basics about chest x ray for all branches of medical science.

2. • CXRBasics
• Types of C
X
R
PA vs. AP Films
• Obtaining Images
• Systematic method to reading CXR
• Common Signs
• Examples

3. A standard chest X-rap
PAImage
Lateral Image
Images read together
• Lots of information
• Be systematic with your
reading
Always compare to prior
studies i possib e

4. • X—Rays are part of the light spectrum
• Unlike visible light, x-rays pass through the
human body
—Pass through lungs without much interference
Difficult to pass through bones
• Place film cassette on other side of patient
and capture the shadow

5. • Organs absorb X-rays differently and thus their
shadow on the film is different
Bone: high absorption (film appears white)
Tissue: moderate absorption (film appears grey)
—Air/Lungs: little absorption (film appears black)

6. • PA and Lateral • Supine AP
Patient facing cassette —X-ray 40 inches away
X-ray 6 feet away Magnifies anterior
structures and
pulmonary vasculature

7. PA AP
• Preferred method • Note heart enlarged, lung
fields not asclear

8. • PAFilm
—Read as if patient is facing you (Patient s left side
is on the right of the X-ray)

9. • Obtained with patient s left side against the
cassette.

10. • Inspiration
• Penetration
• Rotation

11. • Image should be at full inspiration
Diaphragm at level of 8-10 rib
Allows reader to see intrapulmonary structures
Poor Inspiration mimics RML Same patient with proper
‹
n
s
p
‹anon

12. • Amount of radiation required for a quality image
—P
Afilm: should barely see thoracic spine disc spaces
Lateral spine should appear darker as move cadually

14. • Patient should be flat against the cassette
• Rotation of the patient will alter appearance
of mediastinum
• Observe rotation by comparing location of
clavicular heads
—Should be equal distance from spinous process of
thoracic vertebral bodies

15. Normal Rotated to the
Right

17. or Fissu betwee L nd RLL
B: Upper anH lowe boundsries of msjoc fissuYes

18. B Mûjo iss LLung A: Minor Fissure RLung
B: Major Fissure R Lun

21. ° Patient Data (Name, history, age, sex)
 °Technique (PA vs. AP, rotation, penetration, etc)
 °Trachea: midline or deviated, any masses?
 Lunds: masses, in i trates
 Costophrenic angles should be sharp (if not =
effusions)
 Silhouette signs, air-b onchograms, pulmonary
edema
 Pulmonary vessels: enlarged?

22. • Hilar Region: masses or lymphadenopathy
• Heart: enlarged, abnormal shape
• Pleura: effusion, thickening, calcification
• Bones: fractures or masses
• ICU Films: looks for line and tube placement

23. • It is best to focus on a small area of the film
and then scan rather than look at the whole
film at once

25. • Tubular outline of an airway made visible by
filling of the surrounding alveoli by fluid or
inflammatory exudates
• Causes
Pulmonary edema
Lung Consolidation
Severe Interstitial Disease
Neoplasm

26. • Can be innocuous or
potentially fatal lung

27. • Lots of information in a chest x-ray
• Always read the film in the same order
—Never skip to the most prominent abnormality, you
mid miss a small abut potentially important finding)
• Compare to priors if possible
• We will finish with some examples of common
pathology

29. • Airspace disease and
consolidation
• CXR Findings
Airspace opacity
Lobar consolidation
Interstitial opacities

30. Pneumonia
• Normal or increased volume
• No shift
° Consolidation, air space
process
Atelectasis
• Volume Loss
• Associated ipsilateral shift
• Linear, wedge shaped
° Apex at hilum
° Air bronchograms ° Not centered at hi um
° Air bronchograms

34. Lung
Air

37. • Can you find the rib fracture?

40. ed Pulmona Hila
Adeno ath