Chest X-Ray Techniques: Inspiration, Penetration, Rotation – Radiology | Lecturio


[Music] so there are three different major techniques that are used with chest x-rays let’s take a look at each one so we have inspiration penetration and rotation and each of these can change the appearance of the chest so this is an example of an expert or a film versus an inspiratory film when a chest x-ray is obtained you really want to obtain it in optimum inspiration so that means about eight to nine posterior ribs should be visible so taking a look at this inspiratory film here the way you count the posterior ribs is this so the ribs that are seen best are the ones that are posterior these are the ribs that are right here and you want to start from the top and just count all the way down to the bottom a low inspiration results in crowding of the lung markings so as you compare this expert ory film versus the inspiratory film you can see that there is crowding of the lung markings the lung volumes look actually a lot lower on the expert Tori film than they do on the inspiratory film and everything because of that just looks very hazy so oftentimes it’s difficult to detect an abnormality on a patient that doesn’t have a good inspiration penetration is another technical factor so the film on the Left is over penetrated while the film on the right is under penetrated penetration refers to the amount of x-rays that are passing through the area that’s being evaluated and penetration can differ based on patient body type so if a patient if a film is over penetrated that means everything will appear very dark and that can mimic abnormalities such as a pneumothorax which we’ll discuss later if a film is under penetrated then everything will look very white and that can make it very difficult to actually see what’s going on in the lungs rotation is another technical factor if a patient is rotated the mediastinum and hilum turned towards the side of rotation and they appear larger on that side which can mimic a mass so this is an example of three different types of rotation the first one is normal the middle one represents a patient that’s rotated to the right and the last one represents a patient that’s rotated to the left so to tell whether a patient is rotated or not the easiest way is to look at the medial ends of the clavicles and they really should be equidistant from the spinous process so let’s take a look here on this first film here is the medial end of the right clavicle and here is the medial end of the left clavicle if you look right in the midline here these are the spinous processes so you want to be equidistant from the spinous processes which this one is and this is the typical view that we would want to obtain the film in if a patient is rotated to the right you have more space between the right clavicle and the spinous process then you do between the spinous process and the left clavicle so you can see here it almost looks like there’s a little bit of a mass that’s projecting on this side and that’s really just the mediastinal structures that are turning towards the side of rotation similar to a patient that’s rotated on the Left where there’s more space between the left clavicle and the spinous process than there is between the right clavicle and the spinous process so it’s important to develop a normal algorithm to take a look at a chest radiograph this is important in all of radiology for every imaging study that you look at you want to have a normal algorithm so that you ensure that you look at every single structure that’s present on the film so this is an algorithm that I use when looking at a chest x-ray I first take a look at any abnormal tubes lines and foreign objects patients that are in the hospital may have multiple different lines and tubes that are placed within them and you want to make sure that you look at all of these and to ensure that they’re in satisfactory position I then take a look at the lungs I next look at the airway that includes the trachea and the bronchi you want to take a look at all of the mediastinal boundaries and make sure that they look normal without the presence of any mass I then take a look at all of the surrounding soft tissues including the soft tissues of the shoulders the neck and the chest I take a look at the bony structures and you can see multiple ribs you can see clavicles you can often see the shoulders as well on a chest radiograph and then lastly I take a look at the upper abdomen although we don’t see a very large portion of the upper abdomen we do see a small and it’s important to make sure that if there are any abnormalities we see them on the chest radiograph [Music] you

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