Chest x rays-

an introduction.

Heather Stewart
October 2009
 Aims of lecture

 To be aware of the normal appearances of

a chest radiograph
 To gain some understanding of the
complexity of image interpretation
 To acquire some visual experience with
radiographic images
 Plain film imaging
X-ray beam is passed through
area of interest
Conventional radiography
 Onto film behind or beneath
patient
 Film processed
Digital radiography
 CR -computed radiography-
onto image receptor
 DR – digital radiography– onto
detector screen
 Digital image produced viewed
on console
 Orientation

 PA or AP?

 Supine or Erect?

 What difference does

it make?
 What’s what on the image?
 Image produced is a
result of x-rays being
either passed through
the body or absorbed
 Where radiation
passes through image
is black – air/lungs
 Where radiation is
absorbed image is
white – bone/barium
 Five main densities
 Black - air
• e.g. lungs, bowel, stomach
 Dark grey - fat
• e.g. subcutaneous tissue
layer, retroperitoneal fat
 Light grey - soft
tissue/water:
• e.g. solid organs, heart
liver, full bladder
 Dull white -bone
• e.g. bone particularly
medulla
 Bright white -contrast
media
• e.g. barium
 USE OF CONTRAST
MEDIA

PLAIN FILM
RENAL SYSTEM

BARIUM ENEMA
 Chest Radiograph
 Provides a “colour”
image of the organs &
structures within the
chest
 Heart
 Lungs
 Diaphragm
 Major blood vessels
 Bony thorax
 Systematic analysis of the film
Check these before viewing image
 Patient ID
 Date of film
 And time if patient has more than one chest x-
ray in a day
 Anatomical marker

All of this is less of an issue now with digital

viewing
 Check list TRACHEA
 Lung fields Clavicle
 volumes and positioning
 opacity of lungs
 Hilum AA
SVC
 Heart PA
 Mediastinum
PA
 Diaphragms
 Trachea RA LV
 Bones
SVC – superior vena cava
AA – aortic arch
D
PA – pulmonary arteries D
RA – right atrium
LV – left ventricle Liver Gastric air
D - diaphragm bubble
Inspiration
 Opacity of lungs
 They should look black except for the
pulmonary vessels
 Start from the apices and work down to
the diaphragm
 Compare left to right
 Include the periphery
 Check you can see the hemi-diaphragms
 Costo-phrenic and cardio-phrenic angles
 Heart & mediastinum
 Aortic arch on the left followed by the left
pulmonary artery
 2/3 rds of heart on the left side of the chest
 Maximum diameter less than ½ trans-
thoracic diameter
 Right border made up of Rt atrium
 Left border of the heart is made up of the
Lt atrium and Lt ventricle
 Thymus gland in ant mediastinum
 Normal appearances

Paediatric chest
 Any Abnormalities?
Is the abnormality…….

 Too white
 Too black
 Too large
 In the wrong place?

Remember
 abnormalities can represent pathology from
anywhere from the cortex of the rib to the outer
edge of the mediastinum
 Reasons for requesting CXR’s
 Position of tubes, catheters etc.
 Pneumothorax
 Pulmonary oedema
 Pleural effusion
 Pneumonia
 T.B.
 ? Mass
 Heart valve disease
 Enlarged lymph nodes
 Foreign Bodies
Pneumothorax
Pneumothorax
Chest drains
Pulmonary Oedema

Bat’s wing sign

Pulmonary Oedema
Effusion
 Right upper lobe pneumonia

Consolidation – the
lung is opaque, but
there is no evidence
of volume loss
 Mass

Lipoma
Mass
Tuberculosis
Film / MRI
 Nuclear medicine scan
Chest x-ray
CT Scan
MRI scan
If only it were so straight forward!
 References
 Corne J et al (2003) “Chest x-ray made easy”
Chuchill Livingstone. London
 Herring W (2007) “Learning Radiology:
recognizing the basics” Mosby. Philadelphia
 Nicholson D & Driscoll P (2003) “ABC of
Emergency Radiology” BMJ publishing. London
 http.www.xray2000.co.uk
 http://radiologymasterclass.co.uk/site_map_2.ht
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Thanks for listening!