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Basic of Thorax Imaging - 10 September 2013 - by Robby Hermawan
Basic of Thorax Imaging - 10 September 2013 - by Robby Hermawan
• Trauma patient.
Contraindication (relative):
• Pregnant women especially 1st & 2nd trimester.
3/20/2019 www.brainybetty.com 24
Alveoli pore:
Canals of Lambert
• between alveoli and terminal
bronchiole
Pores of Kohn
• between alveoli.
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POSTER0ANTERIOR
ANTEROPOSTERIOR
RIGHT/LEFT LATERAL
RIGHT ANTERIOR OBLIQUE
LEFT ANTERIOR OBLIQUE
RIGHT POSTERIOR OBLIQUE
LEFT POSTERIOR OBLIQUE
TOP LORDOTIC
RIGHT/LEFT LATERAL DECUBITUS
Indication:
Routine
Screening TB
Pre-operative
Technique:
The patient stand between the film and the x-ray tube.
The patient faced the film.
The hands are put in the waist with the elbow flexed to
the anterior (to open scapula so it doesn’t superimposed
with the lung)
The distance of the film to the x-ray tube :
Lung 1.5m
Heart 2.0m
Centre : 6th – 7th thoracic spine
50-60 KV
10-20 MAs
Indication:
(cannot be taken with PA )
• Severely ill patient
• Children
• Obese
• Pregnant
• Ascites
• Intraabdominal tumor
Technique:
1. The patient lie on the table with the arms put beside
the body or put up.
2. The film was placed behind the back.
3. Centre : 6th -7th thoracic spine
• Heart enlargement
• Mediastinal widening
• Crowded
bronchovascular
marking at the basal
zone.
PA AP
• V – shaped clavicles • Straight clavicles
• No lung superposition • Lung superposition with
with the scapula the scapula
• Mediastinal widening
• No mediastinal widening
• Distinct posterior aspect
• Distinct anterior aspect of the costa
of the costa. • Crowded bronchovascular
• Less crowded marking especially at the
bronchovascular marking basal zone.
Indication:
• Look at mediastinal
abnormalities.
• Look at anomalies that
wasn’t clear at
posteroanterior position.
• Heart assessment.
OBLIQUE FISSURE
POSTERIOR RIBS
RT. HEMI
DIAPHRAGM
Type:
Right anterior oblique (RAO)
Left anterior oblique (LAO)
Right posterior oblique (RPO)
Left posterior oblique (LPO)
The side that is mentioned is the side that was close to the film
RAO: The right side and the anterior side was close to the
film
LPO: The left side and the posterior side was close to the
film.
Indication:
To look at anomalies that were not clear at PA and
lateral position.
Techniques:
1. The patient stand between the film and the x ray tube.
2. The side that is mentioned is the side that is close to
the film
3. The angle of obliquity is approximately 450.
4. The arm that was close to the film was put over the
head, while the other hand was put on the waist with
the elbow flexed to the posterior.
5. Centre: 6th -7th thoracic spine
RAO LAO
Indication:
• To look for minimal
fluid collection in
the pleural cavity
(15-20cc) that can
not be seen in the
PA chest x-ray
Technique:
1. The patient lying in the table with the lateral side
close to the table.
1. RLD : The right side of the body is close to the table
2. LLD : The left side of the body is close to the table
2. Both arms are lifted.
3. Centre: 6th – 7th thoracic spine
Indication:
• To look for
anomalies at the
apex of the lung.
Technique:
1. The patient stand between the film and the x-ray tube.
2. The patient is facing the x-ray tube.
3. The distance between the patient and the film is 30cm
4. The patient then rest the back of his shoulder to the
film.
5. The upper border of the film is approximately 1 inch
above the shoulder.
6. Centre: manubrium of the sternum
TOP LORDOTIK
1: Name & Age
2: Date
3: Medical record number
4: Previous examination
5: Position/View: PA/AP/Marker
6: Penetration
} Administration
7: Rotation
8: Inspiration
9: Magnification
10: Angulation
11: Trachea, heart, sinuses, diaphragm
} Quality
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Spurious findings : cardiomegaly, mass at the aortic
arch, patchy opacification in both lower zones.
Spurious findings : cardiomegaly, mass at the aortic
arch, patchy opacification in both lower zones.
• Influence the heart size assessment.
• Depend on the patient position toward the film.
• PA chest x-ray is more accurate in depicting the
heart size than AP chest x-ray.
• Reason:
• The distance between the heart and the film is closer
in PA chest x-ray.
• Not significant in patient < 4 years old.
AP PA
• In erect chest x ray (without cephalad or caudal
angulation) the beam of the x-ray is paralel to
the floor and perpendicular to the thorax the
clavicle is projected below the posterior aspect of
the first rib.
• In top lordotic (cephalad angulation) the clavicle
(anterior structure) is projected above the posterior
aspect of the first rib (posterior structure).
• In top lordotic, the normal ‘S’ shaped clavicle will
be seen as straight structure.
• The assessment of thoracic structure will be
influenced by the angulation.
• Lucent structure contain air.
• Centrally located.
• Normal diameter : 1,5 cm
• Look for deviation.
• Extend to the carina at the level of the sternal
angle (T5 level)
• T4 level on expiration
• T6 level on inspiration
Retrocardiac space
• Clear triangular
shaped
Anterior sinus
• Sharp
• Sometimes covered by
mediastinal fat
• Depend on the
exposure of the film.
Posterior sinus
• Sharp
Diaphragm
• Right diaphragm is
higher.
• Right diaphragm is seen
from the posterior to
the anterior.
• Anterior aspect of left
diaphragm is covered by
the heart shadow.
• Gastric bubble below
the left diaphram.
Hilar area
• Mass will make this
area more opaque
• Vascular opaque
• Bronchi lucent
Lung field
• Clear lung at the
anterio and posterior
of the heart.
• Decrease density from
superio to inferior in
the posterior
mediastinum.
Retrosternal dan retrocardiac space cerah.
Sinus anterior tajam.
Sinus posterior tajam.
Diafragma jelas.
Tidak tampak infiltrat.
Signs and symptoms potentially related to the
respiratory, cardiovascular, and upper
gastrointestinal systems, and the musculoskeletal
system of the thorax.
Screening for neoplasma or metastasis
Follow-up of known thoracic disease
Monitoring of patients with life-support devices and
other devices in the thorax region
Evaluate foreign body
Screening in trauma patient
Surveillance for active tuberculosis or occupational
lung disease
Preoperative radiographic evaluation
o Heart Failure and o Corpus Alienum
pulmonary edema Aspiration
o Pleural Effusion o Hemothorax
o Pulmonary Contusion o Pneumonia
o Atelectasis o Pneumothorax
o Diaphragmatic Hernia o Rib fracture
o Flail chest o Pneumonia Aspiration
Heart is enlarged to the left with the apex
downward toward the diaphragm.
Hilar hazyness.
Infiltrates in the 2/3 medial of both lung
“bat wing appearance “
“butterfly appearance”