INTRODUCTION TO CHEST IMAGING for 5 th year medical students

2. INTRODUCTION TO CHEST IMAGINGfor 5th year medical students DR/HOSSAM ZYTON LECT OF RADIOLOGY

3. 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

4. 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.

5. PLAIN RADIOGRAPHY OF THE CHEST (CXR)

6. Normal PA View of the chest

7. PLAIN RADIOGRAPHY OF THE CHEST (CXR)

8. Normal Lateral View of the chest

9. PLAIN RADIOGRAPHY OF THE CHEST (CXR)

10. 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 patient’s 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?

11. 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

12. Normal PA View of the chest R

13. Centrally Positioned Film Rotated Film

14. Penetration (Exposure) Under Exposed (Soft) Over Exposed (hard)

15. Bronchography Imaging Techniques of the Chest

16. Imaging Techniques of the Chest CT Scan Mediastinal Window Lung Window

17. Imaging Techniques of the Chest MRI

18. Imaging Techniques of the Chest Pulmonary Angiography

19. Imaging Techniques of the Chest Ultrasound

20. Imaging Techniques of the Chest Isotope Studies

21. PLAIN RADIOGRAPHY OF THE CHEST (CXR) RADIOLOGICAL ANATOMY

23. Normal PA View of the chest R

28. Viewing PA radiograph of the chest Pleura and Diaphragm: • The highest point of the right diaphragm is usually 1–1.5 cm higher than that of the left. • Each costophrenic angle should be sharply outlined.

29. 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.

30. 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.

31. 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

32. Viewing PA radiograph of the chest Don’t Forget to look at hidden areas

33. Normal PA View of the chest R

34. PLAIN RADIOGRAPHY OF THE CHEST (CXR) • Soft tissue abnormality • Bony thoracic cage • Pleura • Diaphragm • Lungs • Mediastinum • Heart

36. PATTERNS OF CHEST DISEASE • Airspace disease • Airway disease • Interstitial Disease • Pleural disease • Thoracic cage disease

37. AIRSPACE DISEASE

38. AIRWAY DISEASE

39. INTERSTITIAL DISEASE

40. PLEURAL DISEASE

41. PLEURAL DISEASE

42. CHEST WALL DISEASE

43. COMMON SIGNS IN CHEST RADIOLOGY • Silhouette sign • Air bronchogram • Solitary pulmonary nodule

44. SILHOUETTE SIGN

45. SILHOUETTE SIGN

46. AIR BRONCHOGRAM

47. AIR BRONCHOGRAM

48. AIR BRONCHOGRAM

49. SOLITARY PULMONARY NODULE

50. ADDITIONAL RESOURCES http://www.med-ed.virginia.edu/courses/rad/cxr/index.html http://www.chestradiology.net/ http://www.mc.uky.edu/education/images/flash/chestnew.swf