Transcript Thoracic Imaging - Queen Margaret University

Thoracic Imaging
Thoracic Imaging
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Chest x-ray
Computerised tomography
Ultrasound
Magnetic resonance imaging
New advances
Background Chest X-ray
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Most common radiological investigation
– 40% of all investigations
Standard component of a pulmonary
examination
Systematic review is vital in
interpretation of chest x-rays
Limitations of a chest x-ray
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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
Chest x-ray views/types
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Posteroanterior - PA
Anteroposterior - AP
Lateral
Decubitus
Views
PA
 Standard, radiology dept
 X-rays posterior to anterior
 Standing position
Normal PA
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
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
Normal AP
Views
Lateral
 Localises, shows posterior to heart
 Side of interest placed against film
Decubitus
 PA on side
 Small pleural effusions
vertebrae
Heart
Norm lateral
Lung Anatomy
(1) oblique fissure
(2) transverse fissure
(3) retrocardiac space
(4) retrosternal space
BASICS
Air shows as black solid structures white
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Too white
Too black
Too large
In the wrong place (Corral et al 1997)
Chest x-ray viewing guide
Correct CXR
 Name
 Date of birth
 Date
 Left and right, marker/stomach
Normal PA
Stomach
Patient Position
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PA, AP, lateral or decubitus view
Rotation – Sternal end clavicles equal
from vertebral body
If AP what position
Exposure
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How dark or light a film is
Should see vertebral bodies through
heart
Soft Tissues
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Breast shadows
Piercing
Air in tissues
Tissue folds in obese
Medical equipment
Breast shadows
Surgical
emphysema
surgical emphysema
Heart valve
Pacemaker
ECG
ICD
ETT
Bony Structures
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Ribs
Scapulae
Clavicles
Vertebrae
#Clavicle
#ribs
Trachea
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Deviated
Carina
Artificial airway
ETT
#Ribs
ICD
Mediastinum
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Deviated
Hilar shadows
Aortic arch
Mediastinum - Heart
Size
 No larger than half width of chest
Position
 Two thirds on the left
Borders
 Clear
Diaphragm
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Shape
Height: right –6rib ant, left – 7 ant
Cardiophrenic angle
Costophrenic angle
Lung Fields
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Black with lung markings
Other opacity indicated pathology
Fissures
Zones
Air bronchograms
Consolidation
normal
Right upper lobe collapse
Right Lower lobe collapse
Pneumothorax
Pneumothorax
Consolidation
Pleural effusion
Pleural effusion
Right pneumonia
Air bronchogram
Emphysema
Other imaging
Computerised tomography
 Transverse images, cross section
 Localises masses
 High radiation dose
Other imaging cont
Ultrasound
 Useful for pleural effusions
 Good images of heart and valves
Other imaging cont
MRI
 Malignancy
 Vascular
 Congenital abnormalities
 Tuberculosis
New advances
Patient archive communication system
 Film free radiology
 Computer use
 Image enhancement