MRI
Multiple planes No radiation Common Indication
Pancoast tumour Brachial plexus Cardiac Vascular (aorta)
Usually targeted examination (unlike CT)
Coronal
Nuclear Medicine
Variety of tests: functional rather than anatomic
V/Q specific to chest imaging Others: bone scan, gallium, WBC etc.
Ultrasound
Limited use in thorax (non cardiac) due to air in lungs
Normal Anatomy
Bone-CT Reconstruction
PA View
Clavicle
Rib
Vertebral Column
Intercostal Space
Bone Anatomy
Sternum
Rib
Heart Size
Normal is <50% on PA upright radiograph
Assess pleural effusions Mainly used for procedures
Chest Radiographs
PA (posterior to anterior) and Lateral (left)
Minimizes magnification of heart (heart closest to film)
Carina
Bifurcation
Bronchus
Left and right Lobar (RUL,RML,LUL,LLL) Segmental (8 left, 10 right)
Trachea Carina
R + L Main Bronchi
Lung Anatomy
edema Other Lung Disease: Atelectasis, Nodule Pleura Mediastinal
Other Imaging Methods
CXR-Will be discussed later
Computed Tomography MRI Ultrasound
Mainly for procedures
Nuclear Medicine
Computed Tomography
Numerous protocols/techniques depending on clinical history
Helical/spiral versus high resolution
Contrast
Renal failure Allergy
Computed Tomography
Role of CT
Main further investigation for most CXR abnormality (eg nodule/mass) or to exclude disease with normal CXR
Main investigation for certain scenarios (PE, dissection, trauma)
Portable (nearly always AP)
Supine or Erect
Specialized Views
Lordotic Lateral decubitus (for effusions, pneumothorax)
Chest Radiograph: Approach and Normal Anatomy
Foundations of Medical Practice:
Chest Imaging
Overview
Imaging Methods
CXR: Main Focus Others: Computed Tomography, MRI, Ultrasound,
Nuclear Medicine
Approach to CXR
Lateral view
Cardiac Anatomy: Right Sided Chambers
Cardiac Anatomy: Left Sided Chambers
SVC
Right Descending Pulmonary Artery
Aortic Arch
Left Descending Pulmonary Atery
Densities Anatomy and approach Technical Factors
Overview cont’d
Abnormal CXR findings
Bone Cardiovascular Airspace Disease and Silhouette Sign Interstitial Disease with emphasis on pulmonary
Retrosternal Airspace
Hilum
Scapula
Lungs posteriorly should get darker as you go down more inferiorly
IVC
Pulmonary Vessels
Airway Membranous posteriorly
THERE IS NO ONE APPROACH: BE SYSTEMATIC
Bone and Soft Tissue including abdomen Heart Mediastinum-aorta, trachea Hila Pulmonary Vasculature Lungs Pleura
Radiation Dose
Compare dose to normal background radiation (3mSv/year)
CXR PA view :3 days
CXR PA Lat :18 days
Low Dose CT :0.5 year
HRCT
:1 year
Helical CT:2-3 years