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NORMAL AND PATHOLOGIC CHEST X-RAY

NORMAL AND PATHOLOGIC CHEST X-RAY. Dr. dr. Rista D. Soetikno , Sp.Rad .(K), M.Kes. ANATOMY. Lung Anatomy. Lung Anatomy. Right Lung 3 lobes (divided by major fissure and minor fissure) 10 segments Left Lung : 2 lobes (divided by major fissure) 8 segments

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NORMAL AND PATHOLOGIC CHEST X-RAY

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  1. NORMAL AND PATHOLOGICCHEST X-RAY Dr. dr. Rista D. Soetikno, Sp.Rad.(K),M.Kes.

  2. ANATOMY

  3. Lung Anatomy

  4. Lung Anatomy Right Lung • 3 lobes • (divided by major fissure and minor fissure) • 10 segments Left Lung : • 2 lobes • (divided by major fissure) • 8 segments • Lingula segments ~ medial lobe of the right lung

  5. Lung Anatomy • Minor (horizontal )fissure divides the superior lobe and the middle lobe of the right lung. • There is no minor fissure in the left lung.

  6. Lung Anatomy • In the right lung, the major fissure (oblique) divides the inferior lobe with the middle and superior lobes. • In the left lung, the major fissure (oblique) divides the inferior lobe with the superior lobe.

  7. RIGHT LUNG SEGMENTATION

  8. LEFT LUNG SEGMENTATION

  9. RESPIRATORY TRACT ANATOMY Trachea : • Begins at the lower border of the cricroid cartilage at the level of C6 vertebra. • Extend to the carina at the level of the sternal angle (T5 level) • T4 level on inspiration • T6 level on expiration • The trachea is 15 cm and 2 cm in diameter.

  10. RESPIRATORY TRACT ANATOMY Trachea : • The trachea in children is very pliable. • It may be deviated to the right in normal expiratory film. • It only deviates to the left if the aortic arch is on the right side.

  11. RESPIRATORY TRACT ANATOMY

  12. RESPIRATORY TRACT ANATOMY

  13. RESPIRATORY TRACT ANATOMY Primary lobule • The smallest functional unit of the lung • Comprises all the structures distal to a respiratory bronchiole including 16-40 alveoli. • Normal adult has approximately 23 million primary lobules.

  14. RESPIRATORY TRACT ANATOMY Acinus • Consists of all structures distal to the terminal bronchiole, including vessels, nerves, and connective tissue. • It has a diameter 4-8mm • Contains approximately 10-20 primary lobules

  15. RESPIRATORY TRACT ANATOMY Secondary Lobule • The smallest structural unit of lung parenchyma that is surrounded by a connective tissue septum. • Contains 3-12 acini and measures 1,0-2,5 cm in diameter.

  16. RESPIRATORY TRACT ANATOMY

  17. RESPIRATORY TRACT ANATOMY

  18. TRACHEOBRONCHIAL SYSTEM

  19. Acinus Lobulus primer www.brainybetty.com

  20. Alveoli Alveoli pore: Canals of Lambert • between alveoli and terminal bronchiole Pores of Kohn • between alveoli.

  21. RadioanatomiPosteroanterior Chest X Ray

  22. POSITIONING

  23. CHEST X-RAY POSITION POSTER0ANTERIOR ANTEROPOSTERIOR RIGHT/LEFT LATERAL RIGHT ANTERIOR OBLIQUE LEFT ANTERIOR OBLIQUE RIGHT POSTERIOR OBLIQUE LEFT POSTERIOR OBLIQUE TOP LORDOTIC RIGHT/LEFT LATERAL DECUBITUS

  24. POSTEROANTERIOR Indication: • Routine • Screening TB • Pre-operative

  25. Technique: • The patient stand between the film and the x-ray tube. • The patient faced the film. • The hands are put in the waist with the elbow flexed to the anterior (to open scapula so it doesn’t superimposed with the lung) • The distance of the film to the x-ray tube : • Lung  1.5m • Heart  2.0m • Centre : 6th – 7th thoracic spine • 50-60 KV • 10-20 MAs

  26. ANTEROPOSTERIOR Indication: (cannot be taken with PA ) • Severely ill patient • Children • Infant and neonates • Obese • Pregnant • Ascites • Intraabdominal tumor

  27. Technique: • The patient lie on the table with the arms put beside the body or put up. • The film was placed behind the back. • Centre : 6th -7th thoracic spine

  28. Distortion in Anteroposterior chest x-ray • Heart enlargement • Mediastinal widening • Crowded bronchovascular marking at the basal zone.

  29. PA vs AP CXR

  30. Lateral Chest X-Ray Indication: • Look at mediastinal abnormalities. • Look at anomalies that wasn’t clear at posteroanterior position. • Heart assessment. • To look for minimal fluid collection in the pleural cavity (75cc) that can not be seen in the PA chest x-ray

  31. Lateral Chest X-Ray Technique: • The patient stand between the film and the x-ray tube. • The lateral side of the anomalies (right/left) was closed to the film. • Both arms was lifted up. • Centre: 6th -7th thoracic spine

  32. R

  33. L AORTIC ARCH TRACHEA OBLIQUE FISSURE POSTERIOR RIBS RT. HEMI DIAPHRAGM LT. HEMI DIAPHRAGM COLON GAS

  34. Thorax Lateral

  35. Oblique Position Indication: • To look at anomalies that were not clear at PA and lateral position. Type: • Right anterior oblique (RAO) • Left anterior oblique (LAO) • Right posterior oblique (RPO) • Left posterior oblique (LPO) The side that is mentioned is the side that was close to the film • RAO: The right side and the anterior side was close to the film • LPO: The left side and the posterior side was close to the film.

  36. Oblique Position Indication: • To look at anomalies that were not clear at PA and lateral position. Techniques: • The patient stand between the film and the x ray tube. • The side that is mentioned is the side that is close to the film • The angle of obliquity is approximately 450. • The arm that was close to the film was put over the head, while the other hand was put on the waist with the elbow flexed to the posterior. • Centre: 6th -7th thoracic spine

  37. RAO LAO

  38. Lateral Decubitus Indication: • To look for minimal fluid collection in the pleural cavity (15-20cc) that can not be seen in the PA chest x-ray

  39. Technique: • The patient lying in the table with the lateral side close to the table. • RLD : The right side of the body is close to the table • LLD : The left side of the body is close to the table • Both arms are lifted. • Centre: 6th – 7th thoracic spine

  40. LLD/RLD

  41. Top Lordotic Indication: • To look for anomalies at the apex of the lung.

  42. Technique: • The patient stand between the film and the x-ray tube. • The patient is facing the x-ray tube. • The distance between the patient and the film is 30cm • The patient then rest the back of his shoulder to the film. • The upper border of the film is approximately 1 inch above the shoulder. • Centre: manubrium of the sternum

  43. TOP LORDOTIK

  44. 15 STEPS TO READ CHEST X-RAY

  45. 15 STEPS TO READ CHEST X-RAY } 1: Name & Age 2: Date 3: Medical record number 4: Previous examination 5: Position/View: PA/AP/Marker 6: Penetration 7: Rotation 8: Inspiration 9: Magnification 10: Angulation 11: Trachea, heart, sinuses, diaphragm 12: Hilum, bronchovascular marking 13: Lung field, hemithorax 14: Soft tissue, bone 15: Conclusion Administration } Quality } Diagnostic

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