Cervicothoracic sign.pptx
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The cervicothoracic sign is used to determine if a mediastinal mass is located in the anterior or posterior mediastinum based on whether its superior border is obscured at or below the clavicles. However, this sign can be misleading, as demonstrated by a case of a superior mediastinal mass that appeared to have a positive cervicothoracic sign on x-ray due to the projection of the anterior part of the mass being clearer than the posterior part. Therefore, the cervicothoracic sign should not be solely relied upon to determine the location of a mediastinal mass.
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Positioned to minimize magnification of the anteriorly positioned heart and consequent obscuration of the lungs.
Make sure the patient is standing straight and is equally distributing the weight of the body on both feet.
The upright position is preferred for the following reasons: It prevents engorgement (an excess of blood) of pulmonary vessels.
It allows full expansion of the lungs
To visualize possible air and fluid levels in the chest.
An upright chest film is preferred over an upright abdominal film for the diagnosis of pneumoperitoneum (free air in the abdominal cavity).
Ask the patient to move the shoulders forward and downward, so that the chest wall and both shoulders are in contact with the cassette. This helps to carry the clavicles below the lung apices.
It is very important to minimize breast shadows.
Ask the patient to pull the breasts upward and laterally (outwards), then remove her hands as she leans against the cassette holder to keep them in position.
Rotation
Even a small degree of rotation distorts the mediastinal borders, and the lung nearest the film will appear less translucent.
The following points should be stressed to obtain a true PA view (without rotation):
Ensure that the patient is standing evenly on both feet.
Both shoulders should be rolled forward and downward.
The chest radiograph should be well centred so that the medial ends of the clavicle are equidistant from the vertebral spinous processes at T4/5.
CENTRAL RAY
Over T7 vertebra
SID: 72 inches
Central ray
Film holder (image receptor) placement
The horizontal dimension of an average chest is greater than the vertical dimension.
This requires that a 14 x 17-inch film holder or image receptor (IR) be placed crosswise.
Or lengthwise depending on body type.
Collimation
The upper border of the illuminated field should be at the level of vertebra prominence (4 cm above the apex of lungs).
This will result in a lower collimation border of 1-2 inches below the costophrenic angle, if the central ray was correctly centred.
A general rule for average adult patients is to show a minimum of 10 ribs on a good PA chest radiograph.
Evaluation criteria for a good PA projection
Entire lung fields from apices to costophrenic angles should be clearly demonstrated.
No rotation. (both the right and left sternal ends of the clavicle will be the same distance from the center line of the spine.)
The direction of rotation can be determined by which sternal end of the clavicle is closest to the spine.
Trachea is visible in midline.
Scapula projected outside the lung fields.
Ten posterior ribs are visible above the diaphragm.
There is a sharp outline of the heart and diaphragm.
A faint shadow of the ribs and superior thoracic vertebrae is visible through the heart shadow.
Lung markings are visible from the hilum to the periphery of the lung.
Variations
An expiratory film may be helpful under some circumstances.
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This document provides an overview of CT/PET-CT imaging for lung cancer. It begins with disclaimers and then covers reading chest x-rays, the author's workflow, brightness and contrast adjustments, lung and vessel anatomy identification, incidental findings, lymph node stations, the proximal bronchial tree contouring, esophagus, lung and cord delineation, great vessel delineation, new TNM staging criteria, imaging features of various tumor sizes and node involvement, characteristics of lung cancer histologies including adenocarcinoma and squamous cell carcinoma, metastatic disease patterns, post-radiation changes, differentiating atelectasis from tumor, the role of PET-CT in staging and treatment planning, and situations where imaging may
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Chest x ray quality - how to interpret chest x-ray (1)
in this tutorial i am speaking about chest x-ray quality that include :
1- Inclusion
2- inspiration/lung
3- volume
4- projection
5- penetration
6- Rotation
7- artifact
i try to make it easy and simple for medical students and junior doctors to help them in clinical life.
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Chest x ray - basics
This document provides information about chest x-rays, including:
- Wilhelm Röntgen discovered x-rays in 1895 and they are a form of ionizing electromagnetic radiation ranging from 0.01 to 10 nanometers.
- A radiograph is an x-ray image obtained by placing the patient in front of an x-ray detector and illuminating with a short pulse. Detectors include film, scintillator, and semiconductor diodes.
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Build Trust and Security:
Establish a safe and supportive environment where children feel comfortable expressing themselves.
Encourage Expression:
Enable children to articulate their thoughts, feelings, and experiences.
Promote Emotional Understanding:
Help children identify and understand their own emotions and the emotions of others.
Enhance Listening Skills:
Develop children’s ability to listen attentively and respond appropriately.
Foster Positive Relationships:
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Support Learning and Development:
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Resolve Conflicts:
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Encourage Independence:
Support children in making decisions and solving problems on their own.
Provide Reassurance and Comfort:
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Guide and Educate:
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- 1. CERVICOTHORACIC SIGN IS ITALWAYS DEPENDABLE? DR. C RAVINDRAN MD, DTCD, FRCP PROFESSOR & SENIOR CONSULTANT DEPT. OF PULMONARY MEDICINE
- 4. CERVICOTHORACIC SIGN • When the cephalic border of a mass is obscured at or below the level of the clavicles, it is deemed to be a “cervicothoracic lesion” involving the anterior mediastinum (Positive cervicothoracic sign). • Mediastinal masses posterior to the trachea are well outlined above the level of the clavicles (Negative cervicothoracic sign) due to the interface with lung in the posterior aspects of the lung apices. • Superior mediastinal mass usually have a sharp well delineated lateral border due to the aerated lung giving a good contrast. • If it is in the anterior mediastinum the superior border ends at the clavicle as the anterior mediastinum do not extend beyond clavicle. • At the same time posterior mediastinal mass extends above the clavicle and the lateral border can be traced above the clavicle
- 5. FALLACY • As per the above rule the lesion in figure A is an anterior mediastinal mass as the cervicothoracic sign is positive. • Look at the CT Thorax. • It shows a superior mediastinal mass touching both anterior and posterior chest wall • Its base is towards the posterior aspect.
- 7. EXPLANATION • This can be explained by the projection of X-Ray chest PA view where anterior lesion is close to x-ray film and will be more clear and sharp when compared to posterior part which is distant from the film. • So in this case even though the mass extends to posterior mediastinum, anterior part is denser and clearly visible to the eyes when compared to more distant posterior part. • So the onlooker has a visual illusion that the lesion stops at clavicle like an anterior mediastinal mass. • This is a fallacy of cervicothoracic sign.