Basic Chest Radiology for the TB Clinician Adapted from the ISTC TB Training Modules 2009...

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Transcript of Basic Chest Radiology for the TB Clinician Adapted from the ISTC TB Training Modules 2009...

  • Basic Chest Radiology for the TB ClinicianAdapted from the ISTC TB Training Modules 2009

    PRESENTATION MATERIALS

    ISTC TB Training Modules 2009

    Basic Radiology for the TB ClinicianObjectives: At the end of this presentation, participants will be able to:Analyze the technical quality of chest X-rays (CXRs) using simple parameters Identify basic normal CXR anatomy on both frontal and lateral viewsRecognize radiographic patterns of disease and describe using appropriate terminologyDescribe both the typical and atypical patterns of radiographic presentation for pulmonary tuberculosis2

    ISTC TB Training Modules 2009

    Basic Radiology for the TB Clinician (2)Overview:Technical aspects of chest radiographySystematic approach to reading CXRBasic CXR anatomyPatterns of diseaseRadiographic manifestations of tuberculosis (TB)3

    ISTC TB Training Modules 2009

    Chest Radiography: Basic PrinciplesBlackestairfatsoft tissuecalciumboneX-ray contrastmetalWhitestMaximum X-RayTransmission(least dense tissue)

    Maximum X-Ray Absorption(densest tissue)X-ray photon: Absorbed / scattered / transmittedX-ray absorption depends on:Beam energy (constant)Tissue density4

    ISTC TB Training Modules 2009

    Differential X-Ray AbsorptionWhy we see what we see:Structures are visible on a radiograph because of the juxtaposition of two different densities creating an interface

    Silhouette Sign Loss of an expected interface No boundary can be seen between two structures because they now are similar in densityImage credit: Curry International Tuberculosis Center, University of California, San Francisco5

    ISTC TB Training Modules 2009

    Silhouette Sign: RLL PneumoniaSilhouette Sign: RLL PneumoniaImage credit: Curry International Tuberculosis Center, University of California, San Francisco6

    ISTC TB Training Modules 2009

    Silhouette Sign: RLL PneumoniaSilhouette Sign: RLL PneumoniaImage credit: Curry International Tuberculosis Center, University of California, San Francisco6

    ISTC TB Training Modules 2009

    Assess CXR Technical QualityInspiratory effort9-10 posterior ribsPenetrationthoracic intervertebral disc space just visiblePositioning / rotationmedial clavicle heads equidistant from spinous process7

    ISTC TB Training Modules 2009

    Image credit: Curry International Tuberculosis Center, University of California, San Francisco8

    ISTC TB Training Modules 2009

    10Image credit: Curry International Tuberculosis Center, University of California, San Francisco8

    ISTC TB Training Modules 2009

    10Image credit: Curry International Tuberculosis Center, University of California, San Francisco8

    ISTC TB Training Modules 2009

    10Image credit: Curry International Tuberculosis Center, University of California, San Francisco8

    ISTC TB Training Modules 2009

    Inspiratory EffortLow Lung VolumesFull InspirationImage credit: Curry International Tuberculosis Center, University of California, San Francisco9

    ISTC TB Training Modules 2009

    OverexposureProper ExposureExposureImage credit: Curry International Tuberculosis Center, University of California, San Francisco10

    ISTC TB Training Modules 2009

    OverexposureProper ExposureImage credit: Curry International Tuberculosis Center, University of California, San Francisco11

    ISTC TB Training Modules 2009

    Rotated (Oblique)Image credit: Curry International Tuberculosis Center, University of California, San Francisco12

    ISTC TB Training Modules 2009

    Basic Radiology for the TB ClinicianA systematic approach to reading a CXRImage Credit: Lung Health Image Library/Gary Hampton13

    ISTC TB Training Modules 2009

    Approach to Reading a CXRBe SystematicLungsPleural surfacesCardiomediastinal contoursBones and soft tissuesAbdomenImage credit: Curry International Tuberculosis Center, University of California, San Francisco14

    ISTC TB Training Modules 2009

    Worth a Second LookApicesRetrocardiac areas (left and right)Hilar regionsBelow diaphragm15

    ISTC TB Training Modules 2009

    Apical TBImage credit: Curry International Tuberculosis Center, University of California, San Francisco16

    ISTC TB Training Modules 2009

    Image credit: Curry International Tuberculosis Center, University of California, San FranciscoApical TB (2)17

    ISTC TB Training Modules 2009

    Left Retrocardiac OpacityImage credit: Curry International Tuberculosis Center, University of California, San Francisco18

    ISTC TB Training Modules 2009

    Nodule Behind DiaphragmImage credit: Curry International Tuberculosis Center, University of California, San Francisco19

    ISTC TB Training Modules 2009

    Basic Radiology for the TB ClinicianBasic CXR AnatomyImage credit: Curry International Tuberculosis Center, University of California, San Francisco20

    ISTC TB Training Modules 2009

    Basic CXR AnatomyFrontal and Lateral ViewsHeartAortaPulmonary arteriesAirwaysImage Credit: Lung Health Image Library/Pierre Virot21

    ISTC TB Training Modules 2009

    Image credit: Curry International Tuberculosis Center, University of California, San Francisco22

    ISTC TB Training Modules 2009

    Aortic archRight pulmonary arteryLeft pulmonary arteryTrachea & bronchiImage credit: Curry International Tuberculosis Center, University of California, San Francisco23

    ISTC TB Training Modules 2009

    Aortic archImage credit: Curry International Tuberculosis Center, University of California, San Francisco23

    ISTC TB Training Modules 2009

    Aortic archRight pulmonary arteryImage credit: Curry International Tuberculosis Center, University of California, San Francisco23

    ISTC TB Training Modules 2009

    Aortic archRight pulmonary arteryLeft pulmonary arteryImage credit: Curry International Tuberculosis Center, University of California, San Francisco23

    ISTC TB Training Modules 2009

    Aortic archRight pulmonary arteryLeft pulmonary arteryTrachea & bronchiImage credit: Curry International Tuberculosis Center, University of California, San Francisco23

    ISTC TB Training Modules 2009

    Basic Radiology for the TB ClinicianPatterns of disease24

    ISTC TB Training Modules 2009

    Chest Radiographic Patterns of DiseaseConsolidation / air-space opacityInterstitial opacityNodules and massesLymphadenopathyCysts and cavitiesPleural abnormalities25

    ISTC TB Training Modules 2009

    Consolidation / Air-Space OpacityCaused by filling of alveoli with fluid, pus, blood, cells (tumor), etc.May be diffuse, or isolated to segments or lobes of the lungMay be associated with air bronchograms (air-filled bronchus surrounded by opacified lung)26

    ISTC TB Training Modules 2009

    PneumoniaImage credit: Curry International Tuberculosis Center, University of California, San Francisco27

    ISTC TB Training Modules 2009

    Interstitial OpacityDisease localized to pulmonary interstitium, i.e., the alveolar septae and connective tissues that support the alveoliHallmarks:Lines and/or reticulationSmall, well-defined nodules Miliary patternDDX: Pulmonary edema, interstitial lung diseases (e.g., idiopathic pulmonary fibrosis), sarcoidosis, infection, tumor (lymphangitic spread), etc.28

    ISTC TB Training Modules 2009

    Interstitial Opacity: Lines Image credit: Curry International Tuberculosis Center, University of California, San Francisco29

    ISTC TB Training Modules 2009

    Interstitial Opacity: LinesImage credit: Curry International Tuberculosis Center, University of California, San Francisco29

    ISTC TB Training Modules 2009

    Interstitial Opacity: Lines & ReticulationImage credit: Curry International Tuberculosis Center, University of California, San Francisco30

    ISTC TB Training Modules 2009

    Nodules and MassesNodule: discrete pulmonary lesion, sharply defined, nearly circular opacity 0.2 - 3 cm Mass: larger than 3 cmDescribe with qualifiers:Single or multipleSizeBorder characteristicsPresence or absence of calcificationLocation31

    ISTC TB Training Modules 2009

    Well-DefinedCalcificationIll-DefinedMassImage credit: Curry International Tuberculosis Center, University of California, San Francisco32

    ISTC TB Training Modules 2009

    Lymphadenopathy (LAN)Non-specific terms:Mediastinal wideningHilar prominenceSpecific patterns:Particular station enlargement (location)

    Important to know what normal should look like in order to recognize abnormal33

    ISTC TB Training Modules 2009

    Image credit: Curry International Tuberculosis Center, University of California, San Francisco34

    ISTC TB Training Modules 2009

    Image credit: Curry International Tuberculosis Center, University of California, San Francisco34

    ISTC TB Training Modules 2009

    Image credit: Curry International Tuberculosis Center, University of California, San Francisco34

    ISTC TB Training Modules 2009

    Image credit: Curry International Tuberculosis Center, University of California, San Francisco34

    ISTC TB Training Modules 2009

    Image credit: Curry International Tuberculosis Center, University of California, San Francisco34

    ISTC TB Training Modules 2009

    Infrahilar window (right hilar and/or subcarinal)Left hilarSubcarinalLymphadenopathyImage credit: Curry International Tuberculosis Center, University of California, San Francisco35

    ISTC TB Training Modules 2009

    Infrahilar window (right hilar and/or subcarinal)LymphadenopathyImage credit: Curry International Tuberculosis Center, University of California, San Francisco35

    ISTC TB Training Modules 2009

    Left hilarLymphadenopathyImage credit: Curry International Tuberculosis Center, University of California, San Francisco35

    ISTC TB