thoracic imaging chest x-ray computerised tomography ultrasound magnetic resonance imaging new...
TRANSCRIPT
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Thoracic Imaging
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Thoracic Imaging Chest x-ray Computerised tomography Ultrasound Magnetic resonance imaging New advances
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Background Chest X-ray Most common radiological
investigation – 40% of all investigations
Standard component of a pulmonary examination
Systematic review is vital in interpretation of chest x-rays
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Limitations of a chest x-ray 2 dimensional image of a 3
dimensional structure X-ray findings may lag behind
other clinical features Normal x-ray does not rule out
pathology Dependent on good quality image
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Chest x-ray views/types Posteroanterior - PA Anteroposterior - AP Lateral Decubitus
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Views
PA Standard, radiology dept X-rays posterior to anterior Standing position
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Normal PA
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Lung Anatomy
(1) aortic arch (2) pulmonary trunk(3) left atrial appendage(4) left ventricle(5) right atrium(6) superior vena cava (7 & 8) diaphragm(9) transverse fissure
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Views
AP Cassette placed behind patient X-rays anterior to posterior Sitting in chair, semi-erect in bed,
supine AP marked on film Heart enlarged, poorer inspiration
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Normal AP
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Views
Lateral Localises, shows posterior to heart Side of interest placed against film
Decubitus PA on side Small pleural effusions
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Norm lateral
vertebrae
Heart
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Lung Anatomy
(1) oblique fissure(2) transverse fissure(3) retrocardiac space(4) retrosternal space
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BASICS
Air shows as black solid structures white
Too white Too black Too large In the wrong place (Corral et al
1997)
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Chest x-ray viewing guide
Correct CXR Name Date of birth Date Left and right, marker/stomach
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Normal PA
Stomach
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Patient Position PA, AP, lateral or decubitus view Rotation – Sternal end clavicles
equal from vertebral body If AP what position
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Exposure How dark or light a film is Should see vertebral bodies
through heart
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Soft Tissues Breast shadows Piercing Air in tissues Tissue folds in obese Medical equipment
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Breast shadows
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Surgical emphysema
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surgical emphysema
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Pacemaker
Heart valve
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ICD
ECG
ETT
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Bony Structures Ribs Scapulae Clavicles Vertebrae
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#Clavicle
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#ribs
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Trachea Deviated Carina Artificial airway
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ETT
#RibsICD
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Mediastinum Deviated Hilar shadows Aortic arch
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Mediastinum - Heart
Size No larger than half width of chestPosition Two thirds on the leftBorders Clear
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Diaphragm Shape Height: right –6rib ant, left – 7 ant Cardiophrenic angle Costophrenic angle
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Lung Fields Black with lung markings Other opacity indicated pathology Fissures Zones Air bronchograms Consolidation
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normal
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Right upper lobe collapse
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Right Lower lobe collapse
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Pneumothorax
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Pneumothorax
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Consolidation
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Pleural effusion
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Pleural effusion
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Right pneumonia
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Air bronchogram
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Emphysema
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Other imaging
Computerised tomography Transverse images, cross section Localises masses High radiation dose
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Other imaging cont
Ultrasound Useful for pleural effusions Good images of heart and valves
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Other imaging cont
MRI Malignancy Vascular Congenital abnormalities Tuberculosis
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New advances
Patient archive communication system
Film free radiology Computer use Image enhancement
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