Thoracic Imaging Chest Radiography and other techniques.

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Thoracic Imaging Chest Radiography and other techniques

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X-ray projection

Transcript of Thoracic Imaging Chest Radiography and other techniques.

Page 1: Thoracic Imaging Chest Radiography and other techniques.

Thoracic Imaging

Chest Radiography and other techniques

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X-ray projection Department or mobile unit Projection – PA of AP according to

direction in which X-ray beams travel through patient

Heart magnified in AP projection X-ray taken during full inspiration Arms abducted

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X-ray projection

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X-ray projection Lateral x-ray – patient turned 90º,

effected side against film cassette

Arms extended forward

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X-ray projection

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X-ray projection Lateral decubitus – small pleural

effusions Patient lies horizontally, effected

side placed downwards Film cassette at the back of

patient, X-ray beam from front

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X-ray projection

Lordotic film – middle lobe collapse

AP projection – patient arches back so that shoulders are touching the cassette

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Other techniques Fluoroscopy – “real time” visuals of

patient on television monitor

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Other techniques Ultrasonography – high-frequency

sound waves Limited use in chest, but used for cardiac imaging

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Other techniques Computer tomography – X-ray tube

and detectors rotate around patient

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Other techniques Magnetic resonance imaging –

patient lies in middle of large magnet

Combination of intense magnetic field and series of radiofrequency waves

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Other techniques - MRI

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Other techniques Radionuclide imaging – ventilation-

perfusion scanning of the lung Suspected pulmonary embolus

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Interventional procedures Needle biopsy

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Interventional procedures Arteriography – glide catheter from

femoral vein or vein in elbow, through right side of heart to pulmonary artery

Contrast injected

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Normal chest x-ray Outline of mediastinum and heart The hila Pulmonary vessels and main

bronchi Diaphragm Soft tissue and bones of the

thoracic cage

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Normal chest

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Mediastinum and heart Mediastinum – trachea, aortic arch,

superior vena cava and oesophagus Heart – one-third to right of the

spine and two-thirds to the left Transverse diameter less than

transverse diameter of hemi-thorax

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Hila and diaphragm Hila – pulmonary arteries and veins Diaphragm – highest point of right

hemidiaphragm is between anterior ends of 5th and 7th ribs

Left 2cm lower in erect position Costophrenic angle Lateral view – heart to viewer’s left

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Lateral X-ray

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Interpreting a X-ray Name of patient, time and date Left and right side markers PA or AP Supine vs erect Patient rotation – distance between

medial ends of clavicle and spinous processes

State of inspiration

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Interpreting a X-ray Should be able to see vertebral

bodies through heart shadow Thoracic cage Heart and mediastinum Diaphragm and costophrenic angle Lungs

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Consolidation Air-filled spaces replaced by products of

disease – water, pus or blood Localized areas - infection Radiological signs – air bronchogram and

silhouette sign Air bronchogram – black branching

structures Silhouette sign – border of structure

gone

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Consolidation

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Collapse (atelectasis)

Loss of aeration and collapse of lobe or lung

Tumour, foreign object or mucus plug

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Collapse - signs ↑ density of collapsed lobe Shift of fissures Silhouette sign Hilar and mediastinal shift Crowding of vessels, airways and ribs Elevation of hemidiaphragm

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Right upper lobe collapse

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Right middle lobe collapse

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Right lower lobe collapse

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Left upper lobe collapse

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Left lower lobe collapse

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Pneumothorax

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Pleural effusion

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Pulmonary nodules and metastasis

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Lung abcess

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Paediatrics