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Normal Chest

X Ray
Anggreiny
Basic anatomy
Lobes
Segmen
Lobules
Acinus
Alveoli
Right
Left
Upper Lobe
Middle Lobe
Lower Lobe
Apical
Anterior
Posterior
Lateral
Medial
Superior Lingula
Inferior Lingula
Upper Lobe
Lingula
Anterior
Apicoposterior
Apical
Anterior
Posterior
Medial
Lateral
Lower Lobe
Apicobasal
Anterobasal
Posterobasal
Lateral
Lungs
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
ID
R
kV V Th. 3
PA or AP ?
1
2
PA AP
Maximum
inspiration
1

2

3

4

5
6
Retrosternal space
Retrocardial space
Anterior sinus
Posterior
sinus
Trachea
R
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 4
th


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