the tube focus and the film improves the image clarityand decreases the geometric blur

Page 6: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

How to obtain a good quality chest radiography (5)

Other criteria • Quality of the x-ray grid: the flat metallic plate with very

narrow lead trips close to the film: increase in the image clarity and reduction of the scattered radiation from the patient

• Good quality electrical power supply• Efficient and frequent maintenance of x-ray equipment• Quality of films and good conditions of storage• Good screen-film system• Good techniques for x-ray film processing (developing,

rinsing, fixing, washing and drying procedure). If possible automatic film processor.

Page 7: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

What about digital X ray system?(1)(Direct Digitalised System)

composed with:• Electronic flat-panel X ray detector• High resolution grayscale diagnostic display• High performance computer

Page 8: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

What about digital X ray system ?(2)

• Avantages:

-feasible imaging quality adjusted by computer processing

-easy and quick image processing

-X-ray film and its processing procedures in dark room no more needed.

-Lower dose radiation

- imaging transmission and intepretation via internet to referent radiologist is easily possible

• Disadvantages:

- Costly initial investment (61000 to 400000 $)

- Significant trainning in digital technology needed for the radiological technicians and costly running maintenance

Page 9: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Possible compromise with computed radiography (CR system)

• digital radiography using a Photo‐stimulable Phosphor plate (PSP, also called Imaging Plate, IP) enclosed in a cassette as a detector, instead of a film‐screen.

• The IP is then introduced into a CR Reader which reads the film and converts the recorded signal into a digital grey scale image

• Same avantages than digitalised system

• Lower cost than DR system, because can be used with the existing X ray equipment. Only a CR reader and CR cassette reader (with Imaging Plates) need to be

purchased..

Page 10: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Basic radiographic views:Postero-anterior view

Lateral view

Additional/supplementary view:

radiography in expiration

radiography in supine and lateral position

Back view (antero-posterior view)

Opacification of the oesaphagus

Page 11: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

The thorax is composed of:• Bone (vertebrae, ribs, scapula…). The main component

is calcium, which absorbs the x-ray considerably: the bone image is very opaque (white on the radiography)

• Blood and soft tissue (heart, mediastinum, vessels). The absorption of x-rays is less complete than bones: the image is less opaque (light grey)

• Fat tissue. the absorption of x-rays is lower: the image is dark grey.

• Air (in lungs) which does not absorb the x-ray at all. The image of the lungs is black

Page 12: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

calcium water oil Air

Picture of 4 different solutions on a chest x-ray film

Page 13: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

calcium

Fluid / soft tissu

Fat

air

Page 14: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Dosage of x-rays type of

investigationEquivalent of chest x-ray

Equivalent of natural radiation

chest x-ray 1 3 days

TDM 10 -100 1 month-1year

NMR: no radiation

Page 15: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Chest x-ray: criteria for quality

• Deep inspiration• Adequate contrast / density• Good position of the patient• X-ray beam in postero-anterior view

(the patient is standing)

Page 16: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

© OFCP

Page 17: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Adequate inspiration if you can count9 posterior or 6 anterior parts of ribs over the diaphragm

Poor inspirationFalse opacity of the inferior lobes

Same patient with deep inspiration

Page 18: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

false cardiomegalyclavicles are high and horizontal

The x-ray beam is antero posterior

Same patient with correct postero-anterior x-ray beam

incidence

AP versus PA view

The technician should specify the position of the patient if AP view

PA is the correct view

Page 19: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

D1 D2

D1D2

The heart outline is bigger on D2

( bird’s-eye view of the patient)

Page 20: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Correct standing or sitting position for chest radiography

Page 21: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Standing or sitting position not always easy to obtain…

Page 22: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

If the patient is in supine position (too ill to stand up), the cardiac outline and mediastinum is enlarged. The scapula may be on the lung field.The chest x-ray has poor quality for analysis

Page 23: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Patient in supine position Standing patient with postero-anterior X ray beam

The technician should specify the patient position if supine

Page 24: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Lighy filmUnder penetrationNo detail visiblein the mediastinum area.

Dark filmno detail visiblein the lung area

Page 25: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Correct densityand good contrast:

- Pulmonary vessels visible in the lungs, behind the diaphragmand behind the heart

- Para-aortic line visible

- Vertebra visible behind the mediastinum

© OFCP

Page 26: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Conditions for adequate contrast / density

• Correct x-ray factor (Kv, Mas, exposure time)

• Good conditions of developing and good quality of processing chemicals

• Correct temperature of developer• correct quality of film

In case of digitalised or computerised system, imaging quality is adjusted by computer processing and the 3 last conditions are no more

needed.

Page 27: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Exact front view : the vertical line connecting the spinous process of thoracic vertebrae is in the middle of

the two sterno-claviculars joints.

Page 28: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

exact PA view left anterior oblique position

Page 29: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Front View l a o r a o

D1 D2 D3

D3> D1>D2

Page 30: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Chest x-ray: to ensure top quality

• deep inspiration• adequate contrast / density• correct position of the patient

(exact front view)• x-ray beam in postero anterior

view (the patient is standing)

Page 31: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Process for analysis of the chest radiography: the  check list 

• Verification of name and date• Clinical history and findings• Verification of the factors for good quality• Assess

-thoracic wall and thoracic skeleton

- mediastinum

- each lung field, one after the other

Do not skip any item in the checklist !

Page 32: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.
Page 33: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Normal chest radiography

and some pitfalls…( trouble-shooting)

Page 34: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

© OFCP

Thoracic wallAnd skeleton

Page 35: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Thoracic wall

Sus and retro clavicular fieldExternal side of

Sternocleidomastoid muscle

Page 36: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

thoracic wall

The clavicles are projected on the level

of the 3rd or 4th posterior part of ribs

1

3

4

Page 37: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Cervical ribs: minor malformation

Page 38: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

trap picture: opacity of the superior part of right lung due to a hair braid

Be aware of foreign body or artefacts on the chest x-ray

Page 39: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Breast implant

Page 40: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

The retro-clavicular fields are always difficult to analyse, because of bone superposition:

- Clavicles

- Anterior part of first rib

- Posterior part of third and fourth rib,

- Sterno-clavicular joint

Page 41: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

There are 2 ways to correctly analyse the retro-clavicular fields:

• Always compare right and left• Ask for a chest x-ray with the patient’s

back against the film (AP view, lordotic position)

Page 42: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Always compare left and right

Right TB infiltrate

Page 43: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Patient with fever, cough, AFB sputum positive…

Page 44: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

You have no CT scan. So use your eyes and compare right and left!

If any doubt, request AP/ lordotic chest X ray

Page 45: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Normal chest x-ray , front close to the film

Normal AP chest x-ray, back close to the film

Page 46: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Chest x-ray, front close to the filmChest x-ray, back close to the film

And clavicles out of the field by raising hands

Page 47: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Chest x-ray back close to the film

Page 48: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Thoracic wall

physiological blur of the inferior side of the

ribs

Rib view section

Page 49: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

You must always « read » a chest x-ray with methodology:Example: for the chest wall, you must look at every rib, one after the other

(6th and 9th ribs missing on this CXR)

Page 50: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Chest wall

Top of the axillar hole

Big pectoral muscle

Page 51: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

thoracic wall

Scapula

Page 52: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Congenital clavicles agenesy

What is wrong with this chest x-ray?

Page 53: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.
Page 54: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Thoracic wall

Breast silhouette

Page 55: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Be careful with false opacities in the inferior lobes, consequences of breast superposition.

Page 56: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Chest x-ray. Before and after right mastectomy

Page 57: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Thoracic wall

Diaphragm

The right side is usually higher than the

left side (3cm )

Page 58: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.
Page 59: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

© OFCP

Component elements of Mediatinum and hilus

Page 60: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

RA RVLV

AO

PA

AO

RV

LA

LV

Page 61: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Front view

SVC

RA

AO

PA

LV

AO

RV LA

LV

Lateral view

RALA

LVRV

PA

SVC: superor vena cavaAO : aortic vesselPA: pulmonary arteryRA:Right ventricleLV left ventricleLA: left auricleRV: right venticle

Page 62: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Right pulmonary artery

Left pulmonary artery

Page 63: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

L A

L V

RSPV

RIPV

LPSV

The pulmonary vena are not physiologiccally visible

Page 64: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

• X ray beam crossing thorax and mediastinum meets in some places pleural thickness, producing images on the CXR like lines defining mediastinum lines…

Mediastinum lines

Page 65: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

1. Sub clavicle arterial line

2. Posterior mediastinum line

3. Brachio cepahalic vena line

4. para-azygos line

5. Anterior mediastinum line

6. Descending aortic line

7. Right and left paravertébral line

8. Inferior veina cava line

9. para-œsophageal line

10. para-trachéal line

Mediastinum lines

6Too complicatedAnd not so usefull…

Page 66: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Three of them are really important.

Right paratracheal line

Para-aortic line

Aorto pulmonary line

Page 67: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Mediastinum enlargment due to fat tissu

Page 68: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Be aware of false enlargment of mediastinumif obesity, poor inspiration, oblique view or supine

position

Page 69: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Trap: false mediastinum enlargment in the case of this older woman with cyphoscoliosis,

in supine position

Page 70: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.
Page 71: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Component elements of lungs

Page 72: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

On a normal chest x-ray, bronchi are not visible(opacification with iodin hydrosoluble solution)

Page 73: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

…but pulmonary arteries are visible.

Page 74: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.
Page 75: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.
Page 76: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Right view

Small fissura

Big fissura

Page 77: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Left view

Left fissura

Page 78: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Right superior lobe pneumonia

minor fissura

Large oblique fissura posterior

part

minor fissura

Page 79: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.
Page 80: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Right inferior pneumonia

Large oblique fissura

Page 81: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.
Page 82: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Middle lobe pneumonia

Large fissura

minor fissura

Small pleural effusion

Page 83: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.
Page 84: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

External segment of middle lobe pneumonia

Page 85: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

External segment of middle lobe pneumonia

Page 86: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Left superior lobe pneumonia

Page 87: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.
Page 88: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Left inferior pneumonia

Left scissura

Page 89: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.
Page 90: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.
Page 91: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Normal lateral view

Page 92: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Lateral view

Page 93: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

AO

PA

RV

LA

LV

Page 94: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Front view

SVC

RA

AO

PA

LV

AO

RV LA

LV

Lateral view

RALA

LVRV

PA

Page 95: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Heart and Mediastinum

vessels

AscendingAorta

Superior vena cava

Pulmonary arteria

Right ventricle

Descendingaorta

Page 96: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Heart and Mediastinumvessels

Left ventricle

Inferiorvena cava

Page 97: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Mediastinum

vessels

Aortic arch

Page 98: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

mediastinum vessels

Descending aorta

Page 99: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Mediastinum vessels

Right pulmonary artery

Left pulmonary artery

Page 100: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Lateral view is very useful for diagnosis of mediastinal adenopathies

normal CXR

Page 101: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

trachea

20 mm

Page 102: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Right superior lobe bronchus

Left superior lobe bronchus

Page 103: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.
Page 104: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Retro sternal clear space

Retro cardiac clear space

The «clear spaces»

Page 105: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

The «clear spaces»

Retro tracheal space

Page 106: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

enlargment of the clear spaces: Emphysema

Page 107: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Emphysema Normal lateral view

Page 108: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

The retro sternal space is filled: thymoma

Page 109: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

The retro sternal space is filled: thymoma. Normal view on the right

Page 110: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Diaphragm

Right diaphragm

Leftdiaphragm

Page 111: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Summary normal CXR

Page 112: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Normal frontal chest view

Aortic arch (AA)Descending aorta (DA)Proximal left pulmonary artery (PLPA)Left interlobar pulmonary artery (LPA)Aortopulmonary window (AW)Left main bronchus (LB)Left atrial appendage (LAA)Left ventricle (LV)Superior vena cava (SVC)Right paratracheal stripe (RPS)Azygos vein (AV)Aortic arch (AA)Right interlobar pulmonary artery (RIPA)Right atrium (RA)Trachea (T)Right diaphragm (RD)Left diaphragm (LD)

DA

LPA

RIPA

A W

LB

LV

SVC

RPTS

AV

RA

T

RD

LD

A A

SVCT

Page 113: NORMAL CHEST X RAY. How to obtain a good quality chest radiography (1) 3 aspects are very important for good quality: The penetrating power of the x-ray.

Normal lateral chest viewPosteriorly: vertebral bodies (V) and intervertebral disc spaces (*)Anteriorly: retrosternal clear space (RSCS)Trachea (T) Orifice of Right Upper Lobe bronchus (RUL) appears as circular lucency projecting over the continuation of the tracheal air column

Left pulmonary artery (LPA)Right pulmonary artery (RPA)Left auricle (LA)Left ventricle (LV)Right ventricle (RV)Aortic arch (AA)Postero costo phrenic angle (PCPA)Right diphragm (RD)Left diaphragm (LD)Inferior vena cava (IVC)Scapula (Sc)Retro cardiac clear space (RCCS)

T

V

*

RSCS

RUL

LPA

Sc

RPA

LA

LV

RV

AA

PCPARD

LD

IVC

RCCS


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