1. Kunal D Patel Research Fellow IMM
X-Rays
Kunal D Patel
Research Fellow
IMM

2. } } } The 12-Steps Pre-read Quality Control Findings 1: Name 2: Date
3: Old films
4: What type of view(s)
5: Penetration
6: Inspiration
7: Rotation
8: Angulation
9: Soft tissues / bony structures
10: Mediastinum
11: Diaphragms
12: Lung Fields
Pre-read }
Quality Control }
Findings

3. NOTE normal pleura are NOT visible
Reviewing these areas
Heart
Size
Shape
Silhouette-margins should be sharp
Evidence of stents, clips, wires and valves
Diameter (>1/2 thoracic diameter is enlarged heart)
Mediastinum
Width?
Contour?
Lung fields
Apices
Lobes and fissures
USE SILHOUETTES
CP angles
Diaphragm
Gastric bubble
NOTE 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. CASES
Remember!:
Most disease states replace air with a pathological process
Each tissue reacts to injury in a predictable fashion
Lung injury or pathological states can be either a generalized or localized process

7. Evaluating an Abnormality
1. Identification of abnormal shadows
2. Localization of lesion
3. Identification of pathological process
4. Identification of etiology
5. Confirmation of clinical suspension
Complex problems
Introduction of contrast medium
CT chest
MRI 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 obstruction
Radiologically:
Density corresponding to a segment or lobe
Significant loss of volume
Compensatory hyperinflation of normal lungs

11. Right Middle and Left Upper Lobe Pneumonia

12. Consolidation Lobar consolidation:
Alveolar space filled with inflammatory exudate
Interstitium and architecture remain intact
The airway is patent
Radiologically:
A density corresponding to a segment or lobe
Airbronchogram, and
No 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.

14. TENSION PNEUMOTHORAX

15. Widened Mediastinum: Aortic Dissection

16. Right Middle Lobe Pneumothorax: complete lobar collapse

17. Perihilar mass: Hodgkin’s disease

18. 28 y/o female with sudden onset SOB while jogging this morning
Well demarcated paucity of pulmonary vascular markings in right apex
Left spontaneous pneumothorax