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Radiology Chest X-ray-Systematic Approach PowerPoint Presentation

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Description : Chest X-ray - Systematic approach

Tags : Radiology Chest,X Ray,Systematic Approach,Chest X-Ray

Published on : Sep 09, 2022 | Views : 2519 | Downloads : 9

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RADIOLOGY Dr. Mohamed Abobakar Sharif (Dr. MASH)
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Chest X-Ray Fundamentals
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Chest X-ray Chest X-ray - Systematic approach Chest X-ray - Quality Chest X-ray - Anatomy Chest X-ray - Abnormalities Chest X-ray - Tubes
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Chest X-ray - Systematic approach Chest X-ray
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Chest X-ray – Systematic approach Anatomical structures to check: Trachea and bronchi Hilar structures Lung zones Pleura Lung lobes and fissures Costophrenic angles Diaphragm Heart Mediastinum Soft tissues Bones Below diaphragm and hidden areas
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Systematic approach Anatomical structures to check:
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Systematic approach - Patient and image data Check the patient's identity Note the image date and time Note the image projection: Check if a posterior anterior (PA) or anterior posterior (AP) projection was used, and note if the patient was standing, sitting or supine? Was the mobile X-ray machine used? The image annotations are often useful: This is a mobile chest X-ray taken with the patient supine, at 11.25 am in the resuscitation room. The patient's name, ID number and date of birth are annotated. Note the side marker is correct.
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Systematic approach - projection Chest x-ray : P-A view A-P view : for Ambulatory limit Lateral ( Lt/Rt ) : for Effusion or thickening A-P supine Lateral decubitus (Lt/Rt) Lordotic : for Apical lesion Oblique (Rt/Lt; post/anterior)
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Systematic approach - Image quality Assess the image quality: The chest X-ray should be checked for rotation, inspiration and penetration (Mnemonic-RIP-Rest In Peace ). Comment on the presence of medical artifacts Can the clinical question still be answered?
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Systematic approach - The obvious abnormality It is often appropriate to start by describing the most striking abnormality. However, once you have done this, it is vital to continue checking the rest of the image. Remember that the most obvious abnormality may not be the most clinically important. The elephant in the image! If there is an elephant in the image, don't ignore it! Describe it in detail and then use your system to continue examining the image.
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Systematic approach - Describing abnormalities 'Shadowing', 'Opacification', 'increased density', 'increased whiteness' are all acceptable terms 'Lesion descriptors' may lead you towards a diagnosis Be descriptive rather than jumping to a diagnosis 'Lesion descriptors' Position Anterior/ Posterior/Lung zone etc. Shape Round/ Crescentic/etc. Edge Smooth/ Irregular/Spiculated Pattern Nodular/ Reticular(netlike) 10. Density Air/ Fat/Soft tissue/ Calcium/Metal Tissue involved Lung, heart, aorta, bone etc. Size Large/ Small/Varied Side Right/ Left Unilateral/ Bilateral Number Single/ Multiple Distribution Focal/ Widespread
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Systematic approach - Describing abnormalities 'Shadows, opacities, densities' Tissue involved: Lung Size: Small (>2 cm) Side: Bilateral Number: Multiple Distribution: Widespread Position: Mainly middle to lower zones Shape: Round Edge: Irregular Pattern: Nodular Density: Soft tissue Diagnosis: Description helps with diagnosis. Once you have put all the above terms together, there can only be one diagnosis. Metastatic disease
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Systematic approach - Locating abnormalities Consider its anterior-posterior position. A lateral view may help, but 3D location may also be possible on a posterior-anterior (PA) view if you have a knowledge of chest X-ray anatomy and an understanding of the 'silhouette' sign. The 'silhouette' sign: The silhouette sign is a misnomer ! It should be called the 'loss of silhouette' sign. Normal adjacent anatomical structures of differing densities form a 'silhouette,' or contour. Loss of a specific contour can help determine the position of a disease process.
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Systematic approach - Locating abnormalities The 'silhouette' sign: Loss of contour of : 1 - Left heart border 2 - Hemidiaphragm 3 - Paratracheal stripe Lingula disease Lower lobe lung disease Paratracheal disease 4 - Chest wall Lung, pleural or rib disease
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Systematic approach - Locating abnormalities The 'silhouette' sign: Loss of contour of : 5 - Aortic knuckle 6 - Paraspinal line 7 - Right heart border Anterior mediastinal or left upper lobe disease Posterior thorax disease Middle lobe disease
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Systematic approach - Review areas After a systematic look at the whole chest X-ray, it is worth re-checking hidden areas that may conceal important pathology. Hidden areas: Apical zones Hilar zones Retrocardial zone Zone below the dome of diaphragm
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Systematic approach - Interpretation Whatever the findings are, they should only be interpreted in view of the clinical setting. Remember to treat the patient - not the X-ray! Occasionally there will be an unexpected finding (Incidental Finding), which may need to be considered with caution, especially if equivocal or if it does not fit the clinical scenario. Posteroanterior (PA) chest radiograph shows an incidental finding of a solitary pulmonary nodule adjacent to the left hilum.
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Thank You For Your Attention