10/14/16

1

Basic Radiographic Principles – Part I

Kristopher Avant, D.O. October 19th, 2016

I have no disclosures relevant to the material presented in this discussion.

Real Disclosure!!

10/14/16

2

10/14/16

3

Undergraduate

Deaconess Hospital

Medical School

10/14/16

4

Orthopedic Residency

Hand & UE FellowshipTampa, Florida

10/14/16

5

Additional Disclosure!!!

Orthopedic Surgeon!!!!!

On the MenuØ Chest

Ø Abdomen

Ø MusculoskeletalØ Upper Extremities

Ø Lower Extremities

Ø Pediatrics

Ø Advanced Imaging

Ø Ultrasound

Ø CT Scan

Ø MRI

10/14/16

6

Basic Principles

Ø Be very systematic!!

Ø Correct patient

Ø Correct orientation

Ø Quality of film

Ø Tissue density - Absorb x-ray differently

Ø Bone – High absorption = More White

Ø Soft tissue – Various absorption = Can vary

Ø Air – Low Absorption = More Black

Ø Know normal anatomy!

Chest Objectives

Ø Components in Interpretation

Ø Normal Findings

Ø Abnormal Findings

Ø Common Pathology

Chest Radiographs

10/14/16

7

ABC’s

Ø Airways

Ø Breathing & Bones

Ø Circulation

Ø Diaphragm

Ø Extras

Anatomy

Details

Ø Patient name / DOB

Ø Orientation of x-rayØ Left / Right / AP vs. PA / Upright vs. Supine

Ø Inspiration / Expiration

Ø RotationØ Clavicular distance

Ø PenetrationØ Thoracic vertebra seen

10/14/16

8

Soft Tissue & Bones

Ø Fracture / Dislocations

Ø Blastic or lytic lesions

Ø Foreign bodies / surgical clips

Ø Breast shadows

A – Airway & Mediastinum

Ø Trachea – Midline?

Ø Paratracheal / mediastinal masses / adenopathy

Ø Carina & RMB/LMB

Ø Mediastinal width < 8 cm

Ø Aortic knob

Ø Check vessels, calcification

B - BreathingØ Lung fields

Ø Vascularity

Ø Pneumothorax

Ø Lung field outlines

Ø Abnormal opacity/lucency

Ø Consolidation / Collapse

Ø Pulmonary infiltrates – Interstitial vs. Alveolar

Ø Cavitary lesions

Ø Pleura

Ø Pleural reflections

Ø Pleural thickening

10/14/16

9

C- Circulation

Ø Heart Position – 2/3 to left & 1/3 to right

Ø Heart size – Cardiothoracic Ration (< 0.5)

Ø Heart Borders Ø Right – Right Atrium

Ø Left – Left Ventricle & Atrium

Ø Heart Shape

Ø Aortic Shape

D - Diaphragm

Ø Right hemidiaphram usually higher

Ø Diaphragm shape / contour

Ø Cardiophrenic / Costophrenic angles

Ø Gastric bubble / colonic air

Ø Subdiaphramatic air (Pneumoperitoneum)

E - Extras

Ø ET Tubes

Ø NG Tubes

Ø ECG electrodes

Ø PICC lines

Ø Chest Tubes

Ø Pacemakers, etc

10/14/16

10

Heart

Sharp Angles(Costophrenic / Cardiophrenic)

Hilar Region

10/14/16

11

Consolidation

Pathology

Pneumothorax

10/14/16

12

Tension Pneumothorax

Pneumothorax

RLL Pneumonia

10/14/16

13

Right Middle Lobe Pneumonia

Left basal pleural effusion and consolidation

Congestive Heart Failure

10/14/16

14

Croup - Paromyxovirus

Left Upper Lobe Tumor

Chest Summary

Ø Be very systematic!

Ø Make sure you have good quality films!

Ø Know normal anatomy!

Ø You only see what you know!

10/14/16

15

Abdomen Objectives

Ø Components in Interpretation

Ø Normal Findings

Ø Common PathologyØ Colitis

Ø Constipation

Ø Obstruction

Ø Volvulus

Develop YOUR RoutineØ Rectum

Ø Bowel

Ø Kidneys, Ureters, & Bladder (KUB)

Ø Organs

Ø Bones

Normal Findings

Ø Gas PatternØ Stomach

Ø Small BowelØ Sigmoid & Rectum

Ø Large BowelØ PeripheralØ Haustral markings don’t extend wall to wall

Ø Small BowelØ Central

Ø Valvulae extend across the lumen

10/14/16

16

Normal Anatomy

Gas Pattern

Organs

10/14/16

17

Colitis

Ø Colonic Edema

Ø Mucosal thickening – “Thumb-printing”

Ø “Lead Pipe” colon

Ø Toxic Megacolon

“Thumb-printing”

“Lead Pipe”

10/14/16

18

Toxic Megacolon

Constipation

Ø Clinical Diagnosis

Ø Majority of bowel will always have some stool

Ø X-ray demonstrates limited utility

Locked & Loaded!!

10/14/16

19

Small Bowel Obstruction

Ø Dilated small bowel > 3 cm

Ø Centrally located

Ø Loss of large bowel markings

Ø Valvulae extend all the way across

Ø Post-op ileus appears very similar

Small Bowel Obstruction

Large Bowel Obstruction

Ø Colon is dilated > 6 cm

Ø Peripheral

Ø May lead to SBO

Ø Caused by colo-rectal carcinoma / diverticular strictures

10/14/16

20

Large Bowel Obstruction

Volvulus

Ø Twisting of the bowel

Ø Sigmoid vs. Caecal (rare)

Ø Sigmoid more commonØ Coffee-bean

Ø Points toward right upper quadrant

10/14/16

21

Sigmoid Volvulus

Caecal Volvulus

Abdomen Summary

Ø Develop your routine!

Ø Know your anatomy!

Ø Make sure you have good quality films!

Ø You only see what you know!

10/14/16

22

Questions, Concerns, Complaints?

Thank You!!!