Thoracic Imaging

Thoracic Imaging
Chest x-ray
Computerised tomography
Ultrasound
Magnetic resonance imaging
New advances
Background Chest X-ray
Most common radiological
investigation 40% of all
investigations

Standard component of a pulmonary

examination

Systematic review is vital in

interpretation of chest x-rays
Limitations of a chest x-
ray
2 dimensional image of a 3
dimensional structure
X-ray findings may lag behind
other clinical features
Normal x-ray does not rule out
pathology
Dependent on good quality image
Chest x-ray views/types
Posteroanterior - PA
Anteroposterior - AP
Lateral
Decubitus
Views
PA
Standard, radiology dept

X-rays posterior to anterior

Standing position
Normal PA
Lung Anatomy

(1) aortic arch

(2) pulmonary trunk
(3) left atrial appendage
(4) left ventricle
(5) right atrium
(6) superior vena cava
(7 & 8) diaphragm
(9) transverse fissure
Views
AP
Cassette placed behind patient

X-rays anterior to posterior

Sitting in chair, semi-erect in bed,

supine
AP marked on film

Heart enlarged, poorer inspiration

Normal AP
Views
Lateral
Localises, shows posterior to heart

Side of interest placed against film

Decubitus
PA on side

Small pleural effusions

 vertebrae

Heart

Norm lateral
Lung Anatomy

(1) oblique fissure

(2) transverse fissure
(3) retrocardiac space
(4) retrosternal space
BASICS
Air shows as black solid structures
white

Too white
Too black
Too large
In the wrong place (Corral et al 1997)
Chest x-ray viewing guide
Correct CXR
Name

Date of birth

Date

Left and right, marker/stomach

Normal PA

Stomac
h
Patient Position
PA, AP, lateral or decubitus view
Rotation Sternal end clavicles
equal from vertebral body
If AP what position
Exposure
How dark or light a film is
Should see vertebral bodies
through heart
Soft Tissues
Breast shadows
Piercing
Air in tissues
Tissue folds in obese
Medical equipment
Breast
shadows
Surgical
emphysem
a
surgical
emphysema
 Heart
valve

Pacemaker
 ECG
ICD

ETT
Bony Structures
Ribs
Scapulae
Clavicles
Vertebrae
#Clavic
le
#ribs
Trachea
Deviated
Carina
Artificial airway
 ETT

#Ribs
ICD
Mediastinum
Deviated
Hilar shadows
Aortic arch
Mediastinum - Heart
Size
No larger than half width of chest

Position
Two thirds on the left

Borders
Clear
Diaphragm
Shape
Height: right 6rib ant, left 7 ant
Cardiophrenic angle
Costophrenic angle
Lung Fields
Black with lung markings
Other opacity indicated pathology
Fissures
Zones
Air bronchograms
Consolidation
normal
Right upper lobe collapse
Right Lower lobe collapse
Pneumothorax
Pneumothor
ax
Consolidation
Pleural effusion
Pleural effusion
Right pneumonia
Air bronchogram
Emphysema
Other imaging

Computerised tomography
Transverse images, cross section

Localises masses

High radiation dose

Other imaging cont

Ultrasound
Useful for pleural effusions

Good images of heart and valves

Other imaging cont

MRI
Malignancy

Vascular

Congenital abnormalities

Tuberculosis
New advances

Patient archive communication

system
Film free radiology

Computer use

Image enhancement