1. Reading the CXR Frank Schembri Pulmonary / Critical Care

2. Types of Densities

3. Basic Principles of the CXR Types of views –PA –Lateral –AP –Apical lordotic –Decubitus (R & L)

4. PA vs AP

5. Lateral CXR

6. Apical Lordotic Chest

7. Decubitus Positioning

8. Approaching the CXR Name, date, type of film Type of film Patient positioning / rotation Inspiration Penetration –White is underpenetrated –Black is overpenetrated

9. Approaching the CXR The systematic approach 1. Tubes / Hardware 2. Bones 3. Soft tissues 4.Pleura and diaphragm 5. Trachea and mediastinum 6. Lung parenchyma

10. Rotation

12. Inspiration

13. Penetration

14. Scanning the xray

16. # 1- Hardware

20. 2. Osseous Structures in the Chest

21. 2. Osseous Structures of the Chest

22. 3. Soft Tissues

23. 4. Pleura and Diaphragm

25. 5. Mediastinal Anatomy

27. 5. Mediastinal Compartments

29. 6. Parenchymal Anatomy

30. Anterior View Lateral View

31. 6. Parenchymal Anatomy

32. Left Lung Right Lung

33. Lobes Right upper lobe:

34. Lobes (continued) Right middle lobe:

35. Lobes (continued) Right lower lobe:

36. Lobes (continued) Left lower lobe:

37. Lobes (continued) Left upper lobe with Lingula:

38. Lobes (continued) Lingula:

39. Lobes (continued) Left upper lobe - upper division:

42. Pneumonia

43. Atelectasis Elevation of diaphragm mass Minor fissure Loss of volume Minor fissue

44. Minor fissure Major fissure

45. Pneumothorax Collection of air in pleural cavity Primary and secondary causes Upright position air rises and separates the lung from the chest wall creating a line. Don’t be fooled by skin folds, clothing and bullae. In the supine position air moves anteriorly. The lung will not be clearly separated from the chest wall.

46. PTX

47. Pneumothorax in the Supine Patient Deep sulcus sign hyperlucent Enlarged hemithorax Mediastinal shift Sharper cardiac border

48. Tension

49. Pneumothorax

50. Bat-winged appearance Enlarged heart

51. CHF Perihilar infiltrates/enlarge PA Pleural effusions

52. Kerley B lines

54. Effusions