Interpreting chest & abdominal radiographs - Mr Jamie Dunn
Exeter Surgical Society Mr Jamie Dunn BVSc MBChB MRCVS MRCSWhy do I always starting writing things at half past nine on a Saturday eveningwhen all I really want to do is learn how to use Netflix...hummm
Abdominal Radiographs1. How is an x-ray image created?2. What are the relative X-ray doses?3. Do we know enough core abdominal anatomy for interpretation?4. Do we have a system for reviewing abdominal radiographs?Finally lets review some interesting radiographs...
How is the image created...1. X-ray Source2. Target Penetrance3. Reduce scatter4. Convert x-rays to an imageUnderstand that the imagecreated is a two dimensionalrendering of a threedimensional structure...Think Pixels...
Image Quality Issues• Lack of personal data• Lack of side marking• Patient positioning• Image exposure• Movement blurr
Reviewing Abdominal films 1) Identify subject and date and orientation. 2) Comment on technical flaws preventing interpretation. 3) Is the image / scan contrast enhanced? 4) Comment on any specific abnormalities. 5) The rest......Don’t be baffled into saying nothing ....don’t umm and arrh and don’t point...Try not to be so distracted by the amazing that you miss something else...
Bowel PathologyDistinguishing small verses large bowel...Thinking about distension / obstruction...Thinking about perforationThinking about bowel bowel wall inflammation
Small Bowel: 5 cm Max Diameter... Valvulae Conniventes• Circular folds reach around the whole circumference of the small intestine
Large Bowel: 10 cm Max Diameter Haustra• Haustra of the large bowel do not cross the entire lumen on imaging
Consider a case...• 45 Male • Observations• 7/7 grumbling abdominal pain – Pulse 105 radiating into his back – BP 178/100 – RR 16• Acute exacerbation at 15.15 – Sats 100% (A) today• Attended ED via ambulance at 15.37 • Abg – Ph 7.34• PMH – PO2 16.7 – Asthma – PCo2 2.41 – Bicarb 24 – Planter fasciitis (on diclofenac) – Base Excess -4.5
Consider a case...• 45 Male • Observations• Weight loss for 3/12 – Pulse 86 – BP 145/85• Change in bowel habit – RR 14 including diarrhoea and – Sats 100% (A) melena• Attended general take after GP referral today • Abg – Ph 7.34• PMH – PO2 14.2 – Asthma – PCo2 4.71 – Bicarb 22 – Planter fasciitis (on diclofenac) – Base Excess 1.0
Ureteric ColicMost renal and Ureteric stones are made from calcium...Calcium is radio-dense...Look for stone’s on plain x-ray KUB initiallyCan Anyone tell me why I can sometimes see stones on CT but not on plain x-ray?Consider a Case...