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How read chest xr 1
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How read chest xr 1

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cxr read practical approche

cxr read practical approche

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  • 1. HOW READ CHEST XR -1 ANAS SAHLE ,MD
  • 2. 1. Technical Quality OUTLINE2. look at the mediastinal3. look at the lungs4. diaphragm5. Soft tissues and bones
  • 3. Technical Quality
  • 4. RPPIIs the film centered? RotationIs it PA or AP film ? PositioningIs it exposed properly ? PenetrationIs it a good inspiration film? Inspiration
  • 5. observing the clavicular heads determining whether they areequal distance fromthe spinous process of the thoracic vertebral bodies
  • 6. Is this filmcentered?
  • 7. Is this filmcentered?
  • 8. Why do you have to know whether the film is centered or not ? Difficult to evaluatethe position of Mediastinum if the film is not centered
  • 9. RPPIIs the film centered? RotationIs it PA or AP film ? PositioningIs it exposed properly ? PenetrationIs it a good inspiration film? Inspiration
  • 10. If the scapulae no longer overlie the lung fields then the film is PAIf the scapulae overlie the lung fields then the film is AP
  • 11. Why do you have to know whether it is PA or AP film?
  • 12. The PA (posterioranterior) Positioning Note that the x-ray tube is 72 inches “182.88 cm” away
  • 13. The Supine AP (anteriorposterior) positionNote that the x-ray tube is 40 inches”111.76 cm” from the patient
  • 14. Heart appears larger
  • 15. Mediastinum widens
  • 16. Diaphragms are higher
  • 17. Pulmonary vesselssize is same in upperand lower lung fields
  • 18. RPPIIs the film centered? RotationIs it PA or AP film ? PositioningIs it exposed properly ? PenetrationIs it a good inspiration film? Inspiration
  • 19. The thoracic spine disc spaces should be barelyvisible through the heart
  • 20. Bony details of the spineare not usually seen
  • 21. On the other hand penetration is sufficient thatbronchovascular structurescan usually be seenthrough the heart
  • 22. Normal Penetrated An overpenetrated PA film PA film
  • 23. Normal Penetrated underpenetrated PA PA film film
  • 24. RPPIIs the film centered? RotationIs it PA or AP film ? PositioningIs it exposed properly ? PenetrationIs it a good inspiration film? Inspiration
  • 25. The diaphragm should befound at about the level of the 8th - 10th posterior rib or 5th - 6thanterior rib on good inspiration
  • 26. Why Do You Have To Know Whether It Is Good Inspiration Or Poor Inspiration?
  • 27. Mediastinum appears wider
  • 28. Heart size appears larger
  • 29. Lung bases look whiter(mistaken for interstitial disease)
  • 30. look at the lungs
  • 31. Scan both lungsstarting at the apices andworking downcomparing left with right atthe same level
  • 32. The lungsextend behind the heart solook here too
  • 33. Compare and contrast vascular markings inupper vs. lowerlung fields in PA view
  • 34. List conditions, where vascular markings are prominent in upper lung fields• Mitral stenosis• Congestive heart failure• Alpha one antitrypsin deficiency
  • 35. Compare and contrast vascular markings in outer third vs.inner two thirds of lungs
  • 36. increased markings in outer third of lung fields? increased pulmonary flow• In: 1. Left to right shunts (ASD, VSD, PDA)
  • 37. increased markings in outer third of lung fields?• In : 2. Interstitial disease 3. Lymphangitic malignant spread 4. CHF with increased lymphatic flow
  • 38. Fissures
  • 39. The MinorFissure divides the Right Middle Lobefrom the Right Upper Lobe and issometimes not well seen
  • 40. Localizing lesions
  • 41. The position of lesioncan be described in terms of zones
  • 42. To accurately localize a lesion on chest X rayyou need to look at both the PA and lateral films
  • 43. First look at the PA film
  • 44. The upper zone lies above the anteriorborder of the 2nd rib
  • 45. The middle zone lies between the right anterior borders of the 2nd and 4th ribs
  • 46. The lower zone lies between the right anterior border ofthe 4th rib and the diaphragm
  • 47. It does not give anyinformation about the lobes of the lung
  • 48. Look at the borders of the lesion• If the lesion is next to a dense (white) structure then the border between the lesion and that structure will be lost
  • 49. This is calledthe silhouette sign RML lingula LLL RLL LLL
  • 50. Now look at the lateral film
  • 51. Identify the oblique fissure• (pass obliquely downwards from the T4/T5 vertebrae through the hilum ending at the anterior third of the diaphragm)
  • 52. Identify the horizontal fissure• (pass horizontally from the midpoint of the hilum to the anterior chest wall)
  • 53. If the lesion lies posterior to the oblique fissure it must lie within the lower lobe
  • 54. If the lesion lies anterior to the oblique fissure it may be in the upper or middle lobe
  • 55. If the lesion is below the horizontal fissure it is in the middle lobe
  • 56. If the lesion is above the horizontal fissure it is in the upper lobe
  • 57. There is no middle lobe on the left
  • 58. The white lesion
  • 59. LungThe white lesion pleura
  • 60. parenchymaLung Airway Pneumonectomy
  • 61. Consolidation is another term for air space shadowing Alveolar spaceparenchyma interstitial
  • 62. Alveolar space Consolidationparenchyma interstitial
  • 63. CollapseAlveolar space air spaces filling
  • 64. Loss of volume of part of the lung
  • 65. On the PA film:The right lung should be larger than the left If it is not suspect an area of right sided collapse
  • 66. The major (Primary) sign opacification of the affected lobe due to airlessness
  • 67. The major (Primary) sign displacement of the interlobar fissure
  • 68. The Secondary signs displacement of the mediastinal structures
  • 69. The Secondary signs The right diaphragmshould be higher than theleft (the difference should be less than 3cm) elevation of the hemidiaphragm
  • 70. The Secondary signsdecrease in the distanceof the intercostals spaces
  • 71. The Secondary signs displacement of the hila
  • 72. The Secondary signs compensatory overinflation of the remaining lung
  • 73. The heart border should be distinct If the lung adjacent to the heart is collapsed then the heart border will appear blurredRight heart border is Left heart border is blurred blurred RML collapse lingular collapse
  • 74. Atelectasis Right Upper Lobe
  • 75. Atelectasis Right Upper Lobe
  • 76. Atelectasis Right Upper Lobe
  • 77. Homogenous Atelectasis Right Upper Lobe density right upper lung field.Mediastinal shift to right.Loss of silhouette of ascending aorta.Movement of oblique and transverse fissures.
  • 78. RML Atelectasis
  • 79. Vague density in right lower lung field (almost a normal film). RML Atelectasis
  • 80. Dramatic RML atelectasis in lateral view,Movement of transverse fissure.Other findings include:Azygous lobe RML Atelectasis
  • 81. RML Lateral Segment Atelectasis
  • 82. RML Lateral Segment Atelectasis
  • 83. RLL Atelectasis
  • 84. Right lower lobe atelectasis
  • 85. Complete atelectasis of the right lung
  • 86. Atelectasis Left Upper Lobe
  • 87. Mediastinal shift to left.Density left upper lung field.Loss of aortic knob and left hilar silhouettes. Atelectasis Left Upper Lobe
  • 88. A:Forwardmovementof obliquefissureC:AtelectaticLULB:Herniatedright lung Atelectasis Left Upper Lobe
  • 89. Bowing sign•LUL atelectasis or following resection•The oblique fissure bows forwards
  • 90. Bowing sign
  • 91. Left Lower Lobe Atelectasis
  • 92. Inhomogeneous cardiac density.Triangular retrocardiac density.Left hilum pulled down. Atelectasis Left Lower Lobe
  • 93. Left Lower Lobe Atelectasis
  • 94. •Lateralleftdiaphragmnot visible•Increaseddensityover lowerspine Left Lower Lobe Atelectasis
  • 95. Atelectasis Left Lung