3. Densities Techniques Anatomy CXR Interpretation

4. The big two densities are: (1) WHITE - Bone (2) BLACK - Air The others are: (3) DARK GREY- Fat (4) GREY- Soft tissue/water And if anything Man-made is on the film, it is: (5) BRIGHT WHITE - Man-made

7. Routine chest radiograph Air — least dense; most transparent or radiolucent; unobstructed beam or air-filled densities appear black Lungs, gastric bubble, trachea, ? bifurcation of bronchi Air — least dense; most transparent or radiolucent; unobstructed beam or air-filled densities appear black Lungs, gastric bubble, trachea, ? bifurcation of bronchi

8. Routine chest radiograph Fat — breasts

9. Non-pendulous breast producing impression on the lung field.

10. Routine chest radiograph Blood: heart most opaque, hilar vessels less opaque. Opacity in the hilar vessels decreases distally.

11.  The patient should be examined in full inspiration.  This greatly helps the radiologist to determine if there are intrapulmonary abnormalities.  The diaphragm should be found at about the level of the 8 th - 10 th posterior rib or 5 th - 6 th anterior rib on good inspiration.  A patient can appear to have a very abnormal chest if the film is taken during expiration.

14.  Adequate penetration of the patient by radiation is also required for a good film.  On a good PA film, the thoracic spine disc spaces should be barely visible through the heart.  Bronchovascular structures can usually be seen through the heart.

16.  If there is rotation of the patient, the mediastinum may look very unusual.  One can access patient rotation by observing the clavicular heads and determining whether they are equal distance from the spinous process of the thoracic vertebral bodies.

19. P-A (relation of x-ray beam to patient)

20. Routine chest radiograph PA view – film is placed anteriorly, X-ray beam passes from posterior aspect to anterior side.

21. Lateral

22. Lateral Decubitus The right is an example of a decubitus film in this case showing a mobile pleural effusion (arrows).

23. AP view An AP film, enlarges the shadow of the heart and makes the posterior ribs appear more horizontal.

25. Lung lobes Anteriorly most area is represented by left upper lobe

26. Lung lobes In the lateral view upper lobe occupies upper and anterior portions.

27. Lung lobes Posteriorly maximum portion is occupied by lower lobe

28. Right upper lobe:

29. Right middle lobe:

30. Right lower lobe:

31. Left lower lobe:

32. Left upper lobe with Lingula:

33. Position of the fissure rt lt

34. Made of: 1. Pulmonary Art.+Veins 2. The Bronchi Left Hilus higher (max 1-2,5 cm)

36. The level of the left diaphragm is About 2.5cm below the right one. The level of the left diaphragm is About 2.5cm below the right one. DIAPHRAGM