1. For: Nottingham SCRUBS 26th August 2006 Presented by: Matthew
The Chest X-Ray
For: Nottingham SCRUBS 26th August 2006
Presented by: Matthew

2. Aims: Basics Best exam results Appreciate the role radiology plays
? Instil an interest in radiology

3. Contents: Densities Techniques Anatomy CXR Interpretation
Common Pathologies
Questions

4. Densities 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

5. Techniques - Projection
P-A (relation of x-ray beam to patient)

6. Techniques - Projection (continued)
A-P Supine/Erect

7. Techniques - Projection (continued)
Lateral

8. Techniques - Projection (continued)
Lateral Decubitus

9. Techniques - Projection (continued)
Oblique

10. Orientation
Orientation

11. Rotation

12. Rotation (continued)

13. Penetration

14. Inspiration/Expiration

15. Anatomy

16. Anatomy

17. Anatomy

18. Lobes
Right upper lobe:

19. Lobes (continued)
Right middle lobe:

20. Lobes (continued)
Right lower lobe:

21. Lobes (continued)
Left lower lobe:

22. Left upper lobe with Lingula:
Lobes (continued)
Left upper lobe with Lingula:

23. Lobes (continued)
Lingula:

24. Left upper lobe - upper division:
Lobes (continued)
Left upper lobe - upper division:

25. Pleura
Layers:

26. Heart Right border: Edge of (r) Atrium
3. Left border: (l) Ventricle + Atrium
4. Posterior border: Reft Ventricle
5. Anterior border: Right Ventricle

27. Heart (continued)

28. Heart (continued)

29. Heart (continued)
Valves

30. Mediastinum

31. Hilum Made of: 1. Pulmonary Art.+Veins 2. The Bronchi
Left Hilus higher (max 1-2,5 cm)
Identical: size, shape, density

32. Hilum

33. Ribs

34. Soft tissue & bones

35. Lateral CXR

36. Lateral CXR (continued)

37. Lateral CXR (continued)

38. Lateral CXR (continued)

39. Lateral CXR (continued)

40. CXR Interpretation

41. Type Orientation Rotation Inspiration/expiration Penetration
Technical Details
Type
Orientation
Rotation
Inspiration/expiration
Penetration

42. Lungs Density Symmetry Lesions

43. Heart
Size:

44. Heart Size of heart Size of individual chambers of heart
Size of pulmonary vessels
Evidence of stents, clips, wires and valves
Outline of aorta and IVC and SVC

45. Width Contour AP window
Mediastinum:
Width
Contour
AP window
Hila:
Size
Location

46. Review areas: Apices Behind the heart CP angles Below the diaphragm
Soft tissues ( breast, surgical emphysema)
Ribs & clavicle
Vertebrae

47. Identify the lesion → localise the lesion → describe the lesion → give DD Never stop looking, carry on with your systematic approach!!

48. Pathology

49. RUL pneumonia

50. RML pneumonia

51. RLL pneumonia

52. LUL pneumonia

53. LLL pneumonia

54. Consolidation on CT

55. Hilar m l

56. The Enlarged Hila
Causes: 1. Adenopathies (neoplasia, infection) 2. Primary Tumor 3. Vascular 4. Sarcoidosis

57. Multiple Masses

58. Hilar Lymphadenopathy - BL

60. Pleural Effusion

61. Pulmonary Fibrosis

62. ?

63. Heart failure

64. Pneumothorax

65. RUL collapse

66. LLL collapse

67. Air under the diaphragm

68. Emphysema

69. Cervical Rib

70. Cavitating lesion

71. Hiatus hernia

72. Miliary shadowing

73. Chest Tube, NG Tube, Pulm. artery cath

74. Dextrocardia