RADIOGRAPHY OF CHEST AND SPINE

RADIOGRAPHYCHEST

THORACIC & LUMBAR SPINE

DR.KUNAAL JAIN

CHESTRADIOGRAPHY

POINTS TO NOTE ON CHEST XRAY

PATIENT DATA ( name, age, sex, history, old films)

TECHNICAL QUALITY

1) PROJECTION : AP / PA / LATERAL

2) ORIENTATION : Left or Right markings

3) ROTATION : vertebral spinous process sholud be between medial ends of clavicle.

4) PENETRATION : vertebral bodies are just visible through cardiac shadow.

5) INSPIRATION : midpoint of right hemi-diaphragm between 5th & 7th rib anteriorly.

TRACHEA: Central / Deviated

LUNGS: Abnormal shadowing/ Lucency.

HILA: Masses/ Lymphadenopathy.

HEART: Thorax: Heart width > 2:1

MEDIASTINUM: Thickening/ Mass.

PLEURA & DIAPHRAGM: Effusion/Thickening.

BONES: Fracture/ Lesions.

Recommended projections

• Chest – PA• Chest - Left Lateral• Chest – AP• Chest - Apical• Chest - Lordotic• Chest - Lordotic (Right Middle Lobe)• Chest - Lateral Decubitus• Chest - Dorsal Decubitus• Chest - Ventral Decubitus • Chest - Oblique

POSTERO-ANTERIOR VIEW

Area Covered: Lung fields, apices, costophrenic angles, heart.

Pathology: Pleural effusions, pneumothorax, signs of infection, masses, nodules, atelectasis.

IR Size & Orientation: 35 x 43 cm or 35x35 cm depending on size of the patient

Bucky / Grid: Moving or Stationary Grid.

Exposure: 100 kVp 4 mAs

FFD / SID: 180 cm

Central Ray: Directed to the midsaggital plane at the level of T7.

Collimation: Centre: T7, or the inferior border of the scapula.

Positioning of Patient

-Patient erect, standing or seated, facing the bucky.

-Arms relaxed at the sides.

-Centre the midsaggital plane of the patient to the midline of the IR.

-The patient relax their shoulders and rolled forward to touch the bucky.

-Raise the chin and rest on or above the bucky.

-Clear the scapulae off the lung fields.

ANTERO-POSTERIOR VIEW

Area Covered: Lung fields, apices, costophrenic angles, heart.

IR Size & Orientation: 35 x 43 cm


Exposure: 85 kVp 2 mAs.

FFD / SID: 180 cm

Central Ray: Directed to the midsaggital plane at the level of T7.

Collimation: 10 cm inferior to the jugular notch


-Centre the midsaggital plane of the patient to the midline of the IR.

-Arms relaxed at the sides.

-Pronate hands and bring elbows away from the sides of the body to help clear the scapulae of the lung fields.

-Raise the chin if this is superimposing over the chest

AP VIEWPA VIEW

POSTERO-ANTERIOR VIEWVS


PA VIEW

Lung fields are not shortened.

Scapulae not overlapping lung fields

Clavicles are not projected higher up.

No cardiac magnification and Medistinal widening is not seen.

Fundic air bubble seen.

Ribs appear less Horizontal.

AP VIEW

Lung fields are shortened.

Scapulae overlapping lung fields

Clavicles are projected higher up.

Cardiac magnification and Medistinal widening is seen.

Fundic air bubble not seen.

Ribs appear more Horizontal.

LATERAL VIEW

Area Covered: Lung fields, apices, costophrenic angles.

Pathology: Pathology posterior to the heart, great vessels and sternum

IR Size & Orientation: 35 x 43 cm.


Exposure: 110 kVp 8 mAs.

FFD / SID: 180 cm

Central Ray: Directed to the mid coronal plane at the level of T7.

Collimation: The mid coronal plane at the level of T7.

Position of patient and cassette

•The patient is turned to bring the side under investigation in contact with the cassette.

•The median sagittal plane is adjusted parallel to the cassette. •The arms are folded over the head or raised above the head.

•The mid-axillary line is coincident with the middle of the film, and the cassette is adjusted to include the apices and the lower lobes to the level of the first lumbar vertebra.

LATERAL VIEW

THORACIC SPINE&

LUMBAR SPINE

NORMAL ANATOMY OF SPINE

Total of 33 vertebrae

• 7 CERVICAL vertebrae• 12 THORACIC vertebrae• 5 LUMBAR vertebrae• SACRUM ( 5 fused)• COCCYX ( 4 fused)

Area Covered: C7 to L1

Pathology : Fractures, scoliosis/kyphosis, tumour, infection, congenital abnormality

IR Size & Orientation: 35 x 43 cm Portrait

Bucky / Grid: Moving or Stationary Grid

Exposure: 66 kVp 20 mAs or 66 kVp 20mA

FFD / SID: 100 cm

Central Ray: Directed to T7 (to the midsaggital plane, midway between the jugular notch and the xiphoid process)

Collimation Centre: To the midsaggital plane, midway between the jugular notch and the xiphoid process

THORACIC SPINE

-Patient in lateral recumbent position, with the humerii at right angles to the chest and the elbows flexed.

-Ensure no rotation of the spine, shoulders and pelvis are lateral.

-Flex the patient's knees up towards their chest.


AP VIEW LATERAL VIEW

LUMBAR SPINE RADIOGRAPHY

Area Covered: T11 to distal sacrum - including lumbar vertebral bodies, intervertebral joints, spinous and transverse processes, SI joints and sacrum.

Pathology: fractures, scoliosis and neoplastic processes




FFD / SID: 100 cm

Central Ray Larger patient - centre to iliac crest (L4-5)Smaller patient - centre to L3 (lower costal margin) (4cm above iliac crest)

AP VIEW

- Patient supine on table-Place arms at the side or on the chest -Knees flexed opening up the intervertebral disk spaces-Ensure no rotation of pelvis or torso.


AP VIEW

Area Covered: Open L4 to L5 and L5 to S1 joint space.

Pathology: Spondylolisthesis, fractures and degeneration.




FFD / SID: 100cm

Central Ray: CR 4cm inferior to iliac crest and 5cm posterior to ASIS.

Collimation: Four sides of collimation collimate closely to area of interest

LATERAL VIEW

LATERAL VIEW

-Position patient lateral recumbent.

-Head and knees flexed.

-Ensure pelvis and torso are in a true lateral position.-CR perpendicular to long axis of spine.

LATERAL VIEW

THANK YOU

RADIOGRAPHY OF CHEST AND SPINE

Health & Medicine

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