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Chest Imaging And Anatomy

Overview

Imaging Methods

CXR: Main CXR M i Focus F Others: Computed Tomography, MRI, Ultrasound, Nuclear Medicine Densities Anatomy y and approach pp Technical Factors

Approach to CXR

Other Imaging Methods

Computed Tomography
Numerous protocols/techniques depending on clinical history Helical/spiral versus high resolution Contrast

CXR-Will be discussed later

Computed Tomography MRI Ultrasound

Mainly for procedures

Nuclear Medicine

Renal failure Allergy

Computed Tomography

Role of CT

Main further investigation for most CXR abnormality (eg nodule/mass) or to exclude disease with normal CXR Main investigation for certain scenarios (PE (PE, dissection dissection, trauma)

MRI

Multiple planes No radiation Common Indication


Pancoast tumour Brachial plexus Cardiac Vascular (aorta)

Usually targeted examination (unlike CT)


Coronal

Nuclear Medicine

Variety of tests: functional rather than anatomic V/Q specific to chest imaging Others: bone scan, gallium, WBC etc.

Ultrasound

Chest Radiographs

Limited use in thorax (non cardiac) due to air in lungs Assess pleural effusions Mainly used for procedures

PA (posterior to anterior) and Lateral (left)

Minimizes magnification of heart (heart closest to film) Supine or Erect Lordotic Lateral decubitus (for effusions, pneumothorax)

Portable (nearly always AP)

Specialized Views

Chest Radiograph: Approach and Normal Anatomy


THERE IS NO ONE APPROACH: BE SYSTEMATIC Bone and Soft Tissue including abdomen Heart Mediastinum-aorta, trachea Hila Pulmonary Vasculature Lungs Pleura

Normal Anatomy

Bone-CT Reconstruction Bone Anatomy


PA View
Clavicle

Sternum
Intercostal Space

Rib Vertebral Column

Rib

Lateral view Heart Size

Normal is <50% on PA upright radiograph

Cardiovascular: Heart
Axial CT Image

Cardiovascular: Heart
Axial CT Image

R
Right Ventricle Right Atrium

L Right atrium forms right heart border Right ventricle forms Anterior heart border

R
Left Ventricle Left L ft Atrium

L Left atrium forms Part of posterior heart border Left ventricle forms Left and posterior heart border

Cardiac Anatomy: Right Sided Chambers

Cardiac Anatomy: Left Sided Chambers

Scapula

Retrosternal Airspace

Lungs posteriorly should get darker as you go down more inferiorly

Hil Hilum

SVC

Aortic Arch

Right Descending Pulmonary Artery

IVC

Left Descending Pulmonary Atery

Pulmonary Vessels

Airway Anatomy

Trachea

Cartilage Membranous posteriorly Bifurcation

Trachea R + L Main Bronchi Carina

Carina

Bronchus

Left and right Lobar (RUL,RML,LUL,LLL) S Segmental t l (8 left, l ft 10 right) i ht)

Lung Anatomy

Lobes are separated by fissures Right


Upper Lobe Middle Lobe Lower Lobe Upper Lobe (includes lingula) L Lower L Lobe b

Left

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Pleura and Fissures

Parietal Pleura

Pleura

Lubricates L bi and d prevents f friction i i d during i respiration i i Potential Space Dont see unless abnormal

Visceral pleura

Parietal pleura: Lines chest wall, mediastinal and diaphragmatic surfaces Visceral pleura: Lines lungs, fissures

Diaphragms Normal: Sharp costophrenic sulcus

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Which is right and left diaphragm?

Approach to Chest Radiograph: Technical Factors


Clavicles

Patient Identification (name and date) Markers (Left ( f vs right) ) Assess for rotation (clavicles vs spinous process) Penetration (thoracic spine should be visible) Degree of Inpiration: 6th anterior or 10th posterior
6 7

Spinous Process

Vertebral Body Visible

10 11

Counting anterior ribs

Counting posterior ribs

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Inspiration/Expiration Images

E i ti Expiration

Heart size appear larger Mediastinum is wider Pulmonary vasculature indistinct

4th Anterior

8th Posterior Expiration Image

Expiration

Inspiration: Same Patient

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