Thoracic Imaging
Chest Radiography and other techniques
X-ray projection Department or mobile unit Projection – PA of AP according to
direction in which X-ray beams travel through patient
Heart magnified in AP projection X-ray taken during full inspiration Arms abducted
X-ray projection
X-ray projection Lateral x-ray – patient turned 90º,
effected side against film cassette
Arms extended forward
X-ray projection
X-ray projection Lateral decubitus – small pleural
effusions Patient lies horizontally, effected
side placed downwards Film cassette at the back of
patient, X-ray beam from front
X-ray projection
Lordotic film – middle lobe collapse
AP projection – patient arches back so that shoulders are touching the cassette
Other techniques Fluoroscopy – “real time” visuals of
patient on television monitor
Other techniques Ultrasonography – high-frequency
sound waves Limited use in chest, but used for cardiac imaging
Other techniques Computer tomography – X-ray tube
and detectors rotate around patient
Other techniques Magnetic resonance imaging –
patient lies in middle of large magnet
Combination of intense magnetic field and series of radiofrequency waves
Other techniques - MRI
Other techniques Radionuclide imaging – ventilation-
perfusion scanning of the lung Suspected pulmonary embolus
Interventional procedures Needle biopsy
Interventional procedures Arteriography – glide catheter from
femoral vein or vein in elbow, through right side of heart to pulmonary artery
Contrast injected
Normal chest x-ray Outline of mediastinum and heart The hila Pulmonary vessels and main
bronchi Diaphragm Soft tissue and bones of the
thoracic cage
Normal chest
Mediastinum and heart Mediastinum – trachea, aortic arch,
superior vena cava and oesophagus Heart – one-third to right of the
spine and two-thirds to the left Transverse diameter less than
transverse diameter of hemi-thorax
Hila and diaphragm Hila – pulmonary arteries and veins Diaphragm – highest point of right
hemidiaphragm is between anterior ends of 5th and 7th ribs
Left 2cm lower in erect position Costophrenic angle Lateral view – heart to viewer’s left
Lateral X-ray
Interpreting a X-ray Name of patient, time and date Left and right side markers PA or AP Supine vs erect Patient rotation – distance between
medial ends of clavicle and spinous processes
State of inspiration
Interpreting a X-ray Should be able to see vertebral
bodies through heart shadow Thoracic cage Heart and mediastinum Diaphragm and costophrenic angle Lungs
Consolidation Air-filled spaces replaced by products of
disease – water, pus or blood Localized areas - infection Radiological signs – air bronchogram and
silhouette sign Air bronchogram – black branching
structures Silhouette sign – border of structure
gone
Consolidation
Collapse (atelectasis)
Loss of aeration and collapse of lobe or lung
Tumour, foreign object or mucus plug
Collapse - signs ↑ density of collapsed lobe Shift of fissures Silhouette sign Hilar and mediastinal shift Crowding of vessels, airways and ribs Elevation of hemidiaphragm
Right upper lobe collapse
Right middle lobe collapse
Right lower lobe collapse
Left upper lobe collapse
Left lower lobe collapse
Pneumothorax
Pleural effusion
Pulmonary nodules and metastasis
Lung abcess
Paediatrics
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