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Chest radiography introduction
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Chest radiography introduction

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    Chest radiography introduction Chest radiography introduction Presentation Transcript

    • CHEST RADIOGRAPHB Widaja
    • How to present chest radiograph Name and date Technical quality Systematic approach to describe x-ray
    • Projection AP PA Note scapulae and heart size
    • Rotation Medial ends of clavicles should be equidistant from the spinous process. Check for scoliosis
    • Degree of Inspiration Poor inspiration Good inspirationMidpoint of the right hemidiaphragm should be between the 5th and 7th ribsanteriorly or around 10th rib posteriorly.Note: lung bases appears whiter and heart larger (poor inspiration)
    • Penetration Underpenetrated Overpenetrated The vertebral bodies should only just be visible through the cardiac Shadow. Important when comparing X-ray
    • Orientation Which is the Left/Right side. Note if any Dextrocardia
    • Describing chest x-ray part 1  Trachea ◦ Position – central or tracheal deviation  Mediastinum ◦ Is mediastinal edge clear? ◦ Is mediastinum widened?  Lung fields ◦ Equal transradiancy on both fields (one brighter/darker than the other?) ◦ Horizontal fissure. Check its position (should run from hilum to 6th rib in axillary line) – is it displaced? ◦ Loss of lung volume ◦ Any discrete or generalised shadows? ◦ Costophrenic angles – should be well defined
    • Describing chest x-ray part 2  Hilum ◦ Left hilum should be higher than right (difference should be <2.5cm ◦ Compare shape and densitiy  Heart ◦ Shape ◦ Max diameter <half of transthoracic diameter at broadest part of chest ◦ Any abnormally dense areas of heart shadow?  Diaphragms ◦ Right higher than left (difference should be <3cm) ◦ Smooth outline  Area under diaphragm ◦ Look for air under diaphragm or dilated loops of bowel
    • Localising lesions  Describe position of lesion in terms of zone ◦ Upper zone: above anterior border of 2nd rib ◦ Middle zone: between anterior border of 2nd rib and 4th rib ◦ Lower zone: between anterior border of 4th rib and diaphragm  Note the borders of the lesion ◦ If lesion is next to dense structure (e.g. heart) then the border between lesion and that structure will be lost – silhouette sign