This document provides an overview of how to read a chest X-ray. It discusses the different types of chest X-ray views including posteroanterior (PA), anteroposterior (AP), lateral, and lordotic views. It describes how to assess exposure, inspiration level, rotation, and angulation. Key anatomical structures that should be evaluated are identified as the trachea, hilum, mediastinum, diaphragm, lungs, heart, bones, and soft tissues. Common abnormalities that may be seen involving these structures are also summarized such as tracheal deviation, hilar enlargement, and mediastinal masses.
4 BASIC TYPES OF DENSITY - air , water /soft tissues, metal /bone , fat
Two substances of the same density, in direct contact, cannot be differentiated from each other on an x-ray.
This phenomenon, the loss of the normal radiographic silhouette (contour), due to loss of difference in density is called the silhouette sign.
Learn Chest X-Ray With Its Normal Positioning & Radio-AnatomyDr.Santosh Atreya
Learn Chest X-Ray With Its Normal Positioning & Radio-Anatomy..For some image description please go through the text book "David Sutton" because i have described these image during my presentation Verbally..There are many animations used inside this presentation so to see all the pictures which are placed layer by layer with the help of animations you simple need to download this presentation first.... Thanx.
4 BASIC TYPES OF DENSITY - air , water /soft tissues, metal /bone , fat
Two substances of the same density, in direct contact, cannot be differentiated from each other on an x-ray.
This phenomenon, the loss of the normal radiographic silhouette (contour), due to loss of difference in density is called the silhouette sign.
Learn Chest X-Ray With Its Normal Positioning & Radio-AnatomyDr.Santosh Atreya
Learn Chest X-Ray With Its Normal Positioning & Radio-Anatomy..For some image description please go through the text book "David Sutton" because i have described these image during my presentation Verbally..There are many animations used inside this presentation so to see all the pictures which are placed layer by layer with the help of animations you simple need to download this presentation first.... Thanx.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
1. Approach to a chest
X -ray
Presented by :Dr.K.S.Rithwik
Moderated by :Dr.Sathiq Ali
2. A chest X-ray is a
2Dimensional projection
of a 3 Dimensional
thoracic viscera.
It is a summated and
compressed image .
3. Reading into the Chest Radiograph
With below headings
1) Type of view
2) Exposure /Penetration
3) Inspiratory versus Expiratory film
4) Rotation
5) Angulation
6) Soft tissues and Bony structures
7) Trachea
8) Hilum / Mediastinum
9) Diaphragm
10) Lung fields
11) Cardia
4. Type of view
Chest x ray is having
1)Standard projections-based on direction of X-ray beam projection
Includes
a)PA view (posteroanterior view )
b)AP view (anteroposterior view )
c)Lateral view
2)Additional projection
• Lateral decubitus view
• Lordotic view
5. Standard projections of Chest Radiograph
1)PA View
• Posteroanterior view
• It is the preferred view
• This is obtained from fixed distance between X-ray tube and
cassette of 180 cms (6 feet )
• The ray of beam enters from posteroanteriorly with the film in
front of the patient
6. • Patient will be standing and in
full inspiration.
• Technique of x-ray beam
projection
X-ray beam passes through
the
chest from the back to the
front
10. • AP - Anteroposterior view
• Xray beam passes through the chest from the front to the back
• Beam is from anteroposteriorly with the film behind the patient
• Performed in patients who are not able to stand ,for supine ,ill
patients .
12. • Distance between the cassette and X-ray machine in AP view is
less than 180 cm approximately 100 cms-around 4 feet, because
of shorter distance structures appears to be magnified.
15. PA view and AP view comparison
Parameter PA view (Posteroanterior
view )
AP view (Anteroposterior
view )
1)Patient posture Erect (standing) Supine (lying on back )
2)Scapulae Away from the lung fields Overlie the lung fields
3)Clavicle Project over lung zones Project above lung apices
4)Distinct ribs end Posterior end Anterior end
5)Patients hands Placed on hips On the sides of thorax
6)Heart magnification minimal Moderate ,significant
7)Cardiothoracic ratio Normal 1:2 Spuriously increased
16. Differences between PA and AP view of
CXR
Parameter Posteroanterior view (PA
view )
Anterioposterior view (AP
view )
8)Diaphragm Lowest level Highest Level
9)Gastric air bubble Seen Not seen
10)Respiratory phase Deep inspiration Mid inspiration or
expiration
11)Lung Expansion Maximal Restricted
12)Lung Markings Normal , only lower zone
vessels prominent due to
gravity
Crowded upper zone
vessels unduly prominent
13)Lung Volume Normal Apparently reduced
17. Lateral View
• The ray of beam is from one side with the film placed on the
opposite side of the patient
• Technique : In a fit individual the arms are held high and away
from the thorax
• In a frail elderly patient the arms may have to be positioned in
front of the chest
20. • Lateral CXR is useful to position an abnormality shown in frontal
CXR
• Is it anterior or posterior
• Which lobe is it in?
• Is it actually in a lobe?
• To check the tricky areas to look for
• Behind the heart
• Behind and infront of the hila
• Behind the domes of diaphragm
21.
22.
23. • Lateral Chest X-ray is useful for retrosternal, mediastinal masses,
pneumoniae, pleural effusion in the fissures
24. Lordotic view
• The AP lordotic chest radiograph (or AP axial chest radiograph)
demonstrates areas of the lung apices that appear obscured on
the PA/AP chest radiographic views.
25. Patient positioning:
• The patient is standing with feet approximately 30 cm away from
the image receptor, with back arched until upper back, shoulders
and head are against the image receptor.
• The shoulders and elbows are rolled anteriorly
27. Lateral decubitus view
• Patient position :
• the patient is lying either left lateral or right lateral on a trolley
on top of a radiolucent sponge
• It is useful to demonstrate small pleural effusions, or for the
investigation of pneumothorax and air trapping due to inhaled
foreign bodies
28.
29. 2)Penetration /Exposure:
X-rays must adequately penetrate body parts to visualize the
structures, ideally one should be able to faintly see
a)The thoracic spine ,beyond the fourth thoracic level, through heart
shadow, if proper penetration is employed .
30. Under penetration
• If we cannot visualise the structures in the chest x-ray then the
radiograph is underpenetrated or too light
• It is diffusely bright and soft tissues are readily obscured,
especially those behind the heart
31. Over penetrated X-ray
• In this radiograph, all thoracic vertebrae visible through the heart
shadow
• Lung field darker than normal, have inadequate lung detail.
32.
33. 1)Inspiratory film –should be able to count 9 to 10 posterior ribs
• Heart shadow should not be hidden by the diaphragm
2)Expiratory film –Poor inspiration can crowd lung markings
producing pseudo airspace
• Expiration reduces lung volume ,making a small pneumothorax
easier to see
34. Anatomical changes in chest in various
respiratory phases seen normally
Anatomical part Inspiration Expiration
1)Superior mediastinum normal Magnified
2)Trachea straight Buckled
3)Heart Normal size Magnified
4)CTR Normal Increased
5)Lungs Fully expanded Partially expanded
6)Bronchovascular markings Well spread out Crowded
7)Diaphragm Lowest Highest
8)Rib cage Anterior ends lower Anterior and posterior ends almost
at same level
9)Lung volume Normal Reduced
35.
36. Rotation
• Normal Rotation
• Medial ends of bilateral clavicles are equidistant from
the midline or vertebral bodies
37. • Left rotated film
• If spinous process appears closer to the right clavicle, the patient
is rotated to left side
• Right rotated film
• If spinous process appears closer to the left clavicle ,the patient is
rotated towards the right side
38. Angulation
• Normal Angulation –clavicle
should lie over the 3 rd rib
(posterior end )with proper
angulation are clearly
visualised
39. Soft tissues
• Check neck and axillae for surgical emphysema, hematomas, and
tumours.
• Look for supraclavicular areas, tissues along the side of the
breasts.
• Look for breast shadows, pectoral muscle shadows.
42. • We have to look for shape of the thorax
• Is entire thorax visible ? 9 to 10 posterior ribs should visible in
deep inspiration.
• Look for rib fractures /notching /altered density
• Midline sternotomy sutures
• Intercostal spaces :width and angle ,wide or narrow
43.
44. Trachea
• Look for trachea position ,whether it is midline or deviated ?
• Carina should be visible with slightly blacker outline over the lung
fields themselves, look for carinal angle (normal angle was acute)
47. Causes of tracheal shift
Towards the side of the lung
lesion
Opposite to the side of the
lung lesion
1)Lung collapse 1)Tension pneumothorax
2)Lung fibrosis 2)Massive pleural effusion
3)pneumonectomy 3)Lung cancer
4)Diaphragmatic paralysis
48. Hilum
• Hilum is the wedge shaped area on the central portion of the
each lung where Bronchi, Pulmonary artery, vein leave the lung
99% of each hilar shadows is due to
1) Vessels – Pulmonary arteries and to a lesser extent veins
2) Fat, lymph nodes and bronchial walls are contents of hilum.
• Normal shape is concave
49. • Left hilum should never be lower than the right
• If left hilum appears to be lower than right hilum, then look for:
1)Collapse of either left lower lobe /or Right upper lobe.
2)enlargement of the right hilum (tumor /nodes)
53. Chest X-ray findings in PAH
• Elevated cardiac apex due to right ventricular Hypertrophy
• Enlarged right atrium
• Prominent pulmonary outflow tract
• Enlarged pulmonary arteries
• Pruning of peripheral pulmonary vessels
54. Mediastinum
• Mediastinum is situated between the the pleural covering the
medial aspects of the right and left lungs
• Borders of the mediastinum in lateral CXR:
• Superiorly - the thoracic inlet
• Inferiorly - the diaphragm
• Laterally - Parietal pleura
• Anteriorly - the sternum
• Posteriorly - the vertebral column
56. • Felson divided Mediastinum into
a) anterior mediastinum-boundaries
b) anteriorly - sternum, posteriorly anterior aspect of trachea, and
posterior margin of heart
c) Middle mediastinum: anteriorly
d) Posterior mediastinum
57. Mediastinal boundaries
compartment Anteriorly Posteriorly
Anterior Sternum Anterior aspect of trachea
posterior margin of the
heart
Middle Anterior aspect of trachea
and posterior margin of
trachea
A vertical line drawn along
the thoracic vertebrae 1 cm
behind their anterior
margins
Posterior Vertical line drawn along
the thoracic vertebrae 1 cm
behind their anterior
margins
Costovertebral junctions
61. Diaphragm
• Dome shaped
• Position : Right hemi diaphragm is located at 9 th -10th rib
posteriorly or 6 th rib anteriorly.
• Right hemidiaphragm is higher than the left by 2 cms because the
cardia keeps the left diaphragm down.
• Costophrenic and cardiophrenic angles
• Normal Height of diaphragm -2.5 cms
62. • Normally cardiophrenic and costophrenic angles should be clear,
sharp .
• They are obliterated due to fluid, fat or fibrosis.
• If there is opaque meniscus at a cardiophrenic angle, it requires
approximately 200 to 300 ml pleural fluid to efface the normal
sharp recess between the diaphragm and the ribs
66. Lung fields
• Lungs – Linear and fine nodular shadows of pulmonary vessels
• Blood vessels
• 40 % obscured by other tissues
67. Zones of lungs
• Two lines are drawn
1 ) One connecting the
anteroinferior end of the
second rib on both sides and
2) The second line connecting the
anteroinferior ends of the 4th
rib on both sides
68. • Two lines divides lungs into
• 3 zones :
1)Upper zone
2)Middle zone
3)Lower zone
71. Silhoutee sign
• It actually denotes the loss of a silhoutee
• It is also known as loss of silhoutee sign/loss of contour sign.
• Loss of the anatomic border is described as positive silhoutee
sign.
72. • It is an An intrathoracic lesion touching a border of the heart
,aorta ,or diaphragm will obliterate that border on the
roentgenogram.
• An intrathoracic lesion not anatomically contiguous with a border
of one of these structures will not obliterate that border .
78. Chamber enlargement Condition seen
Left atrial enlargement Enlarged left atrial appendage
Double atrial shadow
Straightening of left heart border
Left shift of aorta (bedford sign )
Pulmonary venous hypertension Grade 1 –cephalisation (prominence of veins of upper lobe
of lung )of pulmonary vasculature (PVP <_20 mm Hg )
Grade 2-Kerley lines -A,B,C(PVP 20 to 25 mm Hg)
Grade 3 :Batwing opacities (PVP >25mm Hg)
Pulmonary artery hypertension Enlarged pulmonary arteries >14mm in women and >16
mm in men with pruning of peripheral pulmonary vessels
Right atrial enlargement Right border more than 5.5cm from midline or 3.5 cm
from sternal border
Left ventricular enlargement Cardiomegaly with obtuse left cardiophrenic angle
79. Pleura
• Pleura is composed of dynamic membrane of mesothelial cells
and a deeper layer of connective tissue containing vessels ,nerves
and lymphatics
• Pleural membrane actively responds to adjacent inflammation
and to accumulates of the fluid .
82. Pneumothorax
• Three cardinal features :
• A clearly defined line (the visceral pleura is visible )it will be
parallel to the chest wall.
• The upper part of the line curved at the lung apex
• The absence of lung markings .
92. References
1)The chest X-ray –A
survival Guide (gerald de
Lacey ,simon morley )
2)Interpretation of chest
xray-by Dr.Balachandran
3)www.radiopedia.org 4)Davidsons principles of
internal medicine
Editor's Notes
Draw a line from cardiophrenic angle to costophrenic angle ,Now draw a perpendicular onto the line from the highest point of the dome of diaphragm ,measure the height of the perpendicular (redline )if the height less than 2.5 cms it indicates flattened diaphragm,flattening occurs secondary to increased intrathoracic pressures (secondary to hyperventilation in COPD ,pneumothorax )
1)Right border of heart is formed by Right atrium,Left heart border is formed by-Aortic knuckle ,Left atrium ,left ventricle
1)A homogenous opacification is noted in the right lower zone with the opacity seen to track along the lateral chest wall. The right costophrenic angle is obliterated with a meniscus noted. Findings are suggestive of a right sided pleural effusion.
Fibrotic opacities are noted in the right apical zone suggestive of an old healed infective etiology.
2) There is homogeneous opacification of the right hemithorax with underlying collapse of its upper lobe. There is secondary obscuration of right hemidiaphragm, cardiac silhouette and hilum.
No obvious mediastinal shift.
Obliteration of left costophrenic angle with a wide pleural based dome shaped opacity projecting into the lung noted tracking along the CP angle and lateral chest wall suggestive of loculated pleural effusion, however the possibility of empyema can not be ruled out completely.
2) Ovoid shaped density at the posterior mid chest, most in keeping with pleural fluid encysted within the right oblique fissure,
Intubated ICU patient, tracheal tube above the tracheal bifurcation, gastric feeding tube in situ, 3 ECG electrodes. There is a central line in the right jugular vessel and two central lines with projection on upper vena cava and right atrium. Bilateral pleural effusions and atelectasis