Thoracic Imaging

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Thoracic Imaging
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Thoracic Imaging

• Chest x-ray
• Computerised tomography
• Ultrasound
• Magnetic resonance imaging
• New advances

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Background Chest X-ray

• Most common radiological investigation 40 of
  all investigations
• Standard component of a pulmonary examination
• Systematic review is vital in interpretation of
  chest x-rays

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Limitations of a chest x-ray

• 2 dimensional image of a 3 dimensional structure
• X-ray findings may lag behind other clinical
  features
• Normal x-ray does not rule out pathology
• Dependent on good quality image

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Chest x-ray views/types

• Posteroanterior - PA
• Anteroposterior - AP
• Lateral
• Decubitus

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Views

• PA
• Standard, radiology dept
• X-rays posterior to anterior
• Standing position

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Normal PA
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Lung Anatomy
(1) aortic arch (2) pulmonary trunk (3) left
atrial appendage (4) left ventricle (5) right
atrium (6) superior vena cava (7 8)
diaphragm (9) transverse fissure
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Views

• AP
• Cassette placed behind patient
• X-rays anterior to posterior
• Sitting in chair, semi-erect in bed, supine
• AP marked on film
• Heart enlarged, poorer inspiration

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Normal AP
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Views

• Lateral
• Localises, shows posterior to heart
• Side of interest placed against film
• Decubitus
• PA on side
• Small pleural effusions

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vertebrae
Heart
Norm lateral
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Lung Anatomy
(1) oblique fissure (2) transverse fissure (3)
retrocardiac space (4) retrosternal space
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BASICS

• Air shows as black solid structures white
• Too white
• Too black
• Too large
• In the wrong place (Corral et al 1997)

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Chest x-ray viewing guide

• Correct CXR
• Name
• Date of birth
• Date
• Left and right, marker/stomach

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Normal PA
Stomach
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Patient Position

• PA, AP, lateral or decubitus view
• Rotation Sternal end clavicles equal from
  vertebral body
• If AP what position

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Exposure

• How dark or light a film is
• Should see vertebral bodies through heart

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Soft Tissues

• Breast shadows
• Piercing
• Air in tissues
• Tissue folds in obese
• Medical equipment

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Breast shadows
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Surgical emphysema
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surgical emphysema
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Heart valve
Pacemaker
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ECG
ICD
ETT
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Bony Structures

• Ribs
• Scapulae
• Clavicles
• Vertebrae

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Clavicle
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ribs
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Trachea

• Deviated
• Carina
• Artificial airway

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ETT
Ribs
ICD
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Mediastinum

• Deviated
• Hilar shadows
• Aortic arch

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Mediastinum - Heart

• Size
• No larger than half width of chest
• Position
• Two thirds on the left
• Borders
• Clear

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Diaphragm

• Shape
• Height right 6rib ant, left 7 ant
• Cardiophrenic angle
• Costophrenic angle

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Lung Fields

• Black with lung markings
• Other opacity indicated pathology
• Fissures
• Zones
• Air bronchograms
• Consolidation

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normal
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Right upper lobe collapse
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Right Lower lobe collapse
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Pneumothorax
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Pneumothorax
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Consolidation
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Pleural effusion
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Pleural effusion
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Right pneumonia
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Air bronchogram
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Emphysema
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Other imaging

• Computerised tomography
• Transverse images, cross section
• Localises masses
• High radiation dose

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Other imaging cont

• Ultrasound
• Useful for pleural effusions
• Good images of heart and valves

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Other imaging cont

• MRI
• Malignancy
• Vascular
• Congenital abnormalities
• Tuberculosis

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New advances

• Patient archive communication system
• Film free radiology
• Computer use
• Image enhancement

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