1. PATTERN RECOGNITION OF THE CHEST Carin Meyer Senior lecturer Diagnostic Radiology - UVS

3. DOCUMENTARY INFORMATION Patient ID Date Age Anatomical marker

4. TECHNICAL CONSIDERATIONS ROUTINE CHEST VIEWS PA and LAT Patient erect Full inspiration FFD 180cm T6

5. 1Patient erect Air-fluid levels Size of blood vessels Diaphragms Mediastinum and heart PRE-REQUISITES FOR OPTIMAL DIAGNOSIS

6. Size of blood vessels Mediastinum and heart SUPINE CHEST FILM

7. REMEMBER The position of the patient has a profound effect on the appearance of the chest radiograph!!!

8. PRE-REQUISITES (continue) 2Include: C7, LAT chest-wall costophrenic angles 3Shoulders depressed, same level 4Scapulae not superimposed lungs 5No rotation – spinous process and sternoclavicular joints

9. PRE-REQUISITES (continue) Rotation - long axis -Distorts mediastinal structures -Radio-opacity R and L hemithoraces Rotation - horizontal axis -Kyphotic and lordotic projection -Sternal end of clavicles superimpose 4 th post rib

10. PRE-REQUISITES (continue) 6 Adequate inflation Diaphragm cross 10 th post rib Under-inflation -Upper and lower zone vessels -Mediastinal structures particularly heart 7No motion

11. PRE-REQUISITES (continue) 8Optimum exposure -Long contrast scale -Vertebral bodies T1-T4 -Post ribs

13. 1SOFT TISSUE (Protocol) -Absence of a breast -Surgical emphysema -Calcifications -Swelling -Amount of fat

14. 2BONE (Protocol continue) -#’s -Absence of a rib -Architecture -Lytic and sclerotic lesions -Distance between ribs -Cervical ribs

15. 3DIAPHRAGM (Protocol continue) -Costophrenic angles sharp -Adequate inflation -R hemidiaphragm -Gastric air bubble -Free air

16. 4MEDIASTINUM / HEART (Protocol continue) -Mediastinum central, silhouette sharp -Upper trachea -Para-trachial line -Cardiac size, contour, marginal clarity -Diameter of normal heart -Cardiac densities -R heart border

17. 5HILA (Protocol continue ) Fibroses causes -shrinking of tissue -shifting of landmark -Position -Compare L and R hila equal density / same size

18. 6FISSURES AND VESSELS (Protocol continue) -Fissures:position configuration thickness -Vessels:upper + lower zone distribution pattern

19. 8DENSITY (Protocol continue) Compare L + R lungs Fluid

20. SILHOUETTE SIGN