1. “V V O I”: A Swift Hand Motion in Detecting Atelectasis on Frontal Chest Radiographs 
Amr M. Ajlan, MD, Genevieve Belley, MD, John Kosiuk, MD 
Canadian Association of Radiologists Journal 
Volume 62, Issue 2, Pages (May 2011)
DOI: /j.carj
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2. Figure 1
“V V O I” hand motion: the first “V.” (A) On normal radiographs, using the right hand to form a “V” will result in the index finger pointing to the higher right hemidiaphragm and the middle finger pointing to the lower left hemidiaphragm. (B) Exaggeration of the tilt to the left (clockwise) should raise the possibility of right-sided volume loss. (C) Reversal of the tilt to the right (counter clockwise) might indicate left-sided volume loss.
Canadian Association of Radiologists Journal  , DOI: ( /j.carj )
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3. Figure 2
“V V O I” hand motion: the second “V.” (A) On normal radiographs, the hand-formed “V” is tilted the other way, so that the right index finger points to the lower right hilum and the right middle finger points to the higher left hilum. (B) Reversal of the tilt to the left (clockwise) should raise the possibility of right upper or left lower lobar volume loss. (C) Exaggeration of the tilt to the right (counter clockwise) might indicate left upper or right lower lobar volume loss.
Canadian Association of Radiologists Journal  , DOI: ( /j.carj )
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4. Figure 3
“V V O I” hand motion: the “O.” The hand forms a circle by using the index and thumb fingers. Placing this circle to the left of the midline of a normal and well-positioned chest radiograph should lead to the “O” overlapping about two-thirds of the cardiac shadow. Filling of the “O” by more than two-thirds of the heart shadow suggests left-sided volume loss. Filling of the “O” by less than two-thirds of the heart shadow suggests right-sided volume loss.
Canadian Association of Radiologists Journal  , DOI: ( /j.carj )
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5. Figure 4
“V V O I: hand motion: the “I.” (A) If the minor fissure is visualized on a normal radiographs, then its course could be followed by using the index finger at its expected location. (B) Depression of the fissure could denote right lower or middle lobe atelectasis. (C) Elevation of the fissure could denote right upper lobe volume loss.
Canadian Association of Radiologists Journal  , DOI: ( /j.carj )
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6. Figure 5 An overall summary of the “V V O I” hand motion trick.
Canadian Association of Radiologists Journal  , DOI: ( /j.carj )
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7. Figure 6
Example 1 to illustrated the “V V O I” hand motion. (A) A 43-year-old man with chronic cough. (B) The first “V” is slightly rotated clockwise because of right hemidiaphragmatic elevation. (C) The second “V” tilt is obviously reversed because of hilar elevation. (D) The “O” is filled by more than two-thirds of the heart shadow. However, this is because of the patient's rotation (a pitfall to keep in mind). (E) The “I” points to an upward-displaced minor fissure. The constellation of findings points to right upper lobe collapse, which was proven to be caused by bronchostenosis secondary to previous tuberculosis. Note that this finding could be easily missed because of the marked compensatory overinflation of the right middle and lower lobes.
Canadian Association of Radiologists Journal  , DOI: ( /j.carj )
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8. Figure 7
Example 2 to illustrate the “V V O I” hand motion. (A) A 46-year-old woman with bilateral axillary lymphadenopathy. (B) The first “V” tilt is exaggerated (clockwise rotation). (C) The second “V” tilt is exaggerated (counter clockwise rotation). (D) The “O” is filled by about half of the heart shadow, denoting rightward shift of the cardiac structures. (E) The “I” appears within the normal position. The constellation of findings points to right lower lobe collapse, which was caused by bronchial obstruction by a known lymphomatous mass. The increased right retrocardiac density and the nonvisualization of the interlobar artery are 2 additional important findings.
Canadian Association of Radiologists Journal  , DOI: ( /j.carj )
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