3. APPROACH
• General
– Patient ID
– Image data
• Projection/view
• Centrally placed?
Rotation?
• Is it good inspiratory film?
• Penetration
• Structures
9. Decubitus position
• The patient faces
towards the
cassette while lying
in decubitus
position and tube Is
towards the back
10. Decubitus position
• To asses the volume
of pleural fluid.
• Loculated pleural
effusion or mobile
note: when
investigating pneumothorax the
side of interest should be up; when
investigating pleural effusions the
side of interest should be down
centring pointmidsagittal place
(xiphisternum) at the level of T7
20. Paired inspiratory and expiratory
• Demonstrate air trapping and
diaphragm movements.
• Very important in diagnosis of inhaled
foreign body in children
21.
22. ROTATION
• The spinous processes of the thoracic
vertebrae are in the midline at the back of the
chest.
• They should form a vertical line that lies
equidistant from the medial ends of the
clavicles, which are at the front of the chest.
• Rotation of the patient will lead to off-setting
of the spinous processes so they lie nearer
one clavicle than the other.
23.
24. • Ribs play a role in assessing the adequacy of
inspiration taken by the patient.
•The anterior end of approximately 5-7 ribs should be
visible above the diaphragm in the mid-clavicular line.
• Less than this indicates an incomplete breath in, and
more than 7 ribs or flattening of the diaphragm,
suggests lung hyper-expansion.
27. PENETRATION
• Penetration is the degree to which X-rays have
passed through the body.
• A well penetrated chest X-ray is one where the
vertebrae are just visible behind the heart.
28. •The left hemidiaphragm
should be visible to the
edge of the spine.
• Loss of the
hemidiaphragm contour
or of the paravertebral
tissue lines may be due
to lung or mediastinal
pathology.
31. TRACHEA
• Trachea and bronchi
are visible - branching
at the carina
• Trachea passes to
the right of the aorta
and so may be slightly
off mid-line to the
right
32. HILAR
STRUCTURES
• Consisting of the major
bronchi and the pulmonary
veins and arteries
• Hilar lymph nodes are not
visible on a normal chest x-
ray
• Hilar enlargement is due
to enlargement of these
nodes.
• Hila may be at the same
level, but commonly the
left hilum is higher than
the right
• Similar size and density
33.
34. FISSURES
• MAIN FISSURES :
• RIGHT LUNG :-
i. Horizontal fissure
• ii. Oblique fissure
• LEFT LUNG :-
• i. Oblique fissure
ACCESSORY FISSURES :
• Azygous fissure
• Superior Accessory fissure
• Inferior Accessory fissure
• Left transverse Fissure
40. LUNG ZONES
• 3 zones - upper, middle
and lower.
• Each of these zones
occupies approximately
one third of the height of
the lungs.
• The lung zones do not
equate to the lung lobes
• Compared with its
opposite side paying
attention to any
asymmetry
41. PLEURA &
PLEURAL SPACES
• Pleura are only
visible when there is
an abnormality
present.
• Some diseases cause
pleural thickening, and
others lead to fluid or
air gathering in the
pleural spaces.
42. COSTOPHRENIC
RECESSES & ANGLES
• Costophrenic recesses are
formed by the
hemidiaphragms and the
chest wall.
• They contain the rim of the
lung bases which lie over the
dome of each
hemidiaphragm.
• On a frontal chest x-ray the
recess is seen in only one
place on each side,
• Where an angle is formed by
the lateral chest wall and the
dome of each
hemidiaphragm.
• These angles are known as
the costophrenic angles.
43. DIAPHRAGM
• Each hemidiaphragm
should appear as a
rounded, domed
structure
• Right hemidiaphragm is
usually a little higher than
the left
• Air in the stomach below
the left hemidiaphragm,
with the appearance of a
dark (less dense) bubble
44. HEART SIZE &
CONTOURS
• Assessed in relation to
the total thoracic width,
and is expressed as a
ratio.
• Cardiothoracic ratio
(CTR) = Cardiac Width :
Thoracic Width
•CTR of greater than 1:2
(50%) is considered
abnormal
45. NORMAL CARDIAC
CONTOUR
• Left heart contour (red
line) consists of the left
lateral border of the Left
Ventricle (LV).
• The right heart contour is
the right lateral border of
the Right Atrium (RA).
