Thoracic Imaging Chest x-ray Computerised tomography Ultrasound Magnetic resonance imaging New...
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Transcript of Thoracic Imaging Chest x-ray Computerised tomography Ultrasound Magnetic resonance imaging New...
Thoracic Imaging
Thoracic Imaging Chest x-ray Computerised tomography Ultrasound Magnetic resonance imaging New advances
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
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
Chest x-ray views/types Posteroanterior - PA Anteroposterior - AP Lateral Decubitus
Views
PA Standard, radiology dept X-rays posterior to anterior Standing position
Normal PA
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
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
Normal AP
Views
Lateral Localises, shows posterior to heart Side of interest placed against film
Decubitus PA on side Small pleural effusions
Norm lateral
vertebrae
Heart
Lung Anatomy
(1) oblique fissure(2) transverse fissure(3) retrocardiac space(4) retrosternal space
BASICS
Air shows as black solid structures white
Too white Too black Too large In the wrong place (Corral et al
1997)
Chest x-ray viewing guide
Correct CXR Name Date of birth Date Left and right, marker/stomach
Normal PA
Stomach
Patient Position PA, AP, lateral or decubitus view Rotation – Sternal end clavicles
equal from vertebral body If AP what position
Exposure How dark or light a film is Should see vertebral bodies
through heart
Soft Tissues Breast shadows Piercing Air in tissues Tissue folds in obese Medical equipment
Breast shadows
Surgical emphysema
surgical emphysema
Pacemaker
Heart valve
ICD
ECG
ETT
Bony Structures Ribs Scapulae Clavicles Vertebrae
#Clavicle
#ribs
Trachea Deviated Carina Artificial airway
ETT
#RibsICD
Mediastinum Deviated Hilar shadows Aortic arch
Mediastinum - Heart
Size No larger than half width of chestPosition Two thirds on the leftBorders Clear
Diaphragm Shape Height: right –6rib ant, left – 7 ant Cardiophrenic angle Costophrenic angle
Lung Fields Black with lung markings Other opacity indicated pathology Fissures Zones Air bronchograms Consolidation
normal
Right upper lobe collapse
Right Lower lobe collapse
Pneumothorax
Pneumothorax
Consolidation
Pleural effusion
Pleural effusion
Right pneumonia
Air bronchogram
Emphysema
Other imaging
Computerised tomography Transverse images, cross section Localises masses High radiation dose
Other imaging cont
Ultrasound Useful for pleural effusions Good images of heart and valves
Other imaging cont
MRI Malignancy Vascular Congenital abnormalities Tuberculosis
New advances
Patient archive communication system
Film free radiology Computer use Image enhancement