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Introduction to Radiographic Interpretation Special Emphasis on CXRs.

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Presentation on theme: "Introduction to Radiographic Interpretation Special Emphasis on CXRs."— Presentation transcript:

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2 Introduction to Radiographic Interpretation Special Emphasis on CXRs

3 Differential Absorption of X-rays Dependent upon –Physical density –Atomic number –Thickness Determine the gray scale of the radiograph Absorb few x-rays = film black many x-rays = film white

4 Five Radiographic Opacities Air Fat Soft tissue BoneMetal least opaquetomost opaque most lucenttoleast lucent BlacktoWhite

5 Radiographic Opacities & Contrasts Air FatMineral oilWater BoneTums Metal???

6 Five Radiographic Opacities

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8 Standard Radiographic Positions

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10 Standard Radiographic Directions As seen when viewing Dorsal Proximal Cranial Ventral Distal Caudal Cranial Rostral Dorsal Right Caudal Palmar Plantar Left

11 Lateral viewCranial-caudal view Radiograph: two-dimensional image of a three-dimensional object So... What is it?

12 Dorsoventral view Radiograph: two-dimensional image of a three-dimensional object So... What is it?

13 Interpretation Challenges Magnification Distortion Image of a familiar object is unfamiliar Loss of depth perception Summation Silhouette effect

14 Interpretation Challenges: Magnification Enlargement of the radiographic image of an object relative to its actual size Increased film-subject distance

15 Interpretation Challenges: Magnification

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17 Interpretation Challenges: Distortion Distortion:Misrepresentation of the true shape of an object

18 Interpretation Challenges: Unfamiliar image of a familiar object

19 Interpretation Challenges: Depth perception

20 Interpretation Challenges: Summation Superimposition of structures in different planes Resultant image = summation of opacities

21 Interpretation Challenges: Summation

22 Interpretation Challenges: Silhouette Effect Two structures of the same radiopacity in contact – their margins cannot be identified

23 Interpretation Challenges: Silhouette Effect

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25 CXR Interpretation Have a system!! Method 1: “Outside-to-inside” –Soft tissues –Bony framework –Lungs & hila –Diaphragm & pleura –Mediastinum & heart Method 2: “Are There Many Lung Lesions?” –Abdomen & diaphragm –Thorax –Mediastinum & heart –Lung (single) –Lungs (both)

26 CXR Interpretation Have a system!! Method 1: “Outside-to-inside” –Soft tissues –Bony framework –Lungs & hila –Diaphragm & pleura –Mediastinum & heart Method 2: “Are There Many Lung Lesions?” –Abdomen & diaphragm –Thorax –Mediastinum & heart –Lung (single) –Lungs (both) A T M LL

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30 CXR Interpretation Beware the poor-quality film!! Poor inspiration –High diaphragms, crowded lung markings “Penetration”: –Disappearing thoracic vertebral details through the heart. Rotation: –Note equal distances from the vertebral spines to the medial ends of the clavicles.

31 CXR Interpretation Beware the poor-quality film: Inspiration

32 CXR Interpretation Normal structures visible 1.Tracheal air column. 2.Carina. 3.First rib. 4.Peripheral lung fields have no markings except: 5.The minor fissure. 6.Top of the R diaphragm is usually between the anterior 6th & 7th ribs, and overlying the posterior 10th & 11th ribs. 7.Left diaphragm is lower (in 90-95%) by roughly half an interspace. 8.Inferior margins of the posterior ribs. 9.Anterior mediastinal line. 10.Superior vena cava. 11.Azygous vein. 12.Right descending pulmonary artery. 13.Pulmonary arteries and veins. 14.Right atrium. 15.Inferior vena cava. 16.Aortic arch. 17.Left pulmonary artery. 18.Border of the left ventricle. 19.Descending aorta. 20.Fat density lines in the intermuscular fascial layers

33 CXR Interpretation Normal structures visible A.Costophrenic angle B.Diaphragm C.Heart D.Aortic arch E.Trachea F.Hilum G.Main carina H.Stomach bubble I.Ascending aorta

34 CXR Interpretation Normal structures visible A.Costophrenic angle B.Diaphragm C.Heart D.Aortic arch E.Trachea F.Hilum G.Main carina H.Stomach bubble I.Ascending aorta

35 CXR Interpretation Normal structures visible 1.Tracheal air column. 2.Carina. 3.First rib. 4.Peripheral lung fields have no markings except: 5.The minor fissure. 6.Top of the R diaphragm is usually between the anterior 6th & 7th ribs, and overlying the posterior 10th & 11th ribs. 7.Left diaphragm is lower (in 90-95%) by roughly half an interspace. 8.Inferior margins of the posterior ribs. 9.Anterior mediastinal line. 10.Superior vena cava. 11.Azygous vein. 12.Right descending pulmonary artery. 13.Pulmonary arteries and veins. 14.Right atrium. 15.Inferior vena cava. 16.Aortic arch. 17.Left pulmonary artery. 18.Border of the left ventricle. 19.Descending aorta. 20.Fat density lines in the intermuscular fascial layers

36 CXR Interpretation PA vs. AP views

37 CXR Interpretation PA & Lateral views

38 CXR Interpretation Hyperexpansion = “Air Trapping”

39 CXR Interpretation “Big Lungs” & “Little Lungs”

40 CXR Interpretation Interstitial Infiltrates A.Generalized interstitial thickening = linear (“reticular”). B.Discrete interstitial thickening = nodules. C.Interstitial & alveolar filling = silhouette.

41 CXR Interpretation Interstitial Infiltrates

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45 CXR Interpretation Alveolar Infiltrates Alveolar-filling, or “airspace” disease: “Pointillist” patterns. Air bronchograms.

46 CXR Interpretation Alveolar Infiltrates

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