INTRODUCTION TO CHEST IMAGING

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INTRODUCTION TO CHEST IMAGINGfor 5th year
medical students

• DR/HOSSAM ZYTON
• LECT OF RADIOLOGY

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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

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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.

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PLAIN RADIOGRAPHY OF THE CHEST (CXR)
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Normal PA View of the chest
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PLAIN RADIOGRAPHY OF THE CHEST (CXR)
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Normal Lateral View of the chest
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PLAIN RADIOGRAPHY OF THE CHEST (CXR)
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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 patients 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?

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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

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Normal PA View of the chest
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Centrally Positioned Film
Rotated Film
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Penetration (Exposure)
Under Exposed (Soft)
Over Exposed (hard)
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Imaging Techniques of the Chest

• Bronchography

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Imaging Techniques of the Chest
Mediastinal Window
Lung Window

• CT Scan

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Imaging Techniques of the Chest

• MRI

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Imaging Techniques of the Chest

• Pulmonary Angiography

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Imaging Techniques of the Chest

• Ultrasound

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Imaging Techniques of the Chest

• Isotope Studies

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PLAIN RADIOGRAPHY OF THE CHEST (CXR)

• RADIOLOGICAL ANATOMY

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Normal PA View of the chest
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Viewing PA radiograph of the chest

• Pleura and Diaphragm
• The highest point of the right diaphragm is
  usually 11.5 cm higher than that of the left.
• Each costophrenic angle should be sharply
  outlined.

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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.

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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.

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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
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Dont Forget to look at hidden areas
Viewing PA radiograph of the chest
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Normal PA View of the chest
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PLAIN RADIOGRAPHY OF THE CHEST (CXR)

• Soft tissue abnormality
• Bony thoracic cage
• Pleura
• Diaphragm
• Lungs
• Mediastinum
• Heart

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PATTERNS OF CHEST DISEASE

• Airspace disease
• Airway disease
• Interstitial Disease
• Pleural disease
• Thoracic cage disease

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AIRSPACE DISEASE
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AIRWAY DISEASE
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INTERSTITIAL DISEASE
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PLEURAL DISEASE
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PLEURAL DISEASE
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CHEST WALL DISEASE
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COMMON SIGNS IN CHEST RADIOLOGY

• Silhouette sign
• Air bronchogram
• Solitary pulmonary nodule

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SILHOUETTE SIGN
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SILHOUETTE SIGN
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AIR BRONCHOGRAM
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AIR BRONCHOGRAM
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AIR BRONCHOGRAM
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SOLITARY PULMONARY NODULE
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ADDITIONAL RESOURCES

• http//www.med-ed.virginia.edu/courses/rad/cxr/ind
  ex.html
• http//www.chestradiology.net/
• http//www.mc.uky.edu/education/images/flash/chest
  new.swf

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Thank You