Chest X_Ray Comprehensive Lecture Details The Essentials of Chest X-ray

1. FUNDAMENTALS OF RADIOLOGY
Training Resource for Paramedics
Academic Year: 2023/2024
Course Title: Medical Imaging Techniques
Mod. 5:
ESSENTIALS OF CHEST
X-RAYS (CXRS)
Course Lecturer
Nchanji Nkeh Keneth
Author/Rad Tech/Sonographer
B.TECH/HPD in MDIRT
Tel: +237671459765
kensacademia@gmail.com
CSMRR No. 001012016
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2. What we, Radiologic Technologists See;
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3. PRESENTATION OUTLINE
 Overview of Chest X-ray (CXR)
 Terminologies used in CXRs
 Indications for CXR
 Patient preparation for CXRs
 Radiographic Projections of the
Chest
 Pathological Findings on CXR
 Radiation Protection and Safety in Chest
radiography
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4. OUTCOME
 At the end of this presentation, students
would have:
Learned about basics of CXR, basic
definitions of CXR projections ,
How to prepare a patient for CXR
Be able to recognize abnormal CXR
findings and correlate with clinical
presentations
Radiation protection during CXR
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5. Requirements for this module:
All Students are Urged to review
their anatomy and physiology
lectures on:
• the Musculoskeletal System
• The Respiratory system
• And Pathological conditions
associated with these body systems
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6. Introduction To CXR
 The most frequently performed Radiographic
exams in radiologic departments of hospitals
world wide are Chest X-rays
 Chest X-rays are crucial in diagnosing most
cardiopulmonary diseases like Tuberculosis
 CXRs have the least Effective Dose of
radiation and can be repeatedly done, mindful
of Radiation Protection principles
 It is a commonly requested radiographic exam
by doctors and allied health professionals
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7. CXRs
 Are particularly crucial in evaluating TB
and Pneumonia
 There are nonetheless false positive
CXR findings, needing Lab and CT
Scan corroboration
 CXRs are useful both in Medical
Diagnosis, research and in Forensic
Science
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8. INDICATIONS FOR A CHEST X-RAY
1. The need to assess the lungs for masses
2. Positive Tb skin test findings, needing CXR
Confirmation
3. To assess the respiratory tract for causes of
persistent cough, hemoptysis
4. To assess the lungs for spread of cancer such
as in Prostate, colon cancer
5. CXR can be used to assess the ribs for bony
lesions and fractures
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9. INDICATIONS FOR CXR CON’T
6. CXR indicated for the assessment of the
abdomen in case of perforated intestinal
obstruction
7. Assessment of thoracic hernias
8. Assessment of sub diaphragmatic masses
9. CXRs are needed in case of follow-up
assessment post medical intervention of
cardiopulmonary pathologies
10. CXRs are indicated for recruitment and
other non-medical purposes
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10. Patient Preparation for a CXR
 Notify the patient of the procedure to be carried out and
reason for the procedure
 Assess the patient for fitness in collaborating (the sick
and elderly need assistance in standing or sitting for the
procedure)
 Let them know they will have to undress their clothes
from the chest and probably wear hospital gown
 If there be pins on their skin, and chains, it will have to
be removed to avoid artefacts on the cxr
 Breathing instructions will be given them and should be
followed for a good CRX outcome
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11. Radiographic Anatomy
 How to Study the Chest X-Ray
 Knowing Normal from Abnormal
Findings
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12. Principles in reading the Chest
Radiograph
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18. Definition of Key Radiographic
Densities on the CXR
 Air in the lungs Appear BLACK
 Bones Look WHITE
 Soft Tissues and Fat Appear Grey
 Fluids appear WHITE
 Metals and Foreign Dense Objects appear
BRIGHT WHITE
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19. Densities
The big two densities are:
(1) WHITE - Bone
(2) BLACK - Air
The others are:
(3) DARK GREY- Fat
(4) GREY- Soft tissue/water
And if anything Man-made is on the film, it is:
(5) BRIGHT WHITE - Man-made
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20. 10/11/2023
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21. RADIOGRAPHIC PROJECTIONS
 PA (Posterior Anterior CXR) in erect position;
This is the standard Position for a CXR
 AP (Anterior Posterior CXR), semi recumbent
position, or with patient lying supine on the
bed
 Lateral CXR
Remark: Gold standard for CXR is the PA Chest
X-ray in Erect Position
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22. PA
Portable
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23. Techniques - Projection
•P-A (relation of x-ray beam to patient)
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24. Techniques - Projection (continued)
•Lateral
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25. Techniques - Projection (continued)
•Lateral Decubitus
•Oblique
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26. ABCDE Rule in Looking at the
CXR
 ABCDE mnemonic …
 Airways
– Trachea, endotracheal tube, etc
 Bones
– Clavicles, ribs, etc…
 Cardiac- heart and associated vessels
 Diaphragm (Right hemi diaphragm slightly higher (~1.5
cm)
 Everything else (tubes), effusions
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30. Remark: PA/AP/Lateral CXRs
 Lateral CXRs are done to assess the
retrosternal and retrocardial areas
 Lateral CXRs equally confirm the location
of lung masses or cavities or lesions seen on
an AP or PA CXRs
 Lateral CXRs are not indicated for
assessing the apices of the Lungs
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31. PA CXR vs. Lateral CXR
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32. Understanding Lung Lobes
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33. Lobes
• Right upper lobe:
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34. LOBES (CONTINUED)
• Right middle lobe:
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35. LOBES (CONTINUED)
• Right lower lobe:
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36. Lobes(continued)
• Left lower lobe:
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37. LOBES (CONTINUED)
• Left upper lobe with Lingula:
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38. Lobes(continued)
• Lingula:
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39. Lobes(continued)
• Left upper lobe - upper division:
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40. Heart(continued 。。。。)
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41. HEART
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42. Ribs
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43. Reading the ribs
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47. PATHOLOGICAL
FINDINGS ON CXR
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48. Opacities
Lobar or not….
 Pneumonia
 Pulmonary Edema
– “fluffy,” diffuse, “bat wing” distribution
 Hemorrhage
– Can’t tell by x-ray, a CT Scan exam or Sputum
analysis
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49. RML pneumonia Opacities
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50. RLL pneumonia
Opacities
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51. RUL pneumonia
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52. LLL pneumonia
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53. The Enlarged Hila
Causes:
1. Adenopathies (neoplasia, infection)
2. Primary Tumor
3. Vascular
4. Sarcoidosis
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54. Lung Mass
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55. Hilar Lymphadenopathy - BL
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56. Multiple lung masses
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57. Pleural effusions
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58. Pulmonary Fibrosis
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59. Heart failure
lung hyperplasia edema）
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60. Heart failure
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61. Pneumothorax
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62. Emphysema
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63. TB
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64. Miliary TB
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65. Thin-walled Cavitating
lesion
Thick-walled Cavitating
lesion
3mm
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66. Bronchiectasis
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67. CARDIOMEGALY
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68. RIB FRACTURES
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70. PLEURAL EFFUSSIONS
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71. PULMONARY EDEMA
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72. PULMONARY FIBROSIS
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73. ATELECTASIS
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74. ATELECTASIS
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75. TUBERCULOSIS
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76. PNEUMOPERITONEUM
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77. THORACIC HERNIAS
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78. THORACIC HERNIA OF ABDOMINAL
STRUCTURES
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79. RADIATION PROTECTION
 All CXR exams must be properly requested
 All CXRs need Justification and should
influence the outcome of patient management
 Sensitive body parts (e.g gonads, etc) should be
protected during CXR
 Past CXR results should be accompanied during
radiographic exams of the chest
 Basic radiographic principles should be applied
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80. Lead apron used to shield the gonads
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81. What we, Radiologic Technologists See;
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82. 10/11/2023
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Nchanji Nkeh Keneth

83. References
1. Weizhong Cheng (n.d): Radiology of
the Respiratory System. Dept.
Radiology, Zhongshan Hospital.
Institute of Medical Imaging,
Shanghai
2. Gerald D.L., Simon M. and Laurence
B., (2008): The Chest X-Ray Survival
Guide. Saunders Elsevier (2008)
3. www.chestradiology.com
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84. Web Link References
 https://willpeachmd.com/radiology-learning-websites
 https://www.med.upenn.edu/normalcxr/
 https://www.radiologyinfo.org/en/info/chestrad
 https://www.radiologymasterclass.co.uk/
 http://www.learningradiology.com/
 https://www.fastcompany.com/90326445/this-free-ai-
reads-x-rays-as-well-as-doctors
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85. https://rpop.iaea.org/SAFRON/
https://rpop.iaea.org/safrad/
https://nucleus.iaea.org/isemir/
http://nucleus.iaea.org/HHW/MedicalPhysics/index.html
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86. Medical Imaging Training Resource
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