RADIO ANATOMY RESPIRATORY TRACTAND MEDIASTINUM

RadioanatomyStudies of human body seeing through the roentgenologic examination

Respiratory Tract1. Upper air passage (Cav. Nasi and pharynx)2. Larynx3. Trachea and bronchus4. Lung + Vascular (lymph)5. Thoracic wall + diaphragm3,4,5 Chest x-rayLung !

Lung Anatomy-Right

Superior Lobe Apical Segment (1)Posterior Segment (2)Anterior Segment (3)Medial Lobe Lateral Segment (4)Medial Segment (5)Inferior LobeApicobasal Segment (6)Mediobasal Segment (7)Anterobasal Segment (8)Laterobasal Segment (9)Posterobasal Segment (10)

Lung Anatomy-Left

Superior LobeApicoposterior Segment (1)Anterior Segment (2) LingulaSuperior Segment (3)Inferior Segment (4) Inferior LobeApical (5)Antero medial basal (6)Latero basal (7)Postero basal (8)

X-ray / Fluoroscopy IndicationContact personCough > 2 weeksRecurrent respiratory infectionHemaptoeEkstra pulmonary TBCErytema nodosum / conjuntivitis phlyctenularisFissura/fistula anichronicumDMPrecautionary indication

X-ray ExaminationRoutine : PASpecial : Lateral Left RightAPOblique Left RightLateral decubitus

Special methode of examinationTomografiBronchografiUSGCT scanMRI

PA PositionPlace patient between film X ray sourceHave the patient stand backward to the X- ray source, chest close to film with hand on the hip, with elbow flexed.Distance between film and X-Ray Lung 1,5 m Heart 2 mRay concentrated at - TH 6-7 - KV 50-60 - MAs 10-20

Good chest X-Ray Depend on:1.Good film qualityDepending on :KVMasProcessing2. Symmetry3. All part of thorax are included4. Identity /Marking5.No artifact6.No motion artifact7. Maximal inspiration

What studied in chest x-raySoft tissueCostae and clavicleTracheaSize, shape and position of heartLung Hilum Bronchovascular marking

Lung field :Lung apexLung top fieldLung middle fieldLung lower field

Lateral chest filmIndicationTo study abnormality that is not visible on PA filmTo study mediastinal disorderHeart studies

Lateral chest procedurePlace patient between film and X-ray sourcePlace lateral side of chest (left/right) on filmHands behind the headRay centered on Th 6-7

What studied on lateral chest filmTrachea and main bronchial branch - radioluscentHeart, aortic arch, asc/ desc aorticLeft/ Right Lung bronchovascular marking superpositionRetrosternal spaceRetrocardial spaceCostophrenic sinus Cardiophrenic sinus

Antero posterior (AP) chest filmIndication : Severely ill patient Children / babiesObese, pregnancy, ascites, abdominal tumorProcedure:Place patient lying down on table with elbow above headPlace film on patients back Centered ray on Th 6-7

Top lordotic chest x-rayIndication :To studies disorder located on apex / medial lobe - clavicle turn upwardProcedure:Place patient between film and x-ray source, have the patient face the x-ray sourceHave the patient stand 30 cm in front with back placed on the cassetteSet top part of the cassette 1 inch above the shoulderCentered ray on manubrium sterni

Oblique chest film:Indication :Heart studiesTo study abnormality that is not yet clear on PA studiesProcedurePlace patient between film and ray sourcePut ventral left/right side of the patients thorax on the cassette making 45 0 angleCenter ray on Vert. Th 6-7

Lateral Decubitus Chest FilmIndication :To study fluid in pleural cavity that is around 100-200 ccOr fluid accumulation that is not yet determined on PA studiesProcedureHave the patient lying down on left/right side with elbow above the head Center ray on vert. Thoracal 6-7 from anterior /posterior aspect

Mediastinum Studies1. Radiograph :Chest film: - PA.Lateral.Esophageal contrast studies.2. Fluoroscopy :To study pulsationTo study placement of organ in chest cavity

To study mass relation with adjacent organDiaphragmEsophagus.Heart and major vesselTo study pericardial effusion.

-To study pericardial effusion.3. Tomografi.4. Angiographies Usually with CT.5. CT Scan / MRI.

6. USG : Mass close to diaphragm / Pericardial effusion.7. Nuclear med. Radioisotop.Radio isotop angiogram.To study localisation of tumor.Eq : thymoma, thyroid, lymph node.

Mediastinum Borders- Top: Apertura thoracis sup.- Dorsal: Vertebral Column.- Ventral: Sternum.- Inferior: Diaphragm.- Lateral: mediastinal pleura.

Mediastinum 1. Anterior superior med2. Anterior medius med3. Anterior inferior med4. Superior medius med5. Middle med6. Posterior superior med7. Posterior medius med8. Posterior inferior med

Location of mediastinal disorderAnterior superior medAneurisma.Tymus HyperplLymphoma.Intrathoracal StrumaAnterior middle med. Dermoid. Teratoma.

Ant. Inferior. Med Thymoma. Pericardial cyst. Hernia diafragmatica.Superior Mid. Med Aneurisma. Dermoid. Teratoma. Mediastinal trauma

Middle Mediastinal Dermoid. Teratoma. Lymphoma. Tumor metastasis

Post superior med. Oesophageal disorder Aneurism Neurinoma, neurofibroma. Pancoast tumor.

Post medius med. Neurogenic tumor. Bronchial defect enteric cyst.

Post inferior med. Neurogenic origin primary tumor. Hernia diaphragmatica.

BibliographyShort textbook of clinical imaging.,David Sutton, Jeremy W.R Young, 1990Rontgen sign in diagnostic imaging col 4 (chest) Meschan Thn 1997Essentials of Coffeys Pediatric X-ray diagnosis, 1990.