![Cardio – Thoracic Ratio (CTR)
The method of determining the CTR –
The cardiothoracic ratio is measured on only a PA chest x-ray.
The CTR is determined on the basis of the ratio of the transverse heart
dimension [A] to the transverse dimension of the chest (internal ribs) [B]
measured on the radiograph in the chest PA projection: CTR = A/B.
A normal measurement is 0.42-0.50.
A CTR > 0.5 (or > 50%) is considered abnormal. In radiology reports, terms
like “cardiomegaly” or “increased heart size” are commonly used to describe
an increased CTR.
A small cardiothoracic ratio (CTR) is defined as <42%/0.42 when assessed on a
PA chest radiograph, and is often called small heart syndrome. A
pathologically-small heart is also known as microcardia. It can be due
to/associated with a number of entities: adrenal insufficiency, e.g. Addison
disease.](https://image.slidesharecdn.com/chestradiographyppt-1-230331152551-bfabf873/85/CHEST-RADIOGRAPHY-Routine-special-radiographs-17-320.jpg)
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CHEST RADIOGRAPHY - Routine & special radiographs
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- 2. CHEST RADIOGRAPHY Thereare many type of views of chest radiography which are divided in Routine and Special radiographs – Routine – PA Erect , Lateral SPECIAL – Supine AP, Oblique (Ant. & Post.), Apicogram (AP), AP Lordotic, Lateral Decubitus
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- 4. CHEST PA (ROUTINE) Position Of the Patient • Pt. is asked to stand facing an upright cassette holder. • Midline of the body should be in the midline of the cassette. • Ask the pt. to rotate shoulder forward, flex the elbows and put the wrist on hips. • Upper border of cassette should be 2-3cm above the shoulder joint.
- 5. CHEST PA (ROUTINE) Central Ray • The central ray is directed horizontally to the level of T5 vertebra. • Stop breathing after deep inhalation for exposure.
- 6. CHEST PA (ROUTINE) Figure • Postero anterior (PA) chest projection position, pt. against chest board
- 7. CHEST PA (ROUTINE) Exposurechart (Film size- 12”*15” or 14”*17”) • Source to Image Receptor Distance (SID) – 180cm or 6ft. • Grid – No • mA station – 200 • kV = 55 – 60 • mAs = 16 – 20 • Exposure Timer = mAs/mA = 20/200 = 0.1sec.
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- 10. CHEST PA (ROUTINE) It is used to evaluate the lungs, heart and chest wall. The PA view is frequently used to aid in diagnosing a range of acute and chronic conditions involving all organs of the thoracic cavity. It may be used for the diagnose of fever, cough, TB, asthma, chest pain, pleural effusion, Pneumo-thorax etc.
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- 15. DIFFERENCES BETWEEN ERECTPA & AP
- 16. DIFFERENCES BETWEEN ERECTPA & AP
- 17. Cardio – ThoracicRatio (CTR) The method of determining the CTR – The cardiothoracic ratio is measured on only a PA chest x-ray. The CTR is determined on the basis of the ratio of the transverse heart dimension [A] to the transverse dimension of the chest (internal ribs) [B] measured on the radiograph in the chest PA projection: CTR = A/B. A normal measurement is 0.42-0.50. A CTR > 0.5 (or > 50%) is considered abnormal. In radiology reports, terms like “cardiomegaly” or “increased heart size” are commonly used to describe an increased CTR. A small cardiothoracic ratio (CTR) is defined as <42%/0.42 when assessed on a PA chest radiograph, and is often called small heart syndrome. A pathologically-small heart is also known as microcardia. It can be due to/associated with a number of entities: adrenal insufficiency, e.g. Addison disease.
- 18. Cardio – ThoracicRatio (CTR)
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- 20. CHEST LATERAL (ROUTINE) Position Of the Patient • Pt. is asked to stand in lateral erect position in front of upright cassette. • Both the arms are elevated upward and forearms are resting on the head. • Mid axillary line of the body should be in the center of the cassette. • Cassette should be placed 2-3cm above the shoulder joint.
- 21. CHEST LATERAL (ROUTINE) Central Ray • The central ray is directed horizontally to the level of T5 vertebra. • Stop breathing after deep inhalation for exposure
- 22. CHEST LATERAL (ROUTINE) Exposurechart (Film size- 12”*15” or 14”*17”) • Source to Image Receptor Distance (SID) – 180cm or 6ft. • Grid – yes • mA station – 200 • kV = 65 – 70 • mAs = 30 – 40 • Exposure Timer = mAs/mA = 45/200 = 0.225sec.
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- 25. CHEST LATERAL (ROUTINE) The lateral chest view can be particularly useful in assessing the retrosternal and retrocardiac airspaces. The lateral chest view examines the lungs, bony thoracic cavity, mediastinum, and great vessels. To see the position of pacemaker, side chest pain etc.
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- 28. Special views ofChest Supine AP Apicogram (AP) Lordotic (AP) Decubitus (LAT) Oblique
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- 30. CHEST SUPINE AP(SPECIAL) If the pt. have difficulty to sit or not able to stand properly or pt. is in very serious condition and on ventilator that time we can do the chest supine AP view. Generally AP view is taken to see the fractures of ribs and effective for the patient of ICUs.
- 31. CHEST SUPINE AP(SPECIAL) Position of the Patient • Ask the pt. lie down in the supine position. • Palm of the both hand should be pronate and elbow should be away from the body. • Midline of the body is in the midline of the cassette. • Place the cassette on the Bucky and 2cm above the shoulder region.
- 32. CHEST SUPINE AP(SPECIAL) Central Ray • The central ray is directed vertically to the level of T5 vertebra. • Stop breathing after deep inhalation for exposure.
- 33. CHEST SUPINE AP(SPECIAL) Exposure chart (Film size- 12”*15” or 14”*17”) • Source to Image Receptor Distance (SID) – 100cm • Grid – yes • mA station – 200 • kV = 55 – 60 • mAs = 12 – 16 • Exposure Timer = mAs/mA = 12/200 = 0.06sec.
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- 37. CHEST APICOGRAM AP Tosee the apices of chest. To see the region under clavicle bone. To remove superimposition of clavicle over apex. For the diagnosis of the Tuberculosis (TB).
- 38. CHEST APICOGRAM AP Positionof the patient Patient stands in AP position before upright cassette. Place the cassette 3 – 4 cm above the shoulder. Patient is asked to lean as much as he can forward after resting the shoulder on the cassette (about 1 to 1.5 feet ahead)
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- 40. CHEST APICOGRAM AP CentralRay • The central ray is directed horizontally with tube angle 30 degree toward head at the level of mid sternum or xiphi sternum. • Stop breathing after deep inhalation for exposure.
- 41. CHEST APICOGRAM AP ExposureChart (Film size- 12”*15” or 14”*17”) • Source to Image Receptor Distance (SID) – 150cm • Grid – No • mA station – 200 • kV = 50 – 60 • mAs = 16 – 20 • Exposure Timer = mAs/mA = 20/200 = 0.1sec.
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- 47. CHEST LORDOTIC AP The view especially useful to demonstrate spontaneous pneumothorax, emphysema and collapse due to an inhaled foreign body. The view also demonstrates right middle lobe collapse or interlobar effusion on right side.
- 48. FOREIGN BODY Aforeign body is something that is stuck inside you but isn't supposed to be there. You may inhale or swallow a foreign body, or you may get one from an injury to almost any part of your body. Foreign bodies are more common in small children, who sometimes stick things in their mouths, ears, and noses.
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- 50. EMPHYSEMA Emphysema isa lung condition that causes shortness of breath. In people with emphysema, the air sacs in the lungs (alveoli) are damaged.
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- 52. CHEST LORDOTIC AP Position of the patient Patient stands in AP position before upright cassette. Place the cassette 3 – 4 cm above the shoulder. Patient is asked to lean as much as he can forward after resting the shoulder on the cassette (about 1 to 1.5 feet ahead)
- 53. CHEST LORDOTIC AP Central Ray • The central ray is directed horizontally at the level of mid sternum or xiphi sternum. • Stop breathing after deep inhalation for exposure.
- 54. CHEST LORDOTIC AP Exposure Chart (Film size- 12”*15” or 14”*17”) • Source to Image Receptor Distance (SID) – 180cm • Grid – No • mA station – 200 • kV = 55 – 60 • mAs = 16 – 20 • Exposure Timer = mAs/mA = 20/200 = 0.1sec.
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- 59. LATERAL DECUBITUS Theprojection is called a right lateral decubitus if the patient is lying on the right side and a left lateral decubitus if the patient is lying on the left side. A lateral decubitus projection can be obtained in anteroposterior (AP) or posteroanterior (PA) view; however, the AP view is more commonly used. To demonstrate the Pleural effusion. To diagnose the Lung cancer To demonstrate Fluid or air collection around the lungs.
- 60. LATERAL DECUBITUS Positionof the patient The patient is lying either left lateral or right lateral on trolley (x-ray table). Note – when investing pleural effusion the side of interest should be down. The detector is placed landscape, posterior to the patient running parallel with the long axis of thorax (in the same position as AP chest). Patient hand should be raised to avoid superimposing on the region of interest; legs may be flexed for balance. Let the patient lie in the same position for few minutes (5 min) to allow the fluid trickle down in dependent part of chest.
- 61. LATERAL DECUBITUS Centralray The central ray is directed horizontally to mid sagittal plane – xiphi sternum). Stop breathing after deep inhalation for exposure.
- 62. LATERAL DECUBITUS ExposureChart (Film size- 12”*15” or 14”*17”) • Source to Image Receptor Distance (SID) – 180cm • Grid – No • mA station – 200 • kV = 55 – 60 • mAs = 20 – 25 • Exposure Timer = mAs/mA = 20/200 = 0.1sec.
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- 67. CHEST OBLIQUE Generally,two types of oblique view of chest are obtained Anterior Oblique Right Anterior Oblique Left Anterior Oblique Posterior Oblique Right Posterior Oblique Left Posterior Oblique Oblique views are prescribed for any type of chest pathology which are not clear in PA view. To see the ribs fractures To see the apical regions (upper ribs)
- 68. ANTERIOR OBLIQUE (PA) Position of the patient – Patient is asked to stand in front of upright cassette holder in PA position. Turn the patient 45-degree oblique (L/R). If the left side is near to the cassette raise the right hand above head or place on the cassette. Place the left hand on the left hip. Upper border of cassette should be 2 – 3 cm above the shoulder joint.
- 69. ANTERIOR OBLIQUE Centralray – • The central ray is directed horizontally at the level of T5. • Stop breathing after deep inhalation for exposure.
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- 72. POSTERIOR OBLIQUE (AP) Patient positioning – Patient is asked to stand in front of upright cassette holder in AP position. Patient is made oblique position. 45-degree angle is made between cassette and unaffected side is way from the cassette. Affect side hand should remain parallel to the body and unaffected side hand should be over the head. No movement in the patient during the exposure.
- 73. POSTERIOR OBLIQUE (AP) Central ray – It is directed horizontal at the xiphoid process. Stop breathing after deep inhalation for exposure
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- 75. CHEST OBLIQUE ExposureChart (Film size- 12”*15” or 14”*17”) • Source to Image Receptor Distance (SID) – 180cm (May be change according to the pt. positioning) • Grid – No • mA station – 200 • kV = 60 – 65 • mAs = 20 – 25 • Exposure Timer = mAs/mA = 20/200 = 0.1sec.