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JasminFlorian

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Thoracic Imaging
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  1. Thoracic Imaging

  2. Thoracic Imaging • Chest x-ray • Computerised tomography • Ultrasound • Magnetic resonance imaging • New advances

  3. Background Chest X-ray • Most common radiological investigation – 40% of all investigations • Standard component of a pulmonary examination • Systematic review is vital in interpretation of chest x-rays

  4. Limitations of a chest x-ray • 2 dimensional image of a 3 dimensional structure • X-ray findings may lag behind other clinical features • Normal x-ray does not rule out pathology • Dependent on good quality image

  5. Chest x-ray views/types • Posteroanterior - PA • Anteroposterior - AP • Lateral • Decubitus

  6. Views PA • Standard, radiology dept • X-rays posterior to anterior • Standing position

  7. Normal PA

  8. Lung Anatomy (1) aortic arch (2) pulmonary trunk (3) left atrial appendage (4) left ventricle (5) right atrium (6) superior vena cava (7 & 8) diaphragm (9) transverse fissure

  9. Views AP • Cassette placed behind patient • X-rays anterior to posterior • Sitting in chair, semi-erect in bed, supine • AP marked on film • Heart enlarged, poorer inspiration

  10. Normal AP

  11. Views Lateral • Localises, shows posterior to heart • Side of interest placed against film Decubitus • PA on side • Small pleural effusions

  12. vertebrae Heart Norm lateral

  13. Lung Anatomy (1) oblique fissure (2) transverse fissure (3) retrocardiac space (4) retrosternal space

  14. BASICS Air shows as black solid structures white • Too white • Too black • Too large • In the wrong place (Corral et al 1997)

  15. Chest x-ray viewing guide Correct CXR • Name • Date of birth • Date • Left and right, marker/stomach

  16. Normal PA Stomach

  17. Patient Position • PA, AP, lateral or decubitus view • Rotation – Sternal end clavicles equal from vertebral body • If AP what position

  18. Exposure • How dark or light a film is • Should see vertebral bodies through heart

  19. Soft Tissues • Breast shadows • Piercing • Air in tissues • Tissue folds in obese • Medical equipment

  20. Breast shadows

  21. Surgical emphysema

  22. surgical emphysema

  23. Heart valve Pacemaker

  24. ECG ICD ETT

  25. Bony Structures • Ribs • Scapulae • Clavicles • Vertebrae

  26. #Clavicle

  27. #ribs

  28. Trachea • Deviated • Carina • Artificial airway

  29. ETT #Ribs ICD

  30. Mediastinum • Deviated • Hilar shadows • Aortic arch

  31. Mediastinum - Heart Size • No larger than half width of chest Position • Two thirds on the left Borders • Clear

  32. Diaphragm • Shape • Height: right –6rib ant, left – 7 ant • Cardiophrenic angle • Costophrenic angle

  33. Lung Fields • Black with lung markings • Other opacity indicated pathology • Fissures • Zones • Air bronchograms • Consolidation

  34. normal

  35. Right upper lobe collapse

  36. Right Lower lobe collapse

  37. Pneumothorax

  38. Pneumothorax

  39. Consolidation

  40. Pleural effusion

  41. Pleural effusion

  42. Right pneumonia

  43. Air bronchogram

  44. Emphysema

  45. Other imaging Computerised tomography • Transverse images, cross section • Localises masses • High radiation dose

  46. Other imaging cont Ultrasound • Useful for pleural effusions • Good images of heart and valves

  47. Other imaging cont MRI • Malignancy • Vascular • Congenital abnormalities • Tuberculosis

  48. New advances Patient archive communication system • Film free radiology • Computer use • Image enhancement