Overview

Imaging Methods
CXR: Main Focus Others: Computed Tomography, MRI, Ultrasound, Nuclear Medicine

Approach to CXR
Densities Anatomy and approach Technical Factors

Other Imaging Methods

CXR-Will be discussed later
Computed Tomography MRI Ultrasound
Mainly for procedures

Nuclear Medicine

Computed Tomography
Numerous protocols/techniques depending on clinical history Helical/spiral versus high resolution Contrast
Renal failure Allergy

Computed Tomography
Role of CT
Main further investigation for most CXR abnormality (eg nodule/mass) or to exclude disease with normal CXR Main investigation for certain scenarios (PE, dissection, trauma)

MRI
Multiple planes No radiation Common Indication
Pancoast tumour Brachial plexus Cardiac Vascular (aorta)

Usually targeted examination (unlike CT)

Coronal

Ultrasound
Limited use in thorax (non cardiac) due to air in lungs Assess pleural effusions Mainly used for procedures

Chest Radiographs
PA (posterior to anterior) and Lateral (left)
Minimizes magnification of heart (heart closest to film)

Portable (nearly always AP)

Supine or Erect

Specialized Views
Lordotic Lateral decubitus (for effusions, pneumothorax)

Normal Anatomy

Bone-CT Reconstruction
PA View
Clavicle

Rib Vertebral Column

Intercostal Space

Heart Size

Normal is <50% on PA upright radiograph

Cardiovascular: Heart
Axial CT Image

R
Right Ventricle Right Atrium

L
Right atrium forms right heart border

Right ventricle forms Anterior heart border

Cardiovascular: Heart
Axial CT Image

L
Left atrium forms Part of posterior heart border

Left Ventricle Left Atrium

Left ventricle forms Left and posterior heart border

Cardiac Anatomy: Right Sided Chambers

Cardiac Anatomy: Left Sided Chambers

SVC

Aortic Arch

Right Descending Pulmonary Artery

Left Descending Pulmonary Atery

Scapula

Retrosternal Airspace Hilum

Lungs posteriorly should get darker as you go down more inferiorly

IVC

Pulmonary Vessels

Airway Anatomy
Trachea
Cartilage Membranous posteriorly

Carina
Bifurcation

Bronchus
Left and right Lobar (RUL,RML,LUL,LLL) Segmental (8 left, 10 right)

Lung Anatomy
Lobes are separated by fissures Right
Upper Lobe Middle Lobe Lower Lobe

Left
Upper Lobe (includes lingula) Lower Lobe

Pleura and Fissures

Pleura
Lubricates and prevents friction during respiration Potential Space Dont see unless abnormal

Parietal pleura: Lines chest wall, mediastinal and diaphragmatic surfaces Visceral pleura: Lines lungs, fissures

Parietal Pleura

Visceral pleura

Diaphragms

Normal: Sharp costophrenic sulcus

Approach to Chest Radiograph: Technical Factors

Patient Identification (name and date) Markers (Left vs right) Assess for rotation (clavicles vs spinous process) Penetration (thoracic spine should be visible) Degree of Inpiration: 6th anterior or 10th posterior

Clavicles

Spinous Process

Vertebral Body Visible

6

10 11

Counting anterior ribs

Counting posterior ribs

Inspiration/Expiration Images
Expiration
Heart size appear larger Mediastinum is wider Pulmonary vasculature indistinct

4th Anterior

8th Posterior

Expiration Image

Expiration

Inspiration: Same Patient