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X-Ray Style Disease

It seems that you like this template, x-ray style disease presentation, free google slides theme, powerpoint template, and canva presentation template.

Need to prepare a presentation where X-rays are the protagonists? Look no further. Here's the perfect proposal for you. This template is inspired by X-ray illustrations, with blue color, traditionally associated with health topics, as it conveys reliability. You can use it to talk about certain diseases or to explain the science behind an X-ray. Resources such as infographics, tables, charts, graphs or maps that we have included will help you to do so.

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Basics of Chest X-Ray

Oct 15, 2014

4.41k likes | 14.97k Views

Basics of Chest X-Ray. Outline. CXR Basics Types of CXR PA vs. AP Films Obtaining Images Systematic method to reading CXR Common Signs Examples. Chest X-ray (CXR) Basics. A standard chest X-ray consists of a PA Image Lateral Image Images read together AP for supine patients

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• pulmonary edema
• examples pericardial effusion
• signs solitary pulmonary nodule

Presentation Transcript

Outline • CXR Basics • Types of CXR • PA vs. AP Films • Obtaining Images • Systematic method to reading CXR • Common Signs • Examples

Chest X-ray (CXR) Basics • A standard chest X-ray consists of a • PA Image • Lateral Image • Images read together • AP for supine patients • Lots of information available on a CXR • Be systematic with your reading • Always compare to prior studies if possible

Basics of X-Rays • X-Rays are part of the light spectrum • Unlike visible light, x-rays pass through the human body • Pass through lungs without much interference • Difficult to pass through bones • Place film cassette on other side of patient and capture the shadow

Basics of X-Ray • Organs absorb X-rays differently and thus their shadow on the film is different • Bone: high absorption (film appears white) • Tissue: moderate absorption (film appears grey) • Air/Lungs: little absorption (film appears black)

Types of CXRs • PA and Lateral • Patient facing cassette • X-ray 6 feet away • Supine AP • X-ray 40 inches away • Magnifies anterior structures and pulmonary vasculature 101 cm 1.83 m

Comparing Chest X-rays Protocols PA AP Note heart enlarged, lung fields not as clear • Preferred method

PA Image • PA Film • Read as if patient is facing you (Patient’s left side is on the right of the X-ray)

Lateral Image • Obtained with patient’s left side against the cassette. • Minimizes heart silhouette magnification

Assessing Film Technique • Inspiration • Penetration • Rotation

Inspiration • Image should be at full inspiration • Diaphragm at level of 8-10 rib • Allows reader to see intrapulmonary structures Poor Inspiration mimics RML Infiltrate Same patient with proper inspiration

Penetration • Amount of radiation required for a quality image • PA film: should barely see thoracic spine disc spaces • Lateral: spine should appear darker as move cadually Examples of adequately penetrated images

Penetration Overpenetrated Underpenetrated

Rotation • Patient should be flat against the cassette • Rotation of the patient will alter appearance of mediastinum • Observe rotation by comparing location of clavicular heads • Should be equal distance from spinous process of thoracic vertebral bodies

Rotation Normal Rotated to the Right

Mass vs. Infiltrate Mass Infiltrate

Lobes and Fissures: PA Film A: Minor Fissure between RML and RLL B: Upper and lower boundaries of major fissures

Lobes and Fissures: Lateral A: Minor Fissure R Lung B: Major Fissure R Lung B: Major Fissure L Lung

CXR Anatomy

How to Read an X-Ray Part 1 • Patient Data (Name, history, age, sex) • Technique (PA vs. AP, rotation, penetration, etc) • Trachea: midline or deviated, any masses? • Lungs: masses, infiltrates? • Costophrenic angles should be sharp (if not = effusions) • Silhouette signs, air-bronchograms, pulmonary edema • Pulmonary vessels: enlarged?

How to Read an X-Ray Part 2 • Hilar Region: masses or lymphadenopathy • Heart: enlarged, abnormal shape • Pleura: effusion, thickening, calcification • Bones: fractures or masses • ICU Films: looks for line and tube placement

How to Read an X-Ray Part 3 • It is best to focus on a small area of the film and then scan rather than look at the whole film at once

Signs: Silhouette Sign • Loss of lung/soft tissue interface caused by mass, fluid, or infiltrate in the normally air filled lung • Commonly applied to heart, aorta, chest wall, and diaphram borders with lung • Location of silhouette sign helps to localize pathology Lose Right Heart and Lung border = RML

Signs: Air Bronchogram • Tubular outline of an airway made visible by filling of the surrounding alveoli by fluid or inflammatory exudates • Causes • Pulmonary edema • Lung Consolidation • Severe Interstitial Disease • Neoplasm

Signs: Solitary Pulmonary Nodule • Can be innocuous or potentially fatal lung cancer • Always compare to prior films for growth • Nodules with irregular borders are suspicious

Conclusions • Lots of information in a chest x-ray • Always read the film in the same order • Never skip to the most prominent abnormality, you will miss a small (but potentially important finding) • Compare to priors if possible • We will finish with some examples of common pathology

Examples: Atelectasis • Collapse or incomplete expansion of alveoli • Causes: • Endobronchial lesions (mucous plug or tumor) • Extrinsic compression (mass, lymph node) • Peripheral compression (pleural effusion) • Linear density on CXR

Examples: Pulmonary Edema • Cephalization of pulmonary vessels (arrow) • Kerley B Lines • Peribronchial cuffing • “Bat Wing” Appearance • Increased Cardiac Size (arrow)

Examples: Pneumonia • Airspace disease and consolidation • CXR Findings • Airspace opacity • Lobar consolidation • Interstitial opacities

Differentiating Atelectasis from Pneumonia Atelectasis Pneumonia Normal or increased volume No shift Consolidation, air space process Not centered at hilum Air bronchograms • Volume Loss • Associated ipsilateral shift • Linear, wedge shaped • Apex at hilum • Air bronchograms

Examples: TB • TB can be seen as consolidation, cavitation, fibrosis, adenopathy, or pleural effusion depending on stage of infection

Examples: Pleural Effusions Fluid in Costophrenic Angle Blunting of Costophrenic Angles

Examples: Pneumothorax (PTX) • Air inside the thoracic cavity but outside the lung • PTX appears as air without lung markings in least dependent area of chest

Examples: Hemopneumothorax Lung Air Fluid

Examples: Interstitial Lung Disease • Hazy ground glass opacification • Volume Loss • Linear opacities bilaterally • “Honeycomb lung”

Examples: COPD and Emphysema • Diffuse hyperinflation • Flattened diaphragms • Increased retrosternal space • Bullae

Examples: Rib Fractures • Can you find the rib fracture?

Examples: Pericardial Effusion

Examples: Hiatal Hernia Gastric Bubble

Hilar Enlargement Enlarged Pulmonary Artery Hilar Adenopathy

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8.1 PRODUCTION AND CHARACTERISTICS OF X-RAYS

Published by Joella Porter Modified over 9 years ago

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Presentation on theme: "8.1 PRODUCTION AND CHARACTERISTICS OF X-RAYS"— Presentation transcript:

Advanced Biomedical Imaging Lecture 3

X-ray tube.

Formation Characteristics

The X-Ray Tube Bushong Ch 7.

X-Ray Interaction with Matter & Human Biology

{ Projection Radiography Chapter 5 (in more detail)

Resident Physics Lectures

X-ray tube and detection of X-rays Lecture 5. Reminder: The rough schematics of an X-ray tube filament cathod target anode photon flux e-e- electron kinetic.

FRCR: Physics Lectures Diagnostic Radiology

ACVR Artifacts Artifacts of Diagnostic Radiology

ENTC 4390 PRODUCTION OF X RAYS.

Radiation Physics II.

Medical Imaging X-Rays I.

BME 560 Medical Imaging: X-ray, CT, and Nuclear Methods X-ray Instrumentation Part 1.

BME 560 Medical Imaging: X-ray, CT, and Nuclear Methods

Types of Radiation Interactions All or Nothing Many Small There is a finite probability per unit length that the radiation is absorbed. If not, there is.

The Origins of X-Rays. The X-Ray Spectrum The X-Ray Spectrum (Changes in Voltage) The characteristic lines are a result of electrons ejecting orbital.

Factors affecting the X-Ray output

X-Ray Production & Emission

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How to present an X-ray

A short guide to help you improve your presentation of radiographsin an exam situation or on the ward

The purpose of this guide isn’t to teach you what you’re going to see, but how you should say it!   Guides to help you get through looking at images systematically can be found elsewhere; our aim is to improve your presentation skills.

Opening line

Imagine you’re sat in an OSCE.  You are presented with a radiograph and invited to comment on it.  How might you start presenting?  Just as you wouldn’t jump straight to the heart sounds when presenting a cardiovascular exam, so you shouldn’t jump straight to the interesting bit of the image.

An opening line of:

“frontal chest radiograph of an adult patient”

…can virtually never be wrong.  This is often enough as an opening line, but you could expand if you can with the details you’re given – especially if you are given some of the patient’s history. For example:

“frontal chest radiograph of an adult male patient with shortness of breath”

For the first radiograph you see, it’s good to briefly demonstrate you know what an adequate radiograph looks like.  DO NOT SPENT LONG DOING THIS (10 seconds at most).  Some medical schools do not award any marks for talking about the adequacy of a radiograph so whatever you do, do not spend much time on this!  The interesting bit is describing the pathology on the radiograph itself.  On your second or subsequent radiograph during a station, if the image is clearly adequate, simply stick with your single opening line and proceed to the lungs.

There are broadly 3 categories of adequacy to assess:

• Rotation: are the clavicles equidistant from the spinous processes?
• Penetration: can you see the spine through the heart?
• Expansion: The anterior aspect of the 6 th rib (the sloping ones) should meet the diaphragm near the mid-clavicular line. You should be able to see the apices and costophrenic angles.

So you might introduce the above radiograph as follows:

“frontal chest radiograph of an adult female patient. It is not rotated, with good penetration and good expansion of the lungs, although the tips of the costophrenic angles are not included on this radiograph”

As a note of caution, some medical schools do not award any marks for talking about the adequacy of a radiograph so whatever you do, do not spend much time on this!  The interesting bit is describing the pathology on the radiograph itself.  On your second or subsequent radiograph during a station, if the image is clearly adequate, simply stick with your single opening line and proceed to the lungs.

Main abnormality

So you’ve made it to the lungs and something looks wrong.  This almost always means there is opacity (whiteness) where there shouldn’t be.  Describe this in terms of appearance and location.

Is the opacity:

• Patchy – hard to draw round properly, heterogeneous (e.g. pulmonary oedema)

• Dense – very white so that you can barely see structures through it (e.g. pleural effusion)

• Rounded – discrete, round(ish) in shape (e.g. a mass lesion in the lung)

Then ask yourself, where is the lesion located?

The lung lobes overlap significantly on a frontal chest radiograph, so it is hard to place an abnormality in a specific lobe when viewed only from the front.  A solution to this is to split the lung into zones – upper zone is above the heart, mid-zone is level with the top half of the heart, and lower zone is below that.  It is also worth looking under the diaphragms and behind the heart for subtle, ‘hidden’ lesions.

Ok, so now think how you might describe the abnormality in the radiograph we showed you at the start.

“there is a solitary rounded opacity in the left upper zone”

Review areas

To complete your assessment of a radiograph, particularly if it’s your first of a session, it’s worth quickly summarising the rest of the radiograph to show you have assessed everything.  If the abnormality is in the lungs, you might also comment on:

• The heart: is it enlarged?
• The diaphragm: can you see any free gas?
• The bones: are there any fractures?

So for our radiograph:

“the heart is not enlarged, there is no free air below the diaphragm, and there are no fractures identified”

Put everything above together and you’ll have had 30 seconds or so to think up a differential diagnosis to put the icing on your presentation:

“this could represent a primary lung malignancy, but might also be a metastasis”

Finally, finish by saying what you would do next:

“I would like to request a CT chest to further evaluate the lesion and look for evidence of malignancy”

So that’s it!

Stick to these basic rules and you will go a long way in your exams and when presenting on the ward.  Good luck!

• Christopher Clarke
• Last updated: 10 October 2021

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