1. Thoracic Imaging Chest Radiography and other techniques

2. X-ray projection Department or mobile unit Projection – PA of AP according to direction in which X-ray beams travel through patient Heart magnified in AP projection X-ray taken during full inspiration Arms abducted

3. X-ray projection

4. Lateral x-ray – patient turned 90º, effected side against film cassette Arms extended forward

5. X-ray projection

6. Lateral decubitus – small pleural effusions Patient lies horizontally, effected side placed downwards Film cassette at the back of patient, X- ray beam from front

7. X-ray projection Lordotic film – middle lobe collapse AP projection – patient arches back so that shoulders are touching the cassette

8. Other techniques Fluoroscopy – “real time” visuals of patient on television monitor

9. Other techniques Ultrasonography – high-frequency sound waves Limited use in chest, but used for cardiac imaging

10. Other techniques Computer tomography – X-ray tube and detectors rotate around patient

11. Other techniques Magnetic resonance imaging – patient lies in middle of large magnet Combination of intense magnetic field and series of radiofrequency waves

12. Other techniques - MRI

13. Other techniques Radionuclide imaging – ventilation- perfusion scanning of the lung Suspected pulmonary embolus

14. Interventional procedures Needle biopsy

15. Interventional procedures Arteriography – glide catheter from femoral vein or vein in elbow, through right side of heart to pulmonary artery Contrast injected

16. Normal chest x-ray Outline of mediastinum and heart The hila Pulmonary vessels and main bronchi Diaphragm Soft tissue and bones of the thoracic cage

17. Normal chest

18. Mediastinum and heart Mediastinum – trachea, aortic arch, superior vena cava and oesophagus Heart – one-third to right of the spine and two-thirds to the left Transverse diameter less than transverse diameter of hemi-thorax

19. Hila and diaphragm Hila – pulmonary arteries and veins Diaphragm – highest point of right hemidiaphragm is between anterior ends of 5 th and 7 th ribs Left 2cm lower in erect position Costophrenic angle Lateral view – heart to viewer’s left

20. Lateral X-ray

21. Interpreting a X-ray Name of patient, time and date Left and right side markers PA or AP Supine vs erect Patient rotation – distance between medial ends of clavicle and spinous processes State of inspiration

22. Interpreting a X-ray Should be able to see vertebral bodies through heart shadow Thoracic cage Heart and mediastinum Diaphragm and costophrenic angle Lungs

23. Consolidation Air-filled spaces replaced by products of disease – water, pus or blood Localized areas - infection Radiological signs – air bronchogram and silhouette sign Air bronchogram – black branching structures Silhouette sign – border of structure gone

24. Consolidation

25. Collapse (atelectasis) Loss of aeration and collapse of lobe or lung Tumour, foreign object or mucus plug

26. Collapse - signs ↑ density of collapsed lobe Shift of fissures Silhouette sign Hilar and mediastinal shift Crowding of vessels, airways and ribs Elevation of hemidiaphragm

27. Right upper lobe collapse

28. Right middle lobe collapse

29. Right lower lobe collapse

30. Left upper lobe collapse

31. Left lower lobe collapse

32. Pneumothorax

33. Pleural effusion

34. Pulmonary nodules and metastasis

35. Lung abcess

36. Paediatrics