PTCUT

IMAGING

LECTURE 2 - CHEST RADIOGRAPHY

Adham Mohamed - Hisham Saeed

 Chest radiography
Plain X-Ray :
Advantages: Disadvantages:
1.Low cost 1. It gives image with 2D dimension, and
2. Give brief diagnosis about the case. our body is 3D dimensions.
3. No radiation remains in a patient's 2. It may not match with the course of
body. the disease.
4. X-rays usually have no side effects. 3. Radiation dose.
5. X-ray equipment is relatively 4. Some cases may not show up on a
inexpensive chest x-ray as: small cancers, blood
6. widely available in emergency rooms, clot in the lungs, pulmonary embolism
physician offices, ambulatory care
centers, nursing homes.
7. Because x-ray imaging is fast, simple
and easy.
8. The results of a chest x-ray can be
available almost immediately for review
by physician
9. It has an excellent resolution.

Preliminary Check: -
1. Transparency: There must be a differention between the whiteness of the
heart and the whiteness of the spine vertebrae.
2. Symmetry: the line joining the midpoint of the clavicle to the spine from
the right side is equal to the one on the left side (to able to comment on
tracheal shifting).
3. P-A view: ability to count the ribs until reaching 8th -10th rib, but in the A-P
view the counting of the ribs till 6th only and the heart appears enlarged.
4. The patient should be examined in full inspiration. The diaphragm should
be found at about the level of the 8th - 10th posterior rib or 5th - 6th anterior
rib on good inspiration.
Steps for optimal Chest X-ray:
1. x-ray beam: PA / AP
2. position: upright/ supine
3. sex: male/female
4. exposure: over/under
5.breath: inspiration/expiration

Views of the chest X-Ray :

P-A view ;
: the x-ray source is positioned so that x-rays
enter through the posterior aspect of the chest,
and exit out of the anterior aspect where they
are detected. It is standard view for chest x-ray
where the patient is in standing position taking
deep inspiration and holding it.
P-A view of the chest

A-P view :
the positions of the x-ray source and detector
are reversed: x-rays enter through the anterior
aspect and exit through the posterior aspect of
the chest.
reserved for situations where it is difficult for
the patient to obtain a normal chest x-ray, such
as when the patient cannot get out of bed.
The heart shadow is magnified because it is an
anterior structure.
A-P view of the chest
Lateral views:
are obtained in a similar fashion as the PA-`
view gives a good image for examining the
mediastinum and lung inflation degree. It can
detect: lobes/retrosternal spaces. retro cardiac
spaces/posterior cost phrenic recesses/Dome
of diaphragm
(The spine appears to be darker as you move
caudally).
‫ ده زي‬PA ‫بس ده بصوره بالجمب وبتبقي االيدين مرفوعه‬
‫لي فوق والناحيه الي هصورها ركنه علي سطح املس‬ Lateral view of the chest

‫ وال‬spine ‫بيبقي ابيض فوق وكل اما انزل يبقي اسود اكتر‬
‫عشان في هوي كتير في الرئه من تحت‬

Oblique view:
for heart, pleura chest walls and ribs
abnormalities (anterior oblique Rt. & Lt. &
posterior oblique Rt. & Lt.) that refers to the
patient rotation 45 degrees anteriorly and
posteriorly while imaging.
‫ ده زي‬L ‫لوره او لقدام‬45‫بس الفرق اني بلف بزااويه‬

Oblique view of the chest

Decubitus:
useful for differentiating pleural effusions from
consolidation and Loculated effusions from free
fluid in the pleura
‫بستخدمه عشان اكتشف لو فيه ميه علي الرئه بنيم المريض‬
‫علي جمبه و اصور لو في ميه هتترسب في لبجمب الي‬
‫تحت وهتبان‬

Movement of the fluid in the pleural

recess from PA view to decubitus view
 Systematic Interpretation
1. Assessment of quality / airways:
1. Position: Is this AP file? / PA file? Or Lateral?
2.Inspiration: Count the ribs to see 10-11.
3. Exposure: Good lung details / outline of spinal column.
4. Symmetry: Both clavicles.

2. Bones: Symmetry, Fractures, Osteoporosis & lesions.

Soft tissue: Foreign bodies, subcutaneous air, breast shadows, swelling,
axillae

3. Cardiac: Seize of heart. – Shape. – Calcifications – Prosthetic valves.

Costophrenic angle: angle between diaphragm and ribs
It appears dark (30)

4. Diaphragm: dome shaped normally

RT is higher than LT by 1-2cm

5. Effusion: pleural effusion/costophrenic angle

Normal pleura is not visible

6. Fields, fissures and foreign body: masses/

Air bronchogram

7. Great vessels & Gastric bubbles: vascular pedicle (aortic knob)

8. Hila & Mediastinum:

Hilum: Pulmonary arteries / Pulmonary veins
Lungs: Linear and fine nodular shadows of pulmonary vessels
Heart: L ventricle and atrium/aortic arch/pulmonary artery

9. Abdomen: Gastric bubble /Air under diaphragm

Neck: Soft tissue mass / Air bronchogram

10. Impression density:

Air – Water – Bone – Tissue
 Gastric bubble

‫الخالصه من الي فات ده ان انا اول ممسك االشاعه ابتدي اشوف االول جوده االشعه وبعدين‬
‫ابتدي اشوف كل حاجه بقي العضم في كسر وال ال في ليشن في التشو وبعدين اشوف القلب‬
‫شكله وحجمه وبعدين الديفرام اشوفه فالت وال كويس وبعدين اشوف االوعيه والشراين الي‬
‫موجوده اشوف لو في اي جسم غريب واشوف الرئه والزونز بتعتها واشوف المناطق المجوره زي‬
‫البطن والرقبه ده كله بيبقي تشيك سريع اول ما امسك االشعه‬

Surface Anatomy
:Trachea
extends from the larynx (2 cm. below the vocal cords) to the carina where it
bifurcates (T1) with average length for the trachea 10-12cm. During
inspiration: length 2cm/ angle 10

Lung Apex:
Situated in the neck above at the medial third of the clavicle (2.5cm.)
Anterior border of the lung: It extends from the apex of the lung vertically
downward to the level of 6th costal cartilage (Rt), & to the 5th costal
cartilage (Lt).
Lower border of the lung: is convex downward from the 6 th sternocostal
junction to the 10th thoracic spinous process.
Posterior border of the lung: indicated by lines drawn from the level of the
spinous process of the 7th cervical vertebrae down either sides of the
vertebral column across the costovertebral joints, as low as the spinous
processes of the 10th thoracic vertebrae
Mediastinum:
At level of T4-T5. It is the central compartment of the thoracic cavity
surrounded by connective tissue.
It contains: Heart & veins Trachea, Esophagus, Thymus, Phrenic & cardiac
nerves, Thoracic duct &Lymph Nodes of central chest.
It consists of: Superior, Thoracic plane and inferior compartments which
divides in relation to the heart into anterior, middle and posterior parts.

‫الخالصه في الحته دي ان دي المنطقه الي في نص الثوركس بلقي فيها القلب والمرئ والبلعوم‬
‫والشرين واالورده بتاعه القلب وكدا بتتقسم لتلت مناطق فوق ودي بتبقي في اول الثوركس من‬
‫فوق و النص بتبقي تحتيها علي طول وتحت وهيا اكبر واهم واحده الي فيها القلب الي بتاخد‬
‫بقيت الثوركس لحد الديفرام وبتتقسم لتلت حتت‬

Heart: The heart rests on the diaphragm and covered anteriorly by the body
of the sternum and the 3rd -6 th costal cartilages of both sides.
Normal Mediastinal width is 8 cm at the aortic arch, or the mediastinum chest
width ratio is 0.25 in children and trachea should be in the midline.

Cardiac silhouette

PA view: right border (R atrium)

Left border (L atrium)

L view: anterior border (R ventricle)

Posterior border (L atrium/ L ventricle)

Cardiac silhouette

chest topography
is very important to be able to comment on the film accurately.
‫دي عباره عن خطوط وهميه بتقسم الثوركس عشان يبقي سهل عليا اوصف الحاله‬
 Chest topography

For extra knowledge click the link : https://youtu.be/LtM-BGGneiQ

By :

Hisham Saeed
_________________