The Chest X-Ray

1
The Chest X-Ray

• For Nottingham SCRUBS 26th August 2006
• Presented by Matthew

2
Aims

• Basics
• Best exam results
• Appreciate the role radiology plays
• ? Instil an interest in radiology

3
Contents

• Densities
• Techniques
• Anatomy
• CXR Interpretation
• Common Pathologies
• Questions

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Densities

• The big two densities are
• (1) WHITE - Bone
• (2) BLACK - Air
• The others are
• (3) DARK GREY- Fat
• (4) GREY- Soft tissue/water
• And if anything Man-made is on the film, it is
• (5) BRIGHT WHITE - Man-made

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Techniques - Projection

• P-A (relation of x-ray beam to patient)

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Techniques - Projection (continued)

• A-P Supine/Erect

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Techniques - Projection (continued)

• Lateral

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Techniques - Projection (continued)

• Lateral Decubitus

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Techniques - Projection (continued)

• Oblique

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Orientation

• Orientation

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Rotation
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Rotation (continued)
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Penetration
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Inspiration/Expiration
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Anatomy
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Anatomy
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Anatomy
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Lobes

• Right upper lobe

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Lobes (continued)

• Right middle lobe

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Lobes (continued)

• Right lower lobe

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Lobes (continued)

• Left lower lobe

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Lobes (continued)

• Left upper lobe with Lingula

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Lobes (continued)

• Lingula

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Lobes (continued)

• Left upper lobe - upper division

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Pleura

• Layers

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Heart

• Right border Edge of (r) Atrium
• 3. Left border (l) Ventricle Atrium
• 4. Posterior border Reft Ventricle
• 5. Anterior border Right Ventricle

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Heart (continued)
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Heart (continued)
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Heart (continued)

• Valves

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Mediastinum
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Hilum

• Made of
• 1. Pulmonary Art.Veins
• 2. The Bronchi
• Left Hilus higher (max 1-2,5 cm)
• Identical size, shape, density

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Hilum
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Ribs
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Soft tissue bones
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Lateral CXR
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Lateral CXR (continued)
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Lateral CXR (continued)
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Lateral CXR (continued)
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Lateral CXR (continued)
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CXR Interpretation
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Technical Details

• Type
• Orientation
• Rotation
• Inspiration/expiration
• Penetration

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Lungs

• Lungs
• Density
• Symmetry
• Lesions

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Heart

• Size

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Heart

• Size of heart
• Size of individual chambers of heart
• Size of pulmonary vessels
• Evidence of stents, clips, wires and valves
• Outline of aorta and IVC and SVC

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Mediastinum

• Width
• Contour
• AP window

Hila

• Size
• Location

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Review areas

• Apices
• Behind the heart
• CP angles
• Below the diaphragm
• Soft tissues ( breast, surgical emphysema)
• Ribs clavicle
• Vertebrae

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Identify the lesion ? localise the lesion ?
describe the lesion ? give DDNever stop
looking, carry on with your systematic approach!!
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Pathology
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• RUL pneumonia

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• RML pneumonia

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• RLL pneumonia

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• LUL pneumonia

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• LLL pneumonia

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• Consolidation on CT

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• Hilar m l

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The Enlarged Hila

• Causes1. Adenopathies (neoplasia,
  infection)2. Primary Tumor3. Vascular4.
  Sarcoidosis

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• Multiple Masses

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• Hilar Lymphadenopathy - BL

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(No Transcript)
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• Pleural Effusion

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• Pulmonary Fibrosis

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• ?

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• Heart failure

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• Pneumothorax

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• RUL collapse

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• LLL collapse

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• Air under the diaphragm

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• Emphysema

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• Cervical Rib

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• Cavitating lesion

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• Hiatus hernia

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• Miliary shadowing

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• Chest Tube, NG Tube, Pulm. artery cath

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• Dextrocardia