Chest X-ray interpretation for students and physicians in training

1. Chest X-ray
Sarfraz Saleemi MD

2. X-ray DENSITIES
Blackest Air< fat< liver< blood< muscle< bone Whitest

3. M C Alraies 3
Technical Aspects
• Identification – name, file number, date & time
• Projection – PA or AP
• Position – Upright or Supine
• Inspiratory effort – ?poor inspiration
• Exposure - ?overexposed ?underexposed
– thoracic intervertebral disc space just visible
• Positioning/rotation
– medial clavicle heads equidistant to spinous process

4. Four major positions of Chest X-ray
• Posterior-anterior (PA)
• Anterior-posterior (AP)
• Lateral
• Lateral Decubitus

5. 5
AP (Antero-posterior)
(Portable)
FILM
FILM
X-ray Beam
PA ( Postero-anterior)
PA or AP view

6. PA
• Scapulae are visible over lung fields
• Heart appear larger
• Mediastinum widens
• Diaphragm are higher
• Pulmonary vascularity increase
AP

7. LATERAL view

8. Decubitus View
• "decubitus" means "lying down“
• To confirm free flowing effusion.

9. Three Main Factors Determine the
Technical Quality of the Radiograph
• Inspiration
• Exposure (Penetration)
• Rotation

10. Good inspiration film Poor inspiration film
9-10 post ribs
6 ant ribs

11. Good exposure Under-exposedOver-exposed
Over-exposed Under-exposed

12. Is this film rotated? Is this film rotated?
Rotation

13. Extreme rotation

14. Anatomical Structures in the Chest
• Mediastinum
• Hilum
• Lung Fields
• Diaphragmatic Domes
• Pleural Surfaces
• Bones
• Soft Tissue

15. Anatomy of Chest X-ray
scapula
Oblique
fissure
Oblique
fissure
horizontal
fissure

16. Upper lobe
Lower lobe
Left LUNGRight Lung
Upper lobe
Lower
lobe
Middle
lobe
Right Lung
2 fissures (oblique and
horizontal).
3 lobes (upper,
middle, lower)
10 segments
Left Lung
1 fissure (oblique)
2 lobes (upper and
lower)
8 segments
Lingula

17. Common Abnormal finding on Chest X-ray
Lucency
(lower density than surrounding tissue)
Opacity
(higher density than surrounding tissue)

18. Linear Reticular Reticulonodular
Alveolar

19. Cavity
Cysts

20. Consollidation Collapse
Nodule Mass

21. Cardiothoracic Ratio

22. Pulmonary vasculature

23. Hilum

24. Silhoutte Adjacent lobe/segment
Right Diaphragm RLL/Basal segments
Right Heart margin RML/Medial segment
Ascending Aorta RUL/Anterior segment
Aortic knob LUL/Posterior segemnt
Left Heart margin Lingula/Inferior segment
Descending Aorta LLL/post segment
Left Diaphragm LLL/Basal segments
SILHOUETTE SIGN

25. Normal X-ray

26. Pleural effusion
Meniscus sign

27. Pulmonary edema

28. Bronchiectasis

29. Bronchiectasis
(Saccular)Varicose Cystic cylindrical

30. Cavities with air fluid level

31. ILD

32. COPD

33. RUL consolidation

34. Cardiomegaly/pericardial effusion

35. Right lung collapse Massive right pleural effusion

36. LLL pneumonia

37. Lingular Pneumonia

38. Lung mass

39. Right Pneumothorax

40. Tension Pneumothorax

41. Dextro-cardia/situs inverses

42. Bilateral hilar lymphadenopathy

43. Right diaphragm paralysis

44. Tenting of right diaphragm due to right upper lobe
collapse

45. NG tube right lung

46. Hiatus Hernia

47. Left lower lobe posterior segment consolidation

48. Hidden areas of Chest X-ray

49. Thanks