The Chest X-Ray

Dr Mohamed El Safwany, MD.

Intended learning outcome

• The student should learn at the end of this lecture Clinical aspects of Chest X ray .

Aims:

•Basics•Best exam results•Appreciate the role radiology plays

Contents:•Densities•Techniques•Anatomy•CXR Interpretation•Common Pathologies•Questions

Densities The big two densities are:

(1) WHITE - Bone

(2) BLACK - Air

The others are:

(3) DARK GREY- Fat

(4) GREY- Soft tissue/water

And if anything Man-made is on the film, it is:

(5) BRIGHT WHITE - Man-made

Techniques - Projection

•P-A (relation of x-ray beam to patient)

Techniques - Projection (continued)

•A-P Supine/Erect

Techniques - Projection (continued)

•Lateral

Techniques - Projection (continued)

• Decubitus

Techniques - Projection (continued)

•Oblique

Rotation

Rotation (continued)

Penetration

Inspiration/Expiration

Anatomy

Anatomy

Lobes• Right upper lobe:

Lobes (continued)

• Right middle lobe:

Lobes (continued)

• Right lower lobe:

Lobes (continued)

• Left lower lobe:

Lobes (continued)

• Left upper lobe with Lingula:

Lobes (continued)

• Lingula:

Lobes (continued)

• Left upper lobe - upper division:

Pleura• Layers:

Parietal , visceral

Heart

Right border: Edge of (r) Atrium

3. Left border: (l) Ventricle + Atrium

4. Posterior border: Reft Ventricle

5. Anterior border: Right Ventricle

Heart (continued)

Heart (continued)

Heart (continued)

• Valves

Mediastinum

Hilum

Made of:

1. Pulmonary Art.+Veins

2. The Bronchi

Left Hilus higher (max 1-2,5 cm)

Identical: size, shape, density

Hilum

Ribs

Lateral CXR (continued)

Lateral CXR (continued)

Lateral CXR (continued)

Lateral CXR (continued)

CXR Interpretation

Technical Details

•Rotation

•Inspiration/expiration

•Penetration

Lungs:

• Lungs

• Density

• Symmetry

• Lesions

Heart•Size:

Heart •Size of heart

•Size of individual chambers of heart

•Size of pulmonary vessels

•Evidence of stents, clips, wires and valves

•Outline of aorta and IVC and SVC

Mediastinum:• Width

• Contour

• AP window

Hila:• Size

• Location

Review areas:

• Apices

• Behind the heart

• CP angles

• Below the diaphragm

• Soft tissues ( breast, surgical emphysema)

• Ribs & clavicle

•Vertebrae

Identify the lesion → localise the lesion → describe the lesion → give DD

Never stop looking, carry on with your systematic approach!!

Pathology

RUL pneumonia

RML pneumonia

RLL pneumonia

LUL pneumonia

LLL pneumonia

Consolidation on CT

Hilar m l

The Enlarged Hila

Causes:

1. Adenopathies (neoplasia, infection)

2. Primary Tumor

3. Vascular

4. Sarcoidosis

Multiple Masses

Hilar Lymphadenopathy - BL

Pleural Effusion

Pulmonary Fibrosis

?

Heart failure

Pneumothorax

RUL collapse

LLL collapse

Air under the diaphragm

Emphysema

Cervical Rib

Cavitating lesion

Hiatus hernia

Miliary shadowing

Chest Tube, NG Tube, Pulm. artery cath

Dextrocardia

Text Book

• David Sutton’s Radiology

• Clark’s Radiographic positioning and techniques

Assignment

• Two students will be selected for assignment.

Question

• Define rotation in chest X ray ?

Thank You

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