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INTERPRETATION OF BASIC CXR
- 1. CLINICORADIOLOGICAL CONFERENCE DEPTT. OF INTERNAL MEDICINE J.L.N MEDICAL COLLEGE AJMER PRESENTOR- DR VIJAY P HAWA GUIDE- DR SANJIV MAHESHWARI
- 2. BASICS OF CHEST X RAY & INTERPRETATION
- 3. X-RAY
- 4. X-rays- describe radiation which is part of the spectrum which includes visible light, gamma rays and cosmic radiation. Unlike visible light, radiation passes through stuff. When you shine a beam of X-Ray at a person and put a film on the other side of them a shadow is produced of the inside of their body.
- 6. Different tissues in our body absorb X-rays at different extents: •Bone- high absorption (white) •Tissue- somewhere in the middle absorption (grey) •Fat-dark grey image •Air- low absorption (black)
- 7. Different views of Xray chest • PA • Lateral • AP,decubitis,supine,oblique • Inspiratory-expiratory • Lordotic,apical
- 8. PA view • Most frequently requested because: • Visualization of the lungs excellent • Clear picture of bronchovascular shadow • Radiation risk to the eyes is minimal.
- 9. PA view positioning • The patient faces towards the cassette and the tube is 6 feet away from the patient. • PA view is better to be taken in full inspiration • Except for small pneumothorax
- 10. Technical aspect • Inspiration • On full inspiration the diaphragm should lie at the level of 8-10th posterior rib or 5-6th anterior rib. • Cardiophrenic angle acute • Lung shadows more black • Rib spaces increase
- 11. Paired inspiratory and expiratory view
- 13. Over penetrated (hypertranslucency) Under penetrated(more whitening)
- 14. rotation
- 15. Rotated x ray
- 16. Interpretation of the PA films 1.name,age,sex,date, side 2.trachea 3.Heart and mediastinum 4.Diaphragm
- 17. 6.Pleural spaces 7.Lungs 8.Hidden areas 9.Hila 10.Below diaphragm 11.Soft tissues 12.Bones
- 18. DETERMINING RIGHT AND LEFT IN CHEST XRAY • Look for marker • Fundal gas left • Apex of heart left side • Aortic knuckle left • Right diaphragm higher • Left hila at same level or slightly higher
- 19. Trachea Examined for • Position • Outline • Should be central, with slight deviation to the right as it crosses the aortic arch. • Can be pushed away from an abnormal lung affected by a large pleural effusion, large simple pneumothorax, tension pneumothorax, aortic aneurysm or mediastinal mass. • The trachea can be pulled towards an abnormal lung affected by extensive collapse, consolidation, pulmonary fibrosis, lobectomy or pneumonectomy.
- 20. • Caliber coronal diameter is 25mm for males and 21mm for females • Para tracheal stripe<5mm • Carina angle:60-75degree.
- 21. Heart • Size • Shape Transverse cardiac diameter:<14.5cm in females and <15.5cm in males. An increase of 1.5 cm is significant.
- 22. SIZE(A- FROM THE MIDLINE TO MAXIMUM DISTANCE TOWARDS RIGHT,B-FROM MIDLINE TO MAXIMUM DISTANCE TOWARDS LEFT,C-MAXIMUM ITD,REFERENCE MID LINE FORMED BY JOINING THE SPINOUS PROCESS OF VERTEBRAE)
- 23. MEDIASTINUM • RIGHT SUPERIOR MEDIASTINAL SHADOW FORMED BY SVC AND INNOMINATE VESSELS. • LEFT SUPERIOR MEDIASTINAL SHADOW FORMED BY THE SUBCLAVIAN ARTERY • ANT JUNCTION LINE • POST JUNCTION LINE • RIGHT PARATRACHEAL • PARAVERBEBRAL (RT/LT) • AZYGOESOPHAGEAL • AORTOPULMONARY • PARASPINAL LINES 10 MM ON THE LEFT AND 3MM ON THE RIGHT • THYMUS
- 24. Ant and post junction lines • Ant junction line • Parietal and visceral pleurae meeting anteromedially.oblique course(blue) • Post juction line.formed by posteromedial surfaces of the pleurae of the upper lobes post to oesophagus(red)
- 25. thymus • Triangular sail-shaped structure, well defined borders projecting from one or both side of the mediastinum.
- 27. Silhouette Sign *The loss of the normal silhouette of a structure is called the silhouette sign *Recognition of this sign is useful in localizing areas of airspace opacities , atelectasis or mass within the lung with the loss of these normal silhouettes on frontal chest radiographs being generally indicative of the site of pathology
- 28. 1-Right paratracheal stripe : right upper lobe 2-Right heart border : right middle lobe or medial right lower lobe 3-Right hemidiaphragm : right lower lobe 4-Aortic knuckle : left upper lobe 5-Left heart border : lingula segments of the left upper lobe 6-Left hemidiaphragm or descending aorta : left lower lobe
- 30. Diaphragm • Outline • shape • relative position
- 31. Pleural spaces • Costophrenic angles • Cardiophrenic angles
- 32. Pleural Fluid : -It takes about 200-300 ml of fluid before it comes visible on an CXR -About 5 liters of pleural fluid are present when there is total opacification of the hemithorax
- 34. lungs • Local,generalised abnormality • Comparison of the translucency • Vascular markings of the lungs
- 35. Zones
- 40. Hidden areas • The apices • Mediastinum and hila • Diaphragm • bones
- 41. Hila • Contain the following structures • The inferior pulmonary ligament • The pulmonary vessels • The bronchial vessels • the bronchi • The lymphatic system • The lymph nodes
- 42. Right hilum
- 43. Left hilum
- 44. Below diaphragms • Gas shadows • Calcifications
- 45. Chilaiditi sign • INCLUDE: • 1)gas between liver and diaphragm 2)rugal folds within the gas suggesting that it is within the bowel and not free
- 46. Soft tissues • Breast shadows and nipple shadows • Skin folds • Muscles • Companion shadows
- 47. Nipple markers
- 48. Skin fold
- 49. Muscles and companion shadows
- 50. bones • Sternum • Clavicles • Scapulae • ribs • spine
- 51. Support Devices may be visible like : a) Endotracheal Tube b) Nasogastric Tube c) Central Venous Catheter d) Chest Drains
- 55. Interpretation of lateral film • The clear spaces • Retrosternal space • Retrotracheal space • Vertebral translucency • Diaphragm outline • The fissures • The trachea • The sternum
- 58. Diaphragm outline • Right diaphragm continues anteriorly • Left is silhouetted posteriorly by heart shadow
- 59. The fissures
- 60. AP view • the patient back is towards the cassette and tube is 40 inches away from the patient. • for patients unable to stand
- 62. Differentiating from PA view AP • Apparent cardiomegaly • Scapula more prominent • Ribs appear horizontal • Clavical appear higher compared to PA view
- 63. Decubitus position • The patient faces towards the cassette while lying in decubitus position and tube Is towards the back
- 64. Decubitus position • To asses the volume of pleural fluid. • Loculated pleural effusion or mobile • Subpulmonic pleural effussion
- 65. Apical view
- 67. Oblique view • To visualize retro cardiac area, the posterior costophrenic angles, the chest wall and the pleural plaques.
- 68. • Lordotic PA view
- 69. Paired inspiratory and expiratory • Demonstrate air trapping and diaphragm movements. • Very important in diagnosis of inhaled foreign body in children.