Chest xray

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  • 1. Chest Xray
  • 2. Different tissues in body absorb X-rays atdifferent extents:• Bone- high absorption (white)• Tissue- somewhere in the middle absorption (grey)• Air- low absorption (black)
  • 3. CXR - PA Vs AP view.PA- the x-rays penetrate through the back of thepatient on to the filmAP-the x-rays penetrate through the front of thepatient on to the film.
  • 4. Penetration / Exposure Able to see ribs through the heart Barely see the spine through the heart Pulmonary vessels can be traced nearly to the edges of the lungs
  • 5. Underpenetrated FilmHemi diaphragms are obscuredPulmonary markings more prominent than they actually
  • 6. Over penetrated Film Lung fields darker than normal—may obscure subtle pathologies• See spine well beyond the diaphragms• Inadequate lung detail
  • 7. Positioning / RotationDoes the thoracic spine align in the center of the sternum and between the clavicles?Clavicles – equidistant from spine
  • 8. Determine side – ? L/R Gastric bubble should be on the left ( normally )
  • 9. Look at Soft tissue Bony cage
  • 10. Soft tissue and bony structures Check for  Symmetry  Deformities  Fractures  Masses  Calcifications  Lytic lesions
  • 11. Look at the diaphram: -Tenting -free air -abnormal elevation Margins should be sharp (the right hemidiaphram is usually slightly higher than the left)
  • 12. Heart Size Shape Silhouette-margins should be sharp Diameter (>1/2 thoracic diameter is enlarged heart) AP views make heart appear larger than it actually is.
  • 13. Costo-phrenic / cardiophrenic anglesMargins shouldbe sharp
  • 14. Lung fields Infiltrates Increased interstitial markings Masses Absence of normal margins Air bronchograms Increased vascularity
  • 15. Cannon ball appearance- DDSOsteogenic sarcomaThyroid (follicular)Testicular carcinomaKidneyChoriocarcinomaProstateMalignant melanoma, Some GI, Some very advanced nasopharyngeal, and pharyngeal carcinomasBreastLymphangitis carcinomatosa