Normal Chest

X Ray
Basic anatomy
Lobes

Segme
n

Lobules

Acinus

Alveoli
 Lungs

Right
Left
Upper Lobe
Apical Upper Lobe
Anterior Anterior
Posterior Apicoposterior

Middle Lobe Lingula

Lateral Superior Lingula
Medial Inferior Lingula

Lower Lobe
Lower Lobe
Apical
Anterior Apicobasal
Posterior Anterobasal
Medial Posterobasal
Lateral Lateral
Radiographic anatomy
 Ascenden
Aorta
Aortic Knob
Left Pulmonary
Artery + Left
Atrium Auricle
Heart waist
Descenden
Aorta
CTR
L

Lung zones
Apex
Upper
Middle
Lower
Indications of CXR
Screening
Cough > 2 weeks
Haemoptoe
Fever
Dyspnea
Chest pain
Trauma
Metastases
Symptoms of Lung TB/Malignancy
Before reading CXR
1. Identity
2. Marker (R/L)
3. Exposure dose (kV, mAs)
4. Position (PA/AP/Lateral/Oblique)
5. Film qualities (asymmetric,
shaken, inspiration/expiration)
6. Artifacts
R ID

kV V Th.
3
PA or AP ?

PA AP
 1

Maximum 3

inspiration 4

5
6
 R

Trachea

Retrosternal
space

Retrocardial space

Anterior
sinus

Posterior
sinus
PA view
1. Position? enough
inspiration?
2. Soft tissue
3. Skeletal
4. Trachea (deviation?)
5. Sinuses and
Diaphragms
6. Mediastinum
Heart (position, size,
configuration)
Great vessels
7. Lungs
Hila
Vascular patterns
Lung apices, pleural line
and fissures
Lateral view
Anterior and
posterior
sinuses
Retro sternal
and retro
cardiac spaces
Thank You
Radiographic anatomy
Trachea (midline)
Carina level at V. Thoracic 5-6
Heart
Position
Size PA view 50%, AP view
55%
Configuration (apex, aortic knob,
pulmonary trunk, auricle of left
atrial, right atrial, SVC)
Diaphragms
Right diaphragm level at V.
thoracic 6-7
Left diaphragm level at V.
thoracic 7-8
Right is higher than left (2,5 cm)
Radiographic anatomy
Right hilum:
formed by the right main
bronchus and right pulmonary
artery, lobar divisions
Between the diaphragm and
lung apex
V. thoracic 5-6
Content: artery, vein,
bronchus, lymph
Left hilum:
V.thoracic 4-5
Content: artery, vein,
bronchus, lymph
Radiographic anatomy
Lungs
Vascular pattern
Lung apices
Lung contours: cardiac
borders, mediastinal
margin
Normal pleural line and
fissures are not visible
Normal minor fissures
PA: level at V Th. 5/
Anterior ribs 4th
Pulmonary Vascular Patterns
Normal: Right <2/3 of lung
field, Left <1/3 lung field
Arteries branching vertically to
upper and lower lobes
Veins running roughly
horizontally towards the lower
hila
Upper lobe vessels smaller
than lower lobe vessels on
erect CXR
Right vessels more crowded
than the left vessels
Vessels difficult to see in
peripheral 1/3 of the lungs
Radiographic anatomy
Skeletal
Clavicles, Scapulae,
Costae, Vertebrae
Fractures
Scoliosis
Osteoporosis
Lytic/blast lesions
metastases/malignancy
Soft Tissues
Mass
Subcutaneous
Emphysema