This document provides an overview of radiographic anatomy of the chest, abdomen, and skeletal system. It begins with an introduction to the discovery of x-rays and the basic densities seen on radiographs. It then covers zones of the lungs, anatomy of the thorax, and learning objectives for identifying structures on a chest x-ray. Specific abnormalities that can be seen on chest x-rays are also outlined. The document then discusses radiographic anatomy, views, and specific abnormalities that can be seen on abdominal and skeletal system x-rays. Patient preparation and positioning for various views are also covered.

1. RADIOGRAPHIC ANATOMY
(CHEST, ABDOMEN AND SKELETAL SYSTEM)
By
AKHIGBE ROBERT
( Bsc(Rad), Msc(Rad),DIR, DMU, PGD ECHO)
Department of Radiography
Lead City University, Ibadan

2.  Introduction
 Learning Objectives
 Basic Views Of Chest X-ray
 Radiographic Anatomy Of The Chest
 General Approach To Viewing Chest
Radiographs
 Signs And Terminologies In Chest Radiology
 Common Abnormalities Of The Chest
CHEST OUTLINE

3.  Prof. Wilhelm Conrad Roentgen on the 8th of November
1895 (awarded the first Nobel price for Physics in 1905)
 X-rays has the ability to register the exact shape and size of
any object on its path on a recording medium (ie film)
Only five radiographic densities exist (in order of increasing
brightness); Gas, Fat, Fluid, Bone and Metal densities.
 Anatomical structures seen on the radiograph can be identified
by their characteristics densities.
e.g lungs are dark; they are filled with air or air densities, heart
appear brighter; while bones are brighter structures because
they are composed of calcium.
DISCOVERY OF X-RAY

4. LEARNING OBJECTIVES
 Zones of the Lungs (Naming & Definition)
 Anatomy of the Thorax
 Identifying Signs in Chest Radiology
 Identifying the following structures on the PA Chest
radiograph:
a. Right Atrium
b. Left Ventricle
c. Paraspinal Lines
d. Trachea
e. Carina
f. Main Bronchi
g. Costophrenic Sulci
 Calculating cardio-thoracic ratio ( CTR )
 Recognizing basic abnormalities of the cardiopulmonary
system

5. RADIOGRAPHIC ANATOMY OF THE CHEST
PA VIEW

6. LATERAL VIEW

7. INDICATIONS FOR CHEST X-RAY
Pulmonary diseases; persistent cough
Shortness in breathing
Cardiac anomaly; Hypertensive heart disease
Bony abnormality; Fracture of the rib
Cancer of distant organ origin to look for
secondary deposits
Extra thoracic conditions; Acute abdomen,
Cancer of distant organ

8. RECOMMENDED PROJECTIONS
 Basic
 Postero-anterior – erect
 Alternate
 Antero-posterior – erect
 Antero-posterior – supine
 Antero-posterior – semi-erect
 Supplementary
 Lateral
 Postero-anterior – expiration
 Apical
 Lordotic
 Decubitus
 PA oblique
 AP oblique

9. PATIENT PREPARATION
 Patient should be identified by all the names written on the request card
and confirm further by his/her age.
 Welcome the patient politely and introduce your self to him/her
 Explain the procedure and also make emphasis where his cooperation is
required
 Patient undress to the waist while females should be provided the clean
gown
 The patient should be asked to remove all the radio-opaque objects
around the chest eg necklace, ear rings, medels long hairs should be
moved up and pinned.
 Rehearse breathing technique prior to positioning

10. PATIENT POSITIONING- ERECT PA
CHEST
 Patient: Stands erect with the legs slightly separated for stability
 Faces the film with the chest in proper contact and the mid saggital
plane (MSP) perpendicular and coincides with the middle of the cassette.
The coronal plane is parallel to the cassette.
 Lifts up the chin and placed centrally at the upper border of the cassette.
 With the elbow flexed, the arms should be abducted and rotated medially
while the dorsum of the hand is placed on the hip postero-laterally.
 Depress and rotates shoulders forward

11. PATIENT POSITIONING (CONT)
 Collimate to the area of interest
 Place correct anatomic maker
 FFD of 150 or 180cm for lungs and heart conditions respectively
 Center at the level of inferior angle of the scapulae along the midline
( spinous process of T7)
 Patient takes in and hold a deep breath
 Exposure is made while observing the patient for any possible movement.

12. PATIENT POSITIONING (CONT)

13. POINTS TO NOTE
 Careful patient preparation is essential
 When an intravenous drip is in situ in the arm: care should be taken not
to dislodge it
 Patients with underwater-seal bottles: Never raise bottle above the level
of the chest
 Anatomic marker placement: Dextrocardia may be misdiagnosed
 Long, plaited hair or long ear ring may cause artifact: should be move up
and pinned
 Reduction in exposure is required in patients suffering from emphysema.
 For images taken in expiration, the kilovoltage should be increased

14. GENERAL APPROACH TO VIEWING CHEST
RADIOGRAPHS
 Labels/makers
 Previous examination
for comparison, important to determine whether a problem
is chronic (old) or acute(new).
 Quality of the film
adequate quality of the film (not be too dark (over exposed)
or too white (under exposed)can really improve the precision
of a diagnosis.
 Rotation
Closer an object is to the film the sharper are the borders.
The farther away it is from the film the more magnified and
fuzzy is the shadow of the object.
 Poor illumination
Viewing radiographs in poorly lit conditions
 Search pattern
Centre of the frontal film and work your way to the edges.

15. SIGNS AND TERMINOLOGIES IN
CHEST RADIOLOGY
 Opacity, any focal area of the
lung devoid of air and of fluid
density with well defined
margins. They can come in
various sizes.
 Consolidation, state of
complete replacement of air
segment of the lung by fluid with
characteristic air –bronchogram
pattern.
 Air-bronchogram Sign, is the
appearance of dark branching
markings in abnormal white lung.
This sign is nonspecific as alveoli
can be filled with pus, blood or
fluid
 Silhouette sign, indicate the
obliteration of the borders of the
heart,or other mediastinal
structures and diaphragm by an
opacity.
 Atelectasis(lung collapse),
diminished lung volume affecting
all or part of the lung(COT).
 Cavity, is any lucency within a
consolidation.
 Air crescent sign, is an area of
lucency around an opacity within
a cavity(Aspergillosis)

16. CARDIO THORACIC RATIO (CTR)

17. SIGNS AND TERMINOLOGIES IN
CHEST RADIOLOGY CONT’D.
 Snow ball sign, to
determine whether a
peripheral mass or nodule
arises from the lungs or
from a surrounding
structure. If the nodule
looks like a snow ball just
before impact, it is
localized in the lung.
 Kelly B sign (Line) are
horizontal lines that are
seen at the periphery of
the lung..
OTHERS
 Continuous diaphragm sign
 Juxtaphrenic sign
 Hampton’s sign
 Bulging Sulcus sign
 Air-crescent sign (halo)

18. COMMON CHEST ABNORMALITIES
CHEST WALL
 Rib Fracture
 Subcuteneous Emphysema
 Diaphragm
 Ruptured Diaphragm
 Ruptured Oesophagus
 Aortic Lacceration
MEDIASTINIUM
 Aortic Lacceration
 Pneumenastinium/continuo
s diaphragm
LUNG TOO WHITE
 Pneumonia
 Plural Effusion
 Congestive heart failure
 Nodules-T.B-Miliary
 Pneumonectomy
ENLARGED CARDIAC SILH.
 Congestive cardiac failure
 Cardiomyopathy
 Pericardiac Effusion
LUNG TOO DARK
 Emphysema
 Pulmonary embolism/oligimia
 Hampton’s sign

19. RIB FRACTURE

20. SUBCUTENEOUS EMPHYSEMA

21. RUPTURED DIAPHRAGM

22. AORTIC LACERATION

23. PNEUMONIA

24. PLURAL EFFUSION

25. CONGESTIVE HEART FAILURE

26. MILIARY TUBERCULOSIS

27. EMPHYSEMA

28. CARDIOMYOPATHY

29. PERICARDIAC EFFUSION

30. ABDOMEN OUTLINE
 Introduction
 Radiographic Anatomy
 General Approach
 Basic Views
 Supine AP
 Left lateral
 Chest X-ray
 Specific Abnormalities

31. INTRODUCTION
 Advancement in radiodiagniosis has evolved overtime
and till recent
 Abdominal x-ray still remain important initial
investigation for a number of disorders.
 Students should be able to recognise radiographic
signs of intestinal obstruction, perforation of
gastrointestinal tract and foreign bodies resulting from
penetrating injuries or ingestion

32. LEARNING OBJECTIVES
 Name and define the various organs in the abdomen
 Abdominal divisions (Anatomy of the Abdomen)
 Recognize the typical appearance of pneumoperitoneum
 State some common abdominal findings in bowel obstruction
 Suggest possible locations abdominal calcification
 Differentiate between large and small intestine
 Describe and distinguish between mechanical bowel
obstruction and ileus

34. RADIOGRAPHIC ANATOMY
Supine View

35. Erect view

37. SPECIFIC ABNORMALITIES
A. Air inside the bowel
i. ileus/localize/generalised
ii. Bowel obstruction
iii. Volvulus
B. Air ouside the bowel
lumen
i. Intraperitoneal air
ii. Retroperitoneal air
iii. Branching air in the liver
iv. Pneumatosis
C. Densities
i. bones/foreign
bodies
ii. Appendicolith
iii. Stones
iv. Pancreatic
calcification
v. Abdominal aortic
aneurysm
D. Free fluid

38. Generalize Ileus

40. SMALL BOWEL OBSTRUCTION
 Central
 Numerous
 2.5 – 5.0cm over
 Have small radius of curvature
 Valvular conniventes
 Multiple fluid levels
 String of beads sign on erect small pocket of gas
trapped between valvulae conneventes

41. Small bowel obstruction

42. LARGE BOWEL OBSTRUCTION
 Tend to be peripheral
 Few in number
 Large; above 5.0cm in diameter
 Haustra, thick white lines that are widely
seperated

43. Large Bowel Obstruction

44. Sigmoid Volvulus

45. Retroperitoneal air

46. Intratroperitoneal air

47. Football sign

48. CHILAIDITI SYNDROME
 A rare condition of pain due to transposition of a
loop of large intestine (usually transverse colon)
in between the diaphragm and the liver,
 Visible on plain abdominal X-ray or chest X-ray
 Normally this causes no symptoms,
 is called Chilaiditi's sign.

49. Chilaiditi sign

50. Pneumobilia

51. Intrabdominal foreign body

52. Intra-abdominal calcifications

53. chronic pancreatitis

54. INTRA ABDOMINAL FLUID COLLECTION

55. SKELETAL SYSTEM
 Introduction
 Radiographic Anatomy
 General Approach
 Specific Abnormalities

56.  The Skeletal system forms the bony framework
of the body and serves several functions
ranging from Calcium metabolism and point of
attachment for muscles to enable movement.
 Generally speaking there are around 206 bones
in the human body. The skeletal system is
subdivided into axial and appendicular
skeleton.

57. RADIOGRAPHIC ANATOMY
Midline
Central vertical axis of the body
Medial
Close to the midline
Lateral
Away from the midline
Proximal
Closer to the head
Distal
Further from the head
Palmar (volar)
Palm side of the hand
TERMINOLOGIES
Anatomical positions
Visualize the human body with
the palms of the hands and
the back of the feet forward

58. Plantar
under side of the foot
Dorsal
back side of the hand and foot
Abduction
movement of a joint way from midline
Adduction
movement of a joint close to the
midline
Pronation
forearm moving from
anatomical psition to palm
facing posterior.
Supination
forearm moving from palm
facing posteriorly back into
anatomical position (palm
facing upward)

59. Epiphysis
End part of a long bone
Diaphysis
middle part of a long bone
Metaphysis
Funnel-shaped part of a long
bone between the epiphysis
and the diaphysis.
Cortex
outer portion of the bone
Intraarticular
Inside the joint
Extraarticular
outside the joint

60. GENERAL APPROACH
Often fractures can only be seen on one view. For this reason,
one must always obtain two views of the bone being studied
(AP and lateral)
 Look for any abnormal black lines (fractures)
 Look for any disruption of the cortex especially at the cortex
lining the joints (intraarticular), which could represent a
fracture. Remember that the cortex border should always be
smooth.
 Look for any narrowing or widening of the joint space.
 Look at the soft tissues for enlargement (swelling) or
evidence of displaced fat pads

61. FRACTURE DESCRIPTION
It is common for students and interns to have to describe a fracture over
the phone.
The following terms are vital to do this
1. AREA
Area radiographed (i.e. Wrist)
2. VIEWS
(i.e. AP and lateral)
3. LOCATION
Bone fractured. Part of the bone.
Intraarticular or extraarticlar (i.e. extraarticular distal radius fracture)

62. 4. PATTERN
 Simple fracture:
The bone is broken in only two pieces.
These are described by the direction of the fracture line
(transverse, oblique, spiral, vertical).
 Comminuted fracture:
The bone is broken in more than two pieces
 Compound fracture:
A fracture fragment extend through the skin into or into an
adacent organ (i.e. the lung)

63. 5. DEFORMITY (displacement)
Translation
Decreased contact between
the fracture surfaces (lateral,
medial, anterior or posterior
translation)
Angulation
The bony fragments form an
angle (apex lateral, apex
medial, apex anterior, and
apex posterior)
Rotated
The distal bony fragment is
rotated in relation to the
proximal one (external,
internal rotation)
Impaction
A bony fragment has been
driven into another
Dislocation
Misalignment of articulating
surfaces of a joint (anterior
or posterior dislocation)

64. 6. TYPE
 Pathological fracture:
Fracture in an area of bone weakened by disease
 Stress fracture:
Fracture due to repetitive small traumas
(i.e. marathon runner)

65. SHOULDER
a. Glenohumeral joint dislocation
b. Acromioclavicular joint seperation
HUMERAL SHAFT FRACTURE
ELBOW
a. Distal humeral fracture
b. Elbow dislocation
 FOREARM
a. Monteggia fracture-dislocation
b. Galeazzi fracture-dislocation
WRIST
a. Colles’ fracture
b. Scaphoid fracture
 HAND
a. First metacarpal base fracture
b. Boxer’s fracture
SPECIFIC ABNORMALITIES
UPPER LIMB

66.  HIP
a. Hip fractures
b. Hip dislocations
 FEMORAL SHAFT STRUCTURE
 KNEE
a. Tibial plateau structure
b. Patellar fracture
LOWER LIMB
 TIBIAL AND FIBULAR FRACTURES
 ANKLE FRACTURE
 FOOT
a. Calcaneal fracture
b. March fracture
c. Jones’ fracture

67. POSTERIOR SHOULDER DISLOCATION

68. ACROMIOCLAVICULAR JOINT SEPERATION

69. HUMERAL SHAFT FRACTURE

70. DISTAL HUMERAL FRACTURE

71. ELBOW DISLOCATION

72. MONTEGGIA FRACTURE-DISLOCATION

73. CALCANEAL FRACTURE

74. THANK YOU