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Learning Radiology

Adequate Chest Radiography

TermDefinition
Penetration Should be able to see the spine through the heart
Inspiration Should see at least eight to nine posterior ribs
Rotation Spinous process should fall equidistant between the medial ends of the clavicles
Magnifications Anteriorposterior films magnify the heart slightly
Angulation Clavicle normally has an S shape and medial end superimposes onto the 3rdor 4th rib.
Posterior ribs Are immediately more apparent to the eye on frontal chest radiography. They are oriented more or less horizontally. Each pair attaches to a thoracic vertebral body.
Anterior ribs are visible, but more difficult to see on the frontal chest radiograph. They are oriented downward toward the feet. They attach to the sternum or to each other with cartilage that usually is not visible until later in life, when the cartilage may calcif
AIR HU -1000, appears that blackest on a radiograph
BONE HU 400-600
FAT HU -40- -100, shown in a lighter shade of gray than air
WATER HU 0
SOFT TISSUE HU 20-100,
DENSE SUBSTANCES absorb more xrays, have high CT numbers, are said to demonstrate increased attenuation, and are displayed as whiter densities on CT scans
LESS DENSE SUBSTANCES absorb fewer xrays have low CT numbers, are said to demonstrate decreased attenuation, and are displayed as blacker densities on CT scans.
Pixels matrix of 1000 tiny squares
Metal Usually absorbs all xrays and appears the whitest
Pleura composed of two layers, the outer parietal and inner visceral layers, with the pleural space between them.
Five key areas of a chest xray retrosternal clear space Hilar region Fissures Thoracic Spine Diaphragm and the posterior costophrenic sulci
Retrosternal clear space lucent crescent between sternum and ascending aorta
Hilar region no discreet mass present
Fissures Major and minor fissures should be pencil-point thin, if visible at all.
Thoracic Spine Rectangular vertebral bodies with parallel end plates; disk spaces maintain height from top to bottom of thoracic spine
Diaphragm and posterior costophrenic sulci Right hemidiaphragm slightly higher than left; sharp posterior costophrenic sulci
Lung Window chosen to maximize the ability to image abnormalities of the lung parenchyma and to identify normal and abnormal bronchial anatomy.
Mediastinal Window chose to display the mediastinal, hilar, and pleural structures
Bone Window utilized quite often as a third way of displaying data, demonstrating the bony structures to their best advantage
Trachea Usually oval shaped, 2 cm in diameter
Aortopulmonary Window Visible space just underneath the arch of the aorta but above the pulmonary artery. It is a common location for enlarged lymph nodes to appear.
Minor Fissure travels in the same horizontal plane as an axial CT image so that it normally is not visible, except in the sagittal or coronal plane. The location can be inferred by an avascular zone between the right upper and middle lobes
Major Fissure demarcates the upper lobe from the lower lobes.
Ascending Aorta Should normally not project farther to the right than the right heart border
Aortic knob normally <35mm (measured from the edge of the air-filled trachea) and will normally push the trachea slightly to the right
Main pulmonary artery segment is usually concave or flat. In younger females, it may be normally convex outward
Normal left atrium does not contribute to the border of the heart on a nonrotated frontal chest radiograph
enlarged left atrium fills-in and straightens the normal concavity just inferior to the main pulmonary artery segment and may sometimes be visible on the right side of the heart.
Left ventricle lower portion of the left heart border is made up of the
Descending aorta parallels the spine and nis barely visible on the frontal radiograph of the chest.
 

 



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