Imaging of the respiratory system -EduPublish-www.slidesharenet-mma kareem

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  • 1. IMAGING OF THE RESPIRATORY SYSTEMProf Madya Dr. Hj. M. Abdul Kareem © © MMA Kareem, USM, KB, Malaysia
  • 2. RESPIRATORY SYSTEM  Modalities: 1. Plain Chest X ray, neck 2. Fluoroscopy 3. Bronchogram 4. CT scan, CT Fluoroscopy & CT Angiography 5. MRI 6. Ultrasound 7. Pulmonary Angiography 8. Nuclear medicine V/Q scan  Our Objectives: Identification of normal structures Interpretation of normal Differentiate pathology © MMA Kareem, USM, KB, Malaysia
  • 3. INDICATIONS FOR A CXR: RME: employment, enrolment,emigration Prior to any surgery (Pre-op check) Prolonged cough, fever,Chest Infections Chronic lung diseases/Pleural disease Chest Trauma Thrombo-embolic diseases Tumour Cardio-vascular diseases © MMA Kareem, USM, KB, Malaysia
  • 4. © MMA Kareem, USM, KB, Malaysia
  • 5. PLAIN CXR VIEWS * Routine Views: 1. PA – Posteroanterior view: Full inspiratory film,Erect- 2. AP – AnteroPosterior view ill patient or children) 3. Lateral 4. Both obliques Special views:  Apical / Lordotic (PTB, ML collapse)  Expiratory film - suspected , air trapping or small pneumothorax.  Lateral Decubitus film • detection of small pleural effusion-5ml Deep Penetrated grid film ( high KV ) Posterior lesions, bronchiectasis © MMA Kareem, USM, KB, Malaysia
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  • 7. READ A CXR?  Identify the film: Name? Is side labelled? dated? Institute, RN, ID PA or AP ? Centering, exposure  PA film erect (common): heart is not magnified, laminae slope of the cervicothoracic vertebrae are clearly seen, medial ends of clavicle –at lower level  Fundus gas  AP film supine / sitting (ill, bedridden, child): heart is magnified, vertebral end plates are clearly seen, clavicle medial ends are higher © MMA Kareem, USM, KB, Malaysia
  • 8. READ A CXR?  Upright? Air fluid level in Fundus, bowel, abscess, hiatus hernia  Is it taken in good inspiration /At the end of full inspiration? The anterior ends of the 5-6th rib or the posterior ends of the 9-10th rib will be visible crossing or just above the dome right hemidiaphragm © MMA Kareem, USM, KB, Malaysia
  • 9. READ A CXR?  Is the film well centered? Any rotation or scoliosis? This causes diff. in densities  Medial end of clavicle should be of equal distance from the spinous process of the vertebrae  Is the film of correct exposure? Midthoracic vertebrae, disc spaces and bronchovascular marks should be just visible through heart © MMA Kareem, USM, KB, Malaysia
  • 10. READ A CXR / Interpretation?  Center   Peripheral  How is the trachea?  Trachea is central in the neck and inclines slight to the Rt at level of aortic knuckle  Is the hilar region normal? Lt normally at a higher level. Look for any increase in densities or enlargement to suggest mass  Are the lung fields clear?  Look for any abnormal opacities or cavities © MMA Kareem, USM, KB, Malaysia
  • 11. READ A CXR?  Are the lung markings visible peripherally? Only 1-2cm from the periphery have no lung markings  If not think the possibility of pneumothorax  Is the soft tissue normal? Identify the breast shadows- sex, mastectomy, Lateral wall thickness gas/air/calcification, neck LN  Is the Thoracic cage bone normal? Assoc # or metastatic deposits © MMA Kareem, USM, KB, Malaysia
  • 12. READ A CXR?  Is the diaphragm normal? It has a smooth curved line which is convex upwards and sharp costophrenic angles laterally against chestwall. Lt hemidiaphragm is lower than Rt due to position of cardiac apex  Rarely at same level © MMA Kareem, USM, KB, Malaysia
  • 13. Lateral and oblique views  Separate the lesion from the bones and soft tissue of the chest wall. Better visible  Localisation of the lesion  Segments of the lung can be located  Retrocardiac area well visualised-left lower lobe  Retrosternal area  Spines and paraspinal region © MMA Kareem, USM, KB, Malaysia
  • 14. ACCEPTIBILITY CRITERIA FOR A CXR  1.Is it labelled as to the side, name, and date?  2. Is it a good inspiratory film?  3. Is it well centered?Any rotation/ scoliosis?  4. Is the film of correct penetration/ exposure?  5. Is the CXR well collimated? Are all the lung fields, costophrenic angles completely visualised? CXR- sides (scapula and part of shoulder joint should be included) and below (just below hemidiaphragm) © MMA Kareem, USM, KB, Malaysia
  • 15. CT SCAN © MMA Kareem, USM, KB, Malaysia
  • 16. ROLE OF CT SCAN CT is performed to further clarify and characterize the nature of abnormalities seen on plain film or us Pre and post operative planning - to localise pathology and staging As a guidance for fine needle aspiration or trucut biopsy © MMA Kareem, USM, KB, Malaysia
  • 17. ROLE OF CT SCAN CT scan - recognition of less dense and smaller lesions, 2-3 mm in any part of the lung. The bronchial tree can be evaluated down to the segmental bronchi. Abnormal lung vessel distributions can be recognised. Evaluation of patients with suspected diffuse lung disease Tissue characterization of pulmonary masses. (eg. fat, fluid, calcification) © MMA Kareem, USM, KB, Malaysia
  • 18. RADIONUCLIDE IMAGING © MMA Kareem, USM, KB, Malaysia
  • 19. RADIONUCLIDE-VQ SCANVentilation Studies. 99mTc-DTPA aerosol, (133 Xenon, 81Krypton) Shows area of low activity representing poor ventilation. Persistent activity denotes air trapping. eg emphysematous bulla. © MMA Kareem, USM, KB, Malaysia
  • 20. RADIONUCLIDE-VQ SCANPerfusion Studies –99mTc macroaggregated albumin (MAA)- mechanical obstruction of artery or alveolar hypoxia - redistribution of blood flow-main indication-suspected Pulmonary embolism © MMA Kareem, USM, KB, Malaysia
  • 21. © MMA Kareem, USM, KB, Malaysia
  • 22. PULMONARY ANGIOGRAPHYIndication :1. Suspected primary pulmonary vasculature abnormalities - arterial aneurysm or arteriovenous fistulae or AVM2. Diagnosis and management of subacute and chronic pulmonary thrombo-embolic disease3. Diagnosis and assessment of operability of Bronchial Carcinoma.  Involvement intrathoracic vessels.  May indicate the extent and dissemination of the tumour © MMA Kareem, USM, KB, Malaysia
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  • 24. © MMA Kareem, USM, KB, Malaysia
  • 25. RADIOLOGICAL ASSISTED LUNG BIOPSY USING CT- FLUOROSCOPY –US GUIDEDIndication:1.Primary mediastinal lesions such as mediastinitis/ mediastinal abscess2.Biopsy of a lung mass-central or peripheral lesion or a pleural based mass3. US- for peripheral lung lesion or pleural based lesion (contact with the thoracic wall) © MMA Kareem, USM, KB, Malaysia