Presentation on theme: "Kunal D Patel Research Fellow IMM"— Presentation transcript:
1 Kunal D Patel Research Fellow IMM X-RaysKunal D PatelResearch FellowIMM
2 } } } The 12-Steps Pre-read Quality Control Findings 1: Name 2: Date 3: Old films4: What type of view(s)5: Penetration6: Inspiration7: Rotation8: Angulation9: Soft tissues / bony structures10: Mediastinum11: Diaphragms12: Lung FieldsPre-read}Quality Control}Findings
3 NOTE normal pleura are NOT visible Reviewing these areasHeartSizeShapeSilhouette-margins should be sharpEvidence of stents, clips, wires and valvesDiameter (>1/2 thoracic diameter is enlarged heart)MediastinumWidth?Contour?Lung fieldsApicesLobes and fissuresUSE SILHOUETTESCP anglesDiaphragmGastric bubbleNOTE normal pleura are NOT visible
4 FINDINGS!A = Airway: are the trachea and mainstem bronchi patent; is the trachea midline?B = Bones: are the clavicles, ribs, and sternum present and are there fractures, lytic lesions?C = Cardiac silhouette: is the diameter of the heart > ½ thoracic diameter (enlarged)?D = Diaphragm: are the costophrenic and costocardiac margins sharp? is one hemidiaphragm enlarged over another? is free air present beneath the diaphragm?E = Effusion/empty space: is either present?F = Fields (lungs): are there infiltrates, increased interstitial markings, masses, air bronchograms, increased vascularity, or silhouette signs?G = Gastric bubble: is it present and on the correct (left) side?H = Hilar region: is there increased hilar lymphadenopathy?
5 Summarise as well!"The trachea is central, the mediastinum is not displaced. The mediastinal contours and hila seem normal. The lungs seem clear, with no pneumothorax. There is no free air under the diaphragm. The bones and soft tissues seem normal."
6 CASESRemember!:Most disease states replace air with a pathological processEach tissue reacts to injury in a predictable fashionLung injury or pathological states can be either a generalized or localized process
7 Evaluating an Abnormality 1. Identification of abnormal shadows2. Localization of lesion3. Identification of pathological process4. Identification of etiology5. Confirmation of clinical suspensionComplex problemsIntroduction of contrast mediumCT chestMRI scan
8 A single, 3cm relatively thin-walled cavity is noted in the left midlung. This finding is most typical of squamous cell carcinoma (SCC). One-third of SCC masses show cavitation
9 LUL Atelectasis: Loss of heart borders/silhouetting LUL Atelectasis: Loss of heart borders/silhouetting. Notice over inflation on unaffected lung
10 Atelectasis Loss of air Obstructive atelectasis: No ventilation to the lobe beyond obstructionRadiologically:Density corresponding to a segment or lobeSignificant loss of volumeCompensatory hyperinflation of normal lungs
12 Consolidation Lobar consolidation: Alveolar space filled with inflammatory exudateInterstitium and architecture remain intactThe airway is patentRadiologically:A density corresponding to a segment or lobeAirbronchogram, andNo significant loss of lung volume
13 Cavitation:cystic changes in the area of consolidation due to the bacterial destruction of lung tissue. Notice air fluid level.