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Chest x ray positioning
- 2. outline • Plain films different views • Positioning • Interpretation of the plain film
- 3. Different views of Xray chest • PA • Lateral • AP,decubitis,supine,oblique • Inspiratory-expiratory • Lordotic,apical
- 4. PA view • Most frequently requested • Visualization of the lungs excellent
- 5. PA view positioning • The patient faces towards the cassette and the tube is 6 feet away from the patient.
- 6. Technical aspect • Inspiration • On full inspiration the diaphragm should lie at the level of 8-10th posterior rib or 5-6th anterior rib.
- 9. Over penetrated Under penetrated
- 10. rotation
- 11. Rotated x ray
- 12. Interpretation of the PA films 1.request form: name,age,sex,date and clinical presentation 2.trachea 3.Heart and mediastinum 4.Diaphragm
- 13. 6.Pleural spaces 7.Lungs 8.Hidden areas 9.Hila 10.Below diaphragm 11.Soft tissues 12.Bones
- 14. Trachea Examined for • Position • outline
- 15. • Caliber coronal diameter is 25mm for males and 21mm for females • Para tracheal stripe<5mm • Azygos vein<10mm • Carina angle:60-75degree.
- 16. Heart • Size • Shape Transverse cardiac diameter:<14.5cm in females and <15.5cm in males. An increase of 1.5 cm is significant Cardiothoracic ratio<50%
- 17. mediastinum • Right superior mediastinal shadow formed by SVC and innominate vessels. • Left superior mediastinal shadow formed by the subclavian artery • Ant junction line • Post junction line • Thymus • Paraspinal lines 10 mm on the left and 3mm on the right
- 18. Ant and post junction lines • Ant junction line • Parietal and visceral pleurae meeting anteromedially.oblique course • Post juction line.formed by posteromedial surfaces of the pleurae of the upper lobes post to oesophagus
- 19. thymus • Triangular sail-shaped structure, well defined borders projecting from one or both side of the mediastinum.
- 21. Diaphragm • Outline • shape • relative position
- 22. Pleural spaces • Costophrenic angles • Cardiophrenic angles
- 23. lungs • Local,generalised abnormality • Comparison of the translucency • Vascular markings of the lungs
- 24. Zones
- 25. Hidden areas • The apices • Mediastinum and hila • Diaphragm • bones
- 26. Hila • Contain the following structures • The inferior pulmonary ligament • The pulmonary vessels • The bronchial vessels • the bronchi • The lymphatic system • The lymph nodes
- 27. Right hilum
- 28. Left hilum
- 29. Below diaphragms • Gas shadows • Calcifications
- 30. Soft tissues • Breast shadows and nipple shadows • Skin folds • Muscles • Companion shadows
- 31. Nipple markers
- 32. Skin fold
- 33. Muscles and companion shadows
- 34. bones • Sternum • Clavicles • Scapulae • ribs • spine
- 36. Interpretation of lateral film • The clear spaces • Retrosternal space • Retrotracheal space • Vertebral translucency • Diaphragm outline • The fissures • The trachea • The sternum
- 39. Diaphragm outline • Right diaphragm continues anteriorly • Left is silhouetted posteriorly by heart shadow
- 40. The fissures
- 41. AP view • the patient back is towards the cassette and tube is 40 inches away from the patient. • for patients unable to stand
- 43. Decubitus position • The patient faces towards the cassette while lying in decubitus position and tube Is towards the back
- 44. Decubitus position • To asses the volume of pleural fluid. • Loculated pleural effusion or mobile
- 45. Apical view
- 47. Oblique view • To visualize retro cardiac area, the posterior costophrenic angles, the chest wall and the pleural plaques.
- 48. • Lordotic PA view
- 49. Paired inspiratory and expiratory • Demonstrate air trapping and diaphragm movements. • Very important in diagnosis of inhaled foreign body in children.
- 50. Paired inspiratory and expiratory view
- 51. Thank you