Intro to the chest radiograph Matthew Bentz, MD OHSU Diagnostic Radiology Assistant Professor 2015.

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Presentation transcript:

Intro to the chest radiograph Matthew Bentz, MD OHSU Diagnostic Radiology Assistant Professor 2015

Goals for today Start with normal vs abnormal Try to develop a mental picture of normal See some commonly encountered and important chest radiograph findings

Teaching points 1)Name the 5 densities that are seen on standard radiographs 2)Choose and utilize a standardized way to view each radiograph 3)Locate the following anatomic structures: – Trachea, carina, subclavian artery and vein, SVC, cavoatrial junction 4)Name the 6 patterns seen on chest imaging

Blank x ray film

Under exposure & over exposure

Density – the key to x ray films

Tissue depth and density matter

Depth and density matter

Physics too – physical density and density to x rays both matter

Density Concept Organ boundaries are seen only when the densities are different between the tissues Examples: – Pulmonary vessels are sharply seen in normal lungs (Soft tissue – air interface) – Airways are not seen in normal lung (Air – Air interface)

Airways not visible in normal lungAirways visible in abnormal lung

Density is key! Converse is true also - If objects have, or develop, the same density, they will be inseparable on CXR

Density is key! Converse is true also - If objects have, or develop, the same density, they will be inseparable on CXR ?

Air Fat Densities Water/tissue Bone Metal Tissue appearance on x-rays

Teaching point #1 Name the 5 densities that are seen on standard radiographs Air Fat Densities Water/tissue Bone Metal

Conceptualize If you know what a cow looks like And you know the color purple You can recognize a purple cow, even if you’ve never see one

Quiz

Air Fat Densities Water/tissue Bone Metal

Quiz

Cartilage is water/soft tissue density Since it is the same density as the adjacent tissue, there is no visible boundary – i.e. cartilage is invisible on radiographs

Quiz #2

Quiz picture #3

“1 views is no views”

Titanic

Normal chest X ray

Pretty easy to spot

Really hard to spot

Are all the lines and tubes ok?

A brief digression into technique related issues

PA versus AP Examination Scapula Position Can Help AP View: 10% magnification

Patient body habitus

Rotation

Rotation: Medial Clavicles With Reference To The Spinous Process (Arrows) Rotated to RPO/LAO Rotated to LPO/RAO

Approaches to a CXR Alphabet method Between, inside, outside the lungs Top down Other – My approach: Abnormalities, right lung, left lung, compare the two lungs, trachea, mediastinum, heart, outside the lungs (including abdomen) and bones

Alphabet Air

Alphabet Air Bone

Alphabet Air Bone Cardiac

Alphabet Air Bone Cardiac Diaphragm

Alphabet Air Bone Cardiac Diaphragm Everything else

BIO Between Inside Outside

BIO Between Inside Outside

BIO Between Inside Outside

Top Down

My Method