2. INTRODUCTION TO CHEST IMAGING for 5th year medical students
DR/HOSSAM ZYTON
LECT OF RADIOLOGY

3. IMAGING TECHNIQUES Plain radiography (CXR): routine, special.
Fluoroscopy with and without contrast.
Bronchography.
Pulmonary Angiography and bronchial Arteriography.
Tomography
C.T scanning
MRI.
Scintigraphy = Isotope studies.
Ultrasound

4. PLAIN RADIOGRAPHY OF THE CHEST (CXR)
IMPORTANCE OF CHEST X-RAY :
Diagnosis & follow up of chest & heart diseases.
Routine pre-employment examination.
Routine preoperative examination
Follow up of malignancy
Medical checkup.

5. PLAIN RADIOGRAPHY OF THE CHEST (CXR)

6. Normal PA View of the chest

7. PLAIN RADIOGRAPHY OF THE CHEST (CXR)

8. Normal Lateral View of the chest

9. PLAIN RADIOGRAPHY OF THE CHEST (CXR)

10. PLAIN RADIOGRAPHY OF THE CHEST (CXR)
ANALYSIS OF THE X-RAY OF THE CHEST
Does the x-ray belong to the correct patient? Check the patient’s name on the film.
Have the left and right side markers been labeled correctly, or does the patient really have dextrocardia?
Lastly has the projection of the radiograph (PA vs. AP) been documented?

11. PLAIN RADIOGRAPHY OF THE CHEST (CXR)
CRITERIA OF A GOOD X-RAY OF THE CHEST
Patient central
a-Sterno-clavincular junction equidistant from midline (spinous process).
b-Mediasternum 2/3 to left and 1/3 to right
Lung apices appear and lower 3 cervical vertebrae.
The diaphragm should be found at about the level of the 8th - 10th posterior rib or 5th - 6th anterior rib on good inspiration.
Costo-phrenic and cardio-phrenic are seen
Scapula away from lung field.
Vertebral bodies should just be visible through the heart. Intervertebral disc spaces and anterior end of ribs not seen through cardiac shadow
Non visualized vertebral bodies & ‘whiter’ film  Underexposure
If the film appears too ‘black’  Overexposure

12. Normal PA View of the chest

13. Centrally Positioned Film
Rotated Film

14. Penetration (Exposure)
Under Exposed (Soft)
Over Exposed (hard)

15. Imaging Techniques of the Chest
Bronchography

16. Imaging Techniques of the Chest
Mediastinal Window
Lung Window
CT Scan

17. Imaging Techniques of the Chest
MRI

18. Imaging Techniques of the Chest
Pulmonary Angiography

19. Imaging Techniques of the Chest
Ultrasound

20. Imaging Techniques of the Chest
Isotope Studies

21. PLAIN RADIOGRAPHY OF THE CHEST (CXR)
RADIOLOGICAL ANATOMY

23. Normal PA View of the chest

28. Viewing PA radiograph of the chest
Pleura and Diaphragm:
The highest point of the right diaphragm is usually 1–1.5 cm higher than that of the left.
Each costophrenic angle should be sharply outlined.

29. Viewing PA radiograph of the chest
Pleura and Diaphragm:
Assessment of diaphragmatic flattening
The highest point of a hemidiaphragm should be at least 1.5 cm above a line drawn from the cardiophrenic to the costophrenic angle.

30. Viewing PA radiograph of the chest
Hilar region:
Both hila should be concave.
Both hila should be of similar density.
The left hilum is usually superior to the right by up to 1 cm.

31. Viewing PA radiograph of the chest
Bones and soft tissue:
Ribs (anterior and posterior)
Clavicles
Vertebrae
Shoulder joints
Look carefully at the soft tissues for asymmetry (i.e. mastectomy)
Ribs

32. Don’t Forget to look at hidden areas
Viewing PA radiograph of the chest
Don’t Forget to look at hidden areas

33. Normal PA View of the chest

34. PLAIN RADIOGRAPHY OF THE CHEST (CXR)
Soft tissue abnormality
Bony thoracic cage
Pleura
Diaphragm
Lungs
Mediastinum
Heart

36. PATTERNS OF CHEST DISEASE
Airspace disease
Airway disease
Interstitial Disease
Pleural disease
Thoracic cage disease

37. AIRSPACE DISEASE

38. AIRWAY DISEASE

39. INTERSTITIAL DISEASE

40. PLEURAL DISEASE

41. PLEURAL DISEASE

42. CHEST WALL DISEASE

43. COMMON SIGNS IN CHEST RADIOLOGY
Silhouette sign
Air bronchogram
Solitary pulmonary nodule

44. SILHOUETTE SIGN

45. SILHOUETTE SIGN

46. AIR BRONCHOGRAM

47. AIR BRONCHOGRAM

48. AIR BRONCHOGRAM

49. SOLITARY PULMONARY NODULE

50. ADDITIONAL RESOURCES

51. Thank You