Interpreting chest radiographs i.

Lung volumes appear low

Dr. Ocampo ii. Lung markings appear falsely prominent
Indications: iii.Cardiac silhouette and mediastinum may
1. Evaluation of symptoms appear falsely enlarged
2. Evaluation of physical signs 3. Assessing penetration/ exposure
3. Evaluation of other/introduced objects to patient’s a) Considered good when the outlines of the
procedure vertebral bodies are visible.
b) Consequences
Factors: i. Excessive brightness- false prominent pulmo
1. Density: air --> Fat/fluid--> soft tissues --> bone --> metals markings
2. Thickness- thicker structure appears brighter ii. Diminished brightness- falsely diminished
3. Duration of exposure- shorter exposure - brighter, longer pulmo markings
exposure- darker iii. Excessive of diminished contrast - falsely
diminished pulmonary markings; obscuring
Projections pulmo nodules and pneumothoraces
1. Postero-anterior view
a) Standard frontal chest SUMMARY
b) Patient is facing backwards 1. Look for rotation
c) For ambulatory patients 2. Adequate respi effort
2. Antero-posterior view 3. Check for exposure
a) Supine or sitting
b) Mediastinal structures appear magnified Abnormalities:
c) For non ambulatory patients
3. Lateral view 1. AIRWAYS
a) Side view a) Narrowing - steeple sign
b) For localizations with PA view b) Deviation
c) Can examine retrosternal or retrocardiac spaces i. Contralateral from affected side
d) May check for pleural effusion retrosternally 1. Pneumothorax
4. Lateral decubitus 2. Pleural effusion
a) Lying on their side 3. Mass
b) To estimate volume of pleural effusion if free ii. Ipsilateral from affec
flowing 1. Atelectasis
c) Differentiate pneumothorax to 2. Lobectomy
pneumomediastinum/pneumoperitoneum iii. Check the carina
d) Significant pleural eff - <10cc / 1cm from the chest c) Foreign object
wall 2. BONES
5. Apicolordotic view a) Fracture
a) Areas of lung apices that are obscured in PA or AP b) Deformities
view c) Scleroses - increase density on the bone
d) Lytic
SYSTEMATIC APPROACH IN ANATOMY e) Dislocations
f) Mass
A- Airway: trachea
B- Bones: ribs, clavicle CTR - Cardiothoracic ratio
C- Cardiac silhouette and mediastinum CTR= a+b/c
D- Diaphragm and pleura CTR >50% indicates enlargement
E- Effusions (pleura)
F- Fields Lefft atrial enlargement: double density sign, splaying of
G- contraptions carinal angle
Right ventricle enlargement: rounded left heart border,
Horizontally oriented ribs - posterior uplifted cardiac apex. Filling of retrosternal space in lateral
Vertically oriented - anterior view

ASSEESMENT OF TECHNICAL QUALITY

1. Rotation
a) Consequences: costophrenic angles may not be
visible. Gastric bubble and intraperitoneal free air
may not be visible. Distortion of cardiac silhouette
2. Inadequate inspiration
a) 9-10 posterior ribs - adequate
b) 6-7 anterior ribs with the 7th rib piercing on the
diaphragm- adequate
c) Consequences: