4. X-rays- describe radiation which is part of the
spectrum which includes visible light, gamma rays and
cosmic radiation.
Unlike visible light, radiation passes through stuff.
When you shine a beam of X-Ray at a person
and put a film on the other side of them a shadow is
produced of the inside of their body.
5.
6. Different tissues in our body absorb X-rays at different extents:
•Bone- high absorption (white)
•Tissue- somewhere in the middle absorption (grey)
•Fat-dark grey image
•Air- low absorption (black)
7. Different views of Xray chest
• PA
• Lateral
• AP,decubitis,supine,oblique
• Inspiratory-expiratory
• Lordotic,apical
8. PA view
• Most frequently requested because:
• Visualization of the lungs excellent
• Clear picture of bronchovascular shadow
• Radiation risk to the eyes is minimal.
9. PA view positioning
• The patient faces towards the
cassette and the tube is 6 feet
away from the patient.
• PA view is better to be taken
in full inspiration
• Except for small
pneumothorax
10. Technical aspect
• Inspiration
• On full inspiration the
diaphragm should lie
at the level of 8-10th
posterior rib or 5-6th
anterior rib.
• Cardiophrenic angle
acute
• Lung shadows more
black
• Rib spaces increase
18. DETERMINING RIGHT AND LEFT IN
CHEST XRAY
• Look for marker
• Fundal gas left
• Apex of heart left side
• Aortic knuckle left
• Right diaphragm higher
• Left hila at same level or slightly higher
19. Trachea
Examined for
• Position
• Outline
• Should be central, with slight deviation to the right as it
crosses the aortic arch.
• Can be pushed away from an abnormal lung affected by a
large pleural effusion, large simple pneumothorax, tension
pneumothorax, aortic aneurysm or mediastinal mass.
• The trachea can be pulled towards an abnormal lung
affected by extensive collapse, consolidation, pulmonary
fibrosis, lobectomy or pneumonectomy.
20. • Caliber coronal diameter is
25mm for males and 21mm for
females
• Para tracheal stripe<5mm
• Carina angle:60-75degree.
21. Heart
• Size
• Shape
Transverse cardiac
diameter:<14.5cm in females
and <15.5cm in males. An
increase of 1.5 cm is
significant.
22. SIZE(A- FROM THE MIDLINE TO MAXIMUM DISTANCE TOWARDS RIGHT,B-FROM
MIDLINE TO MAXIMUM DISTANCE TOWARDS LEFT,C-MAXIMUM ITD,REFERENCE MID
LINE FORMED BY JOINING THE SPINOUS PROCESS OF VERTEBRAE)
23. 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
• RIGHT PARATRACHEAL
• PARAVERBEBRAL
(RT/LT)
• AZYGOESOPHAGEAL
• AORTOPULMONARY
• PARASPINAL LINES 10
MM ON THE LEFT AND
3MM ON THE RIGHT
• THYMUS
24. Ant and post junction lines
• Ant junction line
• Parietal and visceral pleurae
meeting
anteromedially.oblique
course(blue)
• Post juction line.formed by
posteromedial surfaces of the
pleurae of the upper lobes post
to oesophagus(red)
27. Silhouette Sign
*The loss of the normal silhouette of a structure is
called the silhouette sign
*Recognition of this sign is useful in localizing
areas of airspace opacities , atelectasis or
mass within the lung with the loss of these
normal silhouettes on frontal chest radiographs
being generally indicative of the site of pathology
28. 1-Right paratracheal stripe : right upper
lobe
2-Right heart border : right middle lobe or
medial right lower lobe
3-Right hemidiaphragm : right lower lobe
4-Aortic knuckle : left upper lobe
5-Left heart border : lingula segments of the
left upper lobe
6-Left hemidiaphragm or descending aorta
: left lower lobe
32. Pleural Fluid :
-It takes about 200-300 ml of fluid before it
comes visible on an CXR
-About 5 liters of pleural fluid are present
when there is total opacification of the
hemithorax
41. Hila
• Contain the following structures
• The inferior pulmonary ligament
• The pulmonary vessels
• The bronchial vessels
• the bronchi
• The lymphatic system
• The lymph nodes
55. Interpretation of lateral film
• The clear spaces
• Retrosternal space
• Retrotracheal space
• Vertebral translucency
• Diaphragm outline
• The fissures
• The trachea
• The sternum
60. AP view
• the patient back is towards the
cassette and tube is 40 inches
away from the patient.
• for patients unable to stand
61.
62. Differentiating from PA view
AP
• Apparent
cardiomegaly
• Scapula more
prominent
• Ribs appear
horizontal
• Clavical appear
higher compared to
PA view
63. Decubitus position
• The patient faces towards the
cassette while lying in
decubitus position and tube Is
towards the back
64. Decubitus position
• To asses the volume of
pleural fluid.
• Loculated pleural effusion or
mobile
• Subpulmonic pleural effussion
69. Paired inspiratory and expiratory
• Demonstrate air trapping and diaphragm
movements.
• Very important in diagnosis of inhaled foreign
body in children.
