29. RadAnatChest

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MODULE OF SKILL LABORATORIUM PRACTICE

BLOCK : RESPIRATORY SYSTEM

TOPIC : DEMONSTRATE KNOWLEDGE

INTERPRETING NORMAL PLAIN CHEST

RADIOGRAPH


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I. GENERAL OBJECTIVE

After finishing skill practice, the students will be

able to interpret normal plain chest radiograph


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II. SPECIFIC OBJECTIVE

At the end of skill practice, the students

will be able to demonstrate knowledge

a. radiopositioning of the chest

b. conditions of a good chest X-ray.

c. radioanatomy of the chest


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RADIO-POSITIONING

RADIO-ANATOMYOF THE CHEST

Dr. Effendi Mansoor, SpRad(K)


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RADIO POSITIONING

OF THE CHEST X RAY

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Radio positioning Anatomic structurePostero-anterior

projectionHeart and lungs

Antero-posterior

projection

Heart and lungs

Lateral projection Heart and lungs

Oblique projection Heart and lungs

Lateral decubitus

projection

Heart and pleura

Apical top lordotic

projection

Apical and medial lobe

of the lung

Cross table lateralprojection

Lung and pleura


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Chest X-ray Indication:

Contact person with open

pulmonary tuberculosis Cough > 2 weeks after treatment

Recurrent respiratory infection

Hemoptoe

Extra pulmonary TB

Erytema nodosum / conjunctivitis

phlyctenularis Fissura/fistula anichronicum

DM with cough

Screening


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PA Projection in suspended full inspiration:

Place patient between filmX raysource

The patient stands backward to the

X- ray source Chest close to film with hand on thehip & with elbow flexed anteriorly

Distance between film and X-Ray Lung 1.5 m

Heart 2.0 m

Ray concentrated at TH 6-7


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PA position


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Antero posterior (AP) projection

Indication :

Severely ill patient

Children / babies

Obese, pregnancy, ascites, abdominal tumor

Technique :

Place patient lying down on table with elbowabove head

Place film on patients back

Centered ray on Th 6-7


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AP Projection


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Lateral projection

Indication:

To study abnormality that is notvisible on PA film

To study mediastinal disorder

Heart studies

Technique:

Place patient between film and X-raysource

Place lateral side of chest (left/right)on film

Hands behind the head

Ray centered on Th 6-7


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Lateral position


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Oblique projection:

Indication : Heart studies, usually with barium

fill in oesophagus

To study abnormality that is not yet

clear on PA/lateral studies

Technique:

Place patient between film and ray

source. Put ventral left/right side of the

patients thorax on the film making

45 0angle.

Centered ray on Th 6-7


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Lateral Decubitus projection

Indication :

Fluid in pleural cavity that is around100-200 cc.

Fluid accumulation that is not yetdetermined on PA studies.

Technique:

Have the patient lying down onleft/right side with elbow above thehead.

Centered ray on Th. 6-7 fromanterior /posterior aspect.


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Normal


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Pleural effusion


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Top lordotic projection:

Indication :

To studies disorder located on apexclavicle turn upward

Technique :

Place patient between film and x-raysource.

Have the patient face the x-ray source.

Have the patient stand 30 cm in front

with back placed on the film Set top part of the film 1 inch above

the shoulder.

Centered ray on manubrium sterni.


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PA chest radiograph


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Condition of good radiograph of the chest

1. The quality of film is good

KV is enough (the thoracic vertebra

is clearly identified until the 3rd

thoracic vertebrae)

MAs is enough (our finger couldnot

be seen indistingly behind the film)

2. The thoracic cage is symetrical :

compare medial ends of the

clavical on each side with the

midline of thoracic spine (proc.

Spinosus)


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Condition of good radiograph of the chest (cont)

3. The entire lung are include within

the film, no motion with both

scapulas pull-out

4. Identity (marker/R/L, name,

gender, age) are complete

5. No artifact

6. Maximum inspiration : the rightdiaphragm as high as 5th ICS/6

end of the anterior rib

How and what to evaluate


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How and what to evaluate

the PA x-ray chest

1. Soft tissue :

- Is there any swelling/foreign

body/calcification/emphysema ?

2. Bony structure : Clavicle, rib, spine

- Is there any fracture, deformity, defect ?

3. Position of the trachea, is there any deviation ?

4. Heart and aorta : position, shape, size ?

5. Costophrenic and cardiophrenic angle : sharp ?

6. Pleural space : thickening/effusion/pneumothorax ?

7. Diaphragm : shape? position?

8. Pulmonal structure : symetrical brightness, pathologicopafication, nodular, linier, luscency ?


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9. Hilar region : shape, enlargment,

deviation, calcification ?

10. Pulmonary vessels : increase, decrease,

crowded ?

11. Mediastinum : shape, size, density ?


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PA position


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Heart and great vessels normal in size and

shape.

Lung fields clear, no evidence of lung

tuberculosis or any other lung disease

33

Sering tidak ada informasi klinis

ohon thora foto pada pasien dengan

hemoptoe


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Lung Anatomy-Right

Upper Lobe Apical Segment (1)Posterior Segment (2)

Anterior Segment (3)

Middle Lobe Lateral Segment (4)

Medial Segment (5)

Lower Lobe Apical Segment (6)

Medial basal Segment (7)

Anterior basal Segment (8)

Lateral basal Segment (9)

Posterior basal Segment (10)


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Lung Anatomy-Left

UpperLobe

Apicoposterior Segment (1, 2)Anterior Segment (3)

Superior Lingula Segment (4)

Inferior Lingula Segment (5)

Lower

Lobe

Apical (6)

Anterior medial basal (7, 8)Lateral basal (9)

Posterior basal (10)


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Pulmonary Segments


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Pulmonary segments


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Right lung lateral position


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Left lung lateral position


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Lateral position


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Mediastinum Borders

- Top : Apertura thoracis sup.

- Dorsal : Vertebral Column.

- Ventral : Sternum.

- Inferior : Diaphragm.

- Lateral : Mediastinal pleura.


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1. Anterior superior

2. Anterior medius

3. Anterior inferior4. Superior medius

5. Middle

6. Posterior superior7. Posterior medius

8. Posterior inferior

Mediastinal


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29. RadAnatChest

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