Chest radiography introduction

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Chest radiography introduction

  1. 1. CHEST RADIOGRAPHB Widaja
  2. 2. How to present chest radiograph Name and date Technical quality Systematic approach to describe x-ray
  3. 3. Projection AP PA Note scapulae and heart size
  4. 4. Rotation Medial ends of clavicles should be equidistant from the spinous process. Check for scoliosis
  5. 5. 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)
  6. 6. Penetration Underpenetrated Overpenetrated The vertebral bodies should only just be visible through the cardiac Shadow. Important when comparing X-ray
  7. 7. Orientation Which is the Left/Right side. Note if any Dextrocardia
  8. 8. 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
  9. 9. 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
  10. 10. 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

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