Lecture 21 Indications for chest Radiography Clinical Problem

Lecture (21)

• • • • • • Indications for chest Radiography Clinical Problem Chest pain Acute aortic dissection Pulmonary embolus Pericardial effusion Pleural effusion Vascular disease Chest trauma Pneumonia follow up Haemoptysis Non specific chest pain Chest trauma Upper respiratory tract infection Chronic obstructive lung disease Chest masses Chest infection ( consolidation ) Pneumothorax Hydropneumothorax Hydrohaemopneumothorax Haemothorax

• Chest Projections Basic views PA/ AP Upright Lateral RAO / LAO RPO/LPO PA chest Exposure factors Kv m. As FFD (cm) 75 -80 Patient Position 15 180 Grid Focus Cassette non broad 35 x 43 Patient erect, feet spread slightly, weight Distributed on both feet Chin raised resting against cassette Hands on lower hips, palms out and elbows flexed

• Part position • Align Medial sagittal plane to midline of cassette • Ensure no rotation of thorax • Rotate shoulders forward to allow scapula to move laterally away from lung fields • Depress shoulders to downward to move clavicles below the lung apices • Make exposure at end of second full inspiration • Central Ray Perpendicular to medial sagittal plane • Center Point • At level of T 7 (Inferior angle of scapula )

• Structure shown • • • Both lungs from apices to costophrenic angles The air filled trachea from T 1 down Hilum region markings Heart &great vessels Bony Thorax

• AP Chest (For Stretcher or bed patients Patient Position Patient is supine in cart If possible raised the headedcart or bed into a semi erect position Role patient shoulders forward by rotating armmedially or internally Part Position Align Medial sagittal plane to midline of cassette Ensure no rotation of thorax Top of film 4 -5 cm above shoulders Place caste crosswise to avoid lateral cutoff Make exposure at end of second full inspiration Central Ray Angled caudad to be perpendicular to long axis of the sternum Center Point At level of T 7 (3 -4 inches below jugular noch

• AP Chest (For Stretcher or bed patients Patient Position Patient is supine in cart If possible raised the headedcart or bed into a semi erect position Role patient shoulders forward by rotating armmedially or internally Part Position Align Medial sagittal plane to midline of cassette Ensure no rotation of thorax Top of film 4 -5 cm above shoulders Place caste crosswise to avoid lateral cutoff Make exposure at end of second full inspiration Central Ray Angled caudad to be perpendicular to long axis of the sternum Center Point At level of T 7 (3 -4 inches below jugular noch

• • • Structure shown Both lungs from apices to costophrenic angles The air filled trachea from T 1 down Hilum region markings Heart will appear enlarged due to magnification from short FFD Bony Thorax Notes: Crosswise alignment of cassette need accurate perpendicular • alignment of central ray to cassette to avoid grid cutoff • If pleural effusion is suspected decubitus position is recommended to demonstrate air-fluid level