Chest X-ray: Introduction and Approach
Summary
TLDRThis video serves as an introduction to interpreting chest X-rays, emphasizing the importance of understanding normal anatomy and adopting a systematic approach to both frontal and lateral X-rays. Key takeaways include recognizing normal appearances and a step-by-step method for analyzing X-rays, from assessing lines and tubes to examining the heart, mediastinum, lungs, and pleura. The video also discusses radiation doses and the significance of identifying abnormalities, such as lung cancer, through regular practice and case review.
Takeaways
- 📚 **Learning Normal Anatomy**: The video emphasizes the importance of familiarizing oneself with what normal chest x-ray anatomy looks like.
- 🔍 **Solid Approach**: It introduces a systematic approach to analyzing both frontal and lateral chest x-rays, which is crucial for identifying common and critical findings.
- 🌐 **Simplicity Overwhelm**: The speaker advises to keep the approach simple, avoiding getting lost in a laundry list of details that can be overwhelming for beginners.
- ⚠️ **Technical Aspects**: A few technical aspects like patient rotation and film quality are mentioned, but the focus is on the basics rather than minor details.
- 📈 **Radiation Awareness**: The video discusses the radiation dose of chest x-rays, comparing it to background radiation to provide perspective.
- 📊 **Radiographic Densities**: It explains the basic radiographic densities (air, bone, fat, water, soft tissue) and how they appear on x-rays.
- 👀 **Visual Cues**: The script provides visual cues for identifying different anatomical structures and abnormalities on chest x-rays.
- 🔎 **Detailed Examination**: It outlines a detailed method for examining various parts of the chest x-ray, including the heart, mediastinum, lungs, pleura, and bones.
- 📖 **Practice Makes Perfect**: The video concludes by encouraging practice and experience as the best way to improve at interpreting chest x-rays.
- 🔍 **Case Studies**: The next video in the series will focus on applying the learned approach to illustrative cases to help viewers improve their skills.
Q & A
What are the two most important things to take away from the first video on chest x-rays?
-The two most important things are learning normal anatomy and getting used to what normal looks like, and developing a solid approach to both frontal and lateral chest x-rays.
Why is it important to understand the radiation dose of a chest x-ray?
-It is important to understand the radiation dose to know how much radiation a patient is exposed to and to be able to explain this to patients. A chest x-ray uses about 0.1 millisieverts of radiation, which is very low and comparable to about 10 days of background radiation.
What is the difference between a PA and an AP chest x-ray?
-In a PA (posterior-anterior) view, the x-ray beams come from the posterior side of the patient to the anterior side, while in an AP (anterior-posterior) view, the x-rays come from the anterior side to the posterior side. The PA view generally provides a better quality image with more visible lung detail.
What does the cardiothoracic ratio represent on a PA chest x-ray?
-The cardiothoracic ratio represents the ratio of the size of the heart to the size of the entire chest, measured horizontally from pleura to pleura. It is normally less than 0.5 on a PA film.
How can you tell if a patient has rotated during a chest x-ray?
-You can tell if a patient is rotated by looking at the medial aspects of the clavicles in comparison to the spinous processes; the spinous processes should be roughly halfway between the medial aspects of the clavicles.
What is the normal appearance of the AP window on a chest x-ray?
-The AP window, which is the space between the aorta and the pulmonary artery, should normally be concave. If it is convex or filled in, that is abnormal.
What is the significance of the retrosternal airspace on a lateral chest x-ray?
-The retrosternal airspace should appear relatively dark on a lateral chest x-ray. If it is not, it can indicate pathologies such as an anterior mediastinal mass.
Why are lateral chest x-rays more sensitive to small pleural effusions than frontal chest x-rays?
-Lateral chest x-rays are more sensitive to small pleural effusions because they allow for better visualization of the costophrenic angles, where fluids collect in cases of small effusions.
What are the five main things to look for in a simplified approach to a lateral chest x-ray?
-The five main things to look for are the retrosternal airspace, the retro cardiac area, the spine sign, the hilar anatomy for lymphadenopathy, and the costophrenic angles for pleural effusions.
How can you determine if a patient has had a good enough inspiration on a chest x-ray?
-You can determine if a patient has had a good enough inspiration by checking if at least six anterior ribs or ten posterior ribs are projecting over the lungs, indicating adequate inhalation.
Outlines
📘 Introduction to Chest X-Rays
This paragraph introduces the video as an educational resource for learning chest X-rays systematically. It emphasizes the importance of understanding normal anatomy and adopting a structured approach to interpreting both frontal and lateral chest X-rays. The speaker intends to simplify the learning process by focusing on the basics and avoiding overwhelming details. Technical aspects like patient positioning and the significance of the radiation dose used in X-rays are briefly mentioned, with a comparison to background radiation levels to highlight the safety of chest X-rays. The video also covers different types of chest X-ray views, with a focus on the PA view, which is commonly used for outpatients and mobile patients in emergency departments.
🔍 Understanding Radiographic Densities
The second paragraph delves into the concept of radiographic densities, explaining how different tissues appear on X-ray images based on their density. It outlines the four principal radiographic densities: air, soft tissue, fat, and bone. The paragraph uses the example of a normal chest X-ray to illustrate these densities, pointing out how the lungs appear dark due to air, while bones and dense tissues like the heart appear brighter. The speaker also discusses the importance of recognizing normal anatomical structures and the potential for abnormalities, such as pneumomediastinum, which can be identified by gas in the neck soft tissues. The focus is on developing a visual understanding of what constitutes a normal chest X-ray and what variations might indicate a medical issue.
👨⚕️ Approach to Reading Chest X-Rays
Paragraph three introduces a systematic approach to analyzing chest X-rays, starting with the lateral view and discussing the normal anatomy that should be familiar to radiologists. It highlights key structures such as the trachea, bronchi, pulmonary arteries, and cardiac borders. The speaker emphasizes the importance of recognizing normal patterns and being aware of potential signs of lymphadenopathy, such as a 'donut sign'. The paragraph also touches on other aspects of a normal lateral chest X-ray, including the retrosternal airspace, retro cardiac space, spine sign, costophrenic angles, and hemidiaphragm levels. The goal is to establish a foundation for identifying abnormalities by understanding what constitutes a normal chest X-ray in terms of both anatomy and radiographic presentation.
🔎 Detailed Examination of Chest X-Ray Components
This paragraph provides a detailed approach to examining the various components of a chest X-ray, starting with the frontal view. It outlines the steps to check for correctly positioned lines and tubes, assess the heart's borders and size, and look for abnormalities such as calcifications or gas. The mediastinum is also scrutinized for size, position, and any bright or dark areas that might indicate issues. The lungs are examined for asymmetry and abnormalities like consolidation, masses, and reticulation. The pleura is checked for pneumothoraces and pleural effusions, with special attention to the costophrenic angles. The abdomen is briefly examined for free gas under the diaphragm, and the bones and soft tissues are screened for any obvious issues. The speaker also mentions four common areas where abnormalities might be missed: the apices, hila, retro cardiac region, and retro diaphragmatic regions.
📝 Reviewing Chest X-Ray Quality and Pitfalls
The fifth paragraph discusses the importance of assessing the quality of a chest X-ray, including patient rotation, inspiration depth, and exposure levels. It provides tips on how to determine if a patient is rotated by comparing clavicles to spinous processes and how to judge the depth of inspiration by counting visible ribs. The speaker also explains how to identify overexposed and underexposed films and their appearances. The paragraph reinforces the need to be vigilant about potential blind spots and to develop a keen eye for detail when reading X-rays. It concludes with a brief mention of the upcoming video, which will focus on identifying abnormalities in chest X-rays.
👨🏫 Applying the Approach to a Real Case
In the final paragraph, the speaker applies the previously discussed approach to a real chest X-ray of a 60-year-old smoker. The analysis includes checking for lines and tubes, assessing the heart, mediastinum, lungs, pleura, and abdomen, and examining the bones and soft tissues. The speaker also reviews the checkpoints for common oversights. The paragraph concludes with the identification of a lung cancer in the X-ray, underscoring the importance of meticulous examination. The speaker encourages continued practice and familiarity with common pathologies to improve chest X-ray interpretation skills.
Mindmap
Keywords
💡Chest X-ray
💡Anatomy
💡Radiation Dose
💡PA View
💡Lateral Chest X-ray
💡Radiographic Density
💡Pneumomediastinum
💡Cardiothoracic Ratio
💡Pleural Effusion
💡Abdomen
💡Approach
Highlights
Introduction to systematic approach for chest x-rays
Importance of learning normal anatomy in chest x-rays
Overview of the two most important takeaways from the video
Simplification of the approach to chest x-rays by focusing on basics
Technical aspects to consider while interpreting chest x-rays
Understanding radiation doses in chest x-rays
Comparison of radiation doses between chest x-rays and other imaging studies
Different chest x-ray views and their applications
Explanation of PA and AP views in chest x-rays
Importance of x-ray beam orientation in image interpretation
Basic radiographic densities and their appearance on x-rays
Identification of normal anatomy on chest x-rays
Approach to reading a frontal chest x-ray systematically
Importance of checking for lines, tubes, and their positions
How to assess the heart on a chest x-ray
Mediastinum assessment techniques on chest x-rays
Lung assessment for abnormalities on chest x-rays
Pleura assessment for effusions and pneumothoraces
Abdominal assessment on chest x-rays for free air
Bone and soft tissue assessment on chest x-rays
Checkpoints to avoid common mistakes in reading chest x-rays
Simplified approach to lateral chest x-rays
Practical example of reading a chest x-ray and identifying abnormalities
Conclusion and encouragement for practice to improve chest x-ray interpretation
Transcripts
this video is an introductory video
designed to give you a solid systematic
approach to chest x-rays in part 2 we're
gonna practice applying this approach by
looking at a few illustrative cases of
common things that you're gonna see and
things that you shouldn't miss the two
most important things to take away from
this first video are 1 learning normal
anatomy while really getting used to
what normal looks like and then to a
solid approach to both frontal and
lateral chest x-rays there are a few
things that we're gonna cover first
but the anatomy and the approach are the
main things that I want you to take away
from this video so let's get started
this is a chest x-ray when most
resources try to teach you an approach
the first thing that they tell you to do
is to look at a bunch of quality things
like patient name date a few technical
things about film quality I'm gonna skip
over most of this a lot of basic chest
x-ray resources give you a laundry list
of things to think about when you're
looking at chest x-rays and to be honest
it can be a little bit overwhelming at
first so let's keep it simple and focus
on the basics with that being said I'm
gonna mention a few technical things
that I actually do think are important
once you know the basic anatomy things
like how you can tell if the patient is
rotated but again for this video don't
get tied down with little details here
and there focus on the basic principles
and the big picture as you know chest
x-rays use x-rays a form of ionizing
radiation and it's probably important
that you know about how much radiation
that is and how to explain the radiation
dose to patients this bar graph shows
typical effective radiation doses for
different imaging studies in
millisieverts it's important to know
that the background radiation dose that
we are exposed to by just living on
earth from just background radiation
which is very low is about 3
millisieverts per year this helps us put
these doses into perspective a chest
x-ray uses about 0.1 millisieverts of
radiation a very small amount this is on
the order or about 10 days of background
radiation a body CT for comparison is on
the order of a few years of low-level
background radiation still a relatively
low dose for a single exam don't get too
bogged down with any of the numbers here
the key is that you know that yes chest
x-rays do use radiation but the dose is
very low and it's on the order of days
of background radiation there are a
number of different chest x-ray views
that you're commonly going to see
including PA when the x-rays come from
posterior to anterior through the body
ApS which are usually performed portably
is the opposite so the x-rays are coming
from anterior to posterior these can
either be done in a supine position with
the patient lying flat or upright if the
patient is sitting or standing we also
have lateral chest x-rays that we'll
show you and then other special views
like a lateral decubitus views where the
patient's on their side and we'll talk
about applications in the next video
the most common view that you're
probably going to order and probably
gonna see for outpatients and relatively
mobile patients in the emergency
department is a PA view and again that
means that the x-ray beams are going
from the posterior side of the patient
to the anterior side of the patient the
film is on the anterior aspect of the
patient and is exposed by beams that
make it through things that are closer
to the film are going to look smaller
and anything further away from the film
is going to look relatively magnified so
with that in mind we can see why the
orientation of the x-ray beams matter
here we have two films one is a P and
the other is PA the one on the left is
the AP view and the
on the right is the PA view the film is
usually labeled but you can usually tell
by just looking at the pictures things
closer to the film are going to look
smaller and sharper and things further
away from the film are going to look
relatively magnified on the PA view you
can see that the heart is smaller you
can see the anterior ribs which I've
outlined here are relatively sharper and
the overall quality of the film is
better on the PA film here as a result
of all of these things we're gonna see
more of the lungs on the PA film and
we're also gonna be able to pick up more
abnormalities the PA and lateral films
are the two standard chest x-rays that
you're gonna see most commonly in
practice for eMobile patients like
patients from the ICU who often get
films daily they are often taken
portably by the patient's bed in AP so
back to our chest x-ray we mentioned
that x-ray beams that make it through
the patient can be detected on the other
side and those that don't make it
through obviously cannot on an x-ray
areas that don't attenuate the x-rays as
much I II the x-rays that make it
through easily show up as darker this
means that in general less dense things
look darker like the lungs and more
dense things look brighter
we covered the basic radiographic
density's in the introduction to CT
video and abdominal x-ray video so we
won't belabor the point but it's
important to remember the main
radiographic density's remember on CT we
can quantify densities on a scale called
the Hounsfield unit scale this is also
covered in other videos like the
introduction to CT video in more detail
but for x-ray things are a little bit
more simple so don't worry about the
stuff for now in general we can simplify
this to four principal radiographic
densities we have air that is very low
density we have bone and metal that are
higher in density are going to show up
as brighter and then in between we
fat water and soft tissue remember fat
is less dense than water if we mix oil
and water oil floats because it's less
dense and it's gonna show up as slightly
darker than soft tissue and water and if
we look at a normal chest x-ray we can
immediately apply this basic knowledge
although these structures are
overlapping and any point on the image
or on the x-ray is a reflection of all
of the materials between the x-ray
source and the film at that particular
location you can still identify the
radiographic density's the lungs are
filled with air and show up as very dark
the bones are denser and show up
relatively brighter soft tissues are
slightly less dense and there are even a
few places on the x-ray where you just
see fat and are relatively low density
so for example you have subcutaneous
fatty tissue that you see part of here
that's darker than the soft tissues
adjacent you also see between the
musculature planes of fatty tissue here
that are relatively darker and again
this is a normal chest x-ray another
location where you commonly will see fat
normally is up here in the neck this is
important to know because when you have
pneumomediastinum or air in the
mediastinum it can track up into the
neck and gas in the neck soft tissues is
often a sign for pneumomediastinum for
inexperienced readers they might look at
the fat here and wonder if it's gas so
remember what this normally looks like
okay now that you understand the basic
densities let's go through the normal
anatomy and we're gonna go into order
here so number one here shows where the
trachea is on a normal plane film number
two the right mainstem bronchus number
three the left mainstem bronchus number
four is the left pulmonary artery number
five is the right upper lobe pulmonary
vein number six is the right inter low
bar artery
number seven is the right pulmonary vein
for number four to seven it's not as
important when you're starting out to be
able to distinguish them individually
instead just get used to what the normal
high-low look like and we'll talk about
that and show examples of it in a bit
number eight is the normal a or tech
arch number nine is the SVC number ten
is where the as igus arches or as a kiss
vein is number eleven is the right heart
border which is made of the right atrium
remember the right ventricle is an
anterior structure and number twelve is
the left heart border which is mainly
the left ventricle and a little bit of
left atrium I'll also draw your
attention to the space between the aorta
here or the air-duct notch and the
pulmonary artery here this here is
called the AP window for a for aorta P
for pulmonary artery this should be
concave this is convex or filled in
that's AB if this is convex or filled in
that's abnormal this is a labeled
lateral film and we're gonna go through
the anatomy here and shortly go through
an approach number one here is the
trachea number two is bronchus
intermedius number three is the left
upper lobe bronchus number four is the
right upper lobe bronchus number five is
the left pulmonary artery and number six
is the right pulmonary artery from one
to six the only important things I think
you need to know are you have a trachea
here you have Lucent circles which are
the upper lobe bronchi on both sides and
then anteriorly you have a density that
is the right pulmonary artery and
posterior superior lis you have the left
pulmonary artery density as well okay so
you're gonna see a lucency down the
middle a density anteriorly and a
density posterior superior Lee
you're gonna have a relative paucity of
densities in this inferior region here
and this is normal if you have densities
that are surrounding the entire bronchus
here that is often a sign of lymph
adenopathy called the doughnut sign so
get used to this normal pattern at the
Hilah lucency down the middle density
anterior to it is the right pulmonary
artery and density posterior superior
li7 is the pulmonary vein confluence h
is the aortic arch 9 is the SVC 10 or
the anterior heart border is the border
of the right ventricle 11 and 12 are the
posterior border of the heart here made
up of the eleven left atrium and twelve
part of the left ventricle I also want
to point out a few other things about a
normal lateral chest x-ray this lucency
posterior to the sternum here is called
the retrosternal airspace this should
usually be relatively dark this region
here behind the heart is called the
retro cardiac space you'll notice that
as you go down the spine and the spinal
elements are outlined here the lung gets
more and more Lucent this is called the
spine sign the lungs should get more
loosened as you go more inferiorly down
the spine on the lateral you have the
costophrenic angles here and this is
where fluids gonna collect when you have
small pleural effusions blunting of this
is the sign of pleural effusion the
lateral chest x-rays are much more
sensitive to smaller pleural effusions
than the frontal chest x-rays the right
and left hemidiaphragm ZAR marked off
here as well in telling which ones which
there are a few different ways you can
do that the one that I caught most
commonly uses that the right
hemidiaphragm you're gonna see extend
very clearly from posterior to anterior
where the left hemidiaphragm you often
lose it when it
touches the heart also the right
hemidiaphragm is usually higher than the
left and this can be confirmed in the
frontal okay now that we've gone through
the anatomy we're gonna go through a
basic approach to chest x-ray this is
something that's gonna be systemic and
something that you're gonna practice
over and over and over again and it's
gonna become second nature so let's
start with a frontal x-ray so this is a
PA film I generally start by looking for
lines and tubes and making sure that
they're appropriately positioned things
that you're commonly gonna see include
chest tubes mediastinal drains
endotracheal tubes in the trachea and
central lines we're gonna talk about
specific positioning of these tubes in
another video I then look at the heart
when I'm looking at the heart I start by
looking at the borders of the heart and
the size of the heart when I'm looking
at the size I'm looking for enlargement
radiologists commonly use a
cardiothoracic ratio on PD on PA films
namely the ratio of the size of the
heart in horizontal distance to the size
of the entire chest here from pleura to
pleura the cardiothoracic ratio is
normally less than 0.5 on a PA film I
then look at the position of the heart
this is a normal position seeing if it's
shifted one way or the other I then look
for anything that's very bright namely
calcifications or metal in the valves or
in the pericardium and then look for
anything that's very dark namely gas so
looking for gas around the heart in the
setting of pneumopericardium so to
review when I'm looking at the heart I'm
looking at borders size position thing
that's things that are very bright and
things that are very dark when I look at
the mediastinum I'm doing the exact same
thing I'm looking at the borders we see
a normal AP window here we see normal
contours the size the position looking
for a shift of the mediastinum anything
that's very bright like calcifications
metal foreign bodies etc anything that's
very dark namely pneumomediastinum when
we have pneumomediastinum ER
pneumopericardium what's the difference
well pneumo just means gas or air and if
it's pneumopericardium it's gas in the
pericardial sac that stays in the
pericardial sac and the reflection of
the pericardium ends at the base of the
great vessel so you're only gonna see
gas below that level and your mo
pericardium pneumomediastinum you have
gas throughout the mediastinum which
often two sex more superiorly in the
mediastinum and then up into the neck
commonly as well as a general point
whenever you see air anywhere where it's
not supposed to be you need to figure
out why it's there I like to break this
down simply by breaking it down into
three categories one air from outside
the body two air from inside the body
and three air from gas forming infection
in this setting of numa numa mediastinum
for example air can come from outside
the body for example if they had a
recent surgery or open procedure in line
placement or trauma it can come from
inside the patient for example from
esophageal perforation or it can come
from a gas forming infection which is
relatively rare so remember when you're
trying to figure out why there is gas in
an abnormal location think is it coming
from outside the patient
somewhere inside the patient or gas
forming infection I then look at the
lungs and I'm comparing both sides to
look for asymmetry normally it's
symmetric and then I look at each lung
more closely by zigzagging up the lungs
for more subtle abnormalities again
remember that there's lung behind the
diaphragm as well as behind the heart
here as well
what I'm looking for abnormalities in
the lung the main things you're looking
for include consolidation which are
going to look like fluffy brighter
opacities cloud like opacities or other
words that are used to describe
consolidation you're gonna look for
masses which are more rounded
abnormalities and you're also gonna look
for abnormal reticulation in other words
too many lines in order to pick up a
reticular abnormality it's good to know
what the normal vasculature looks like I
generally split the lungs into thirds we
have the medial third the middle third
and the peripheral third as you move out
peripherally you're gonna have less and
less markings as you can see from normal
vessels in the peripheral third you
should have next to no or no markings in
a normal situation if you see too many
lines here peripherally that's abnormal
once I've looked at the lungs I look at
the pleura so I follow the pleura around
in both lungs mainly looking for
pneumothoraces aka gas in the pleural
space and pleural effusions the most
sensitive locations in an upright film
are gonna be the costophrenic angles for
a pleural effusion you're gonna see
blunting of the costophrenic angle here
it's very sharp
remember lateral films are more
sensitive than frontal films for pleural
effusions and I'm also gonna look in an
upright patient for small pneumo
authorities at the apex of the lung you
can also look for pleural calcifications
I then look at the abdomen and you can
watch the abdominal x-ray video for more
details the main thing you don't want to
miss is free gas or free air under the
diaphragm
and a patient who hasn't recently had
surgery this is often seen with bowel
perforation which is something you don't
want to miss I then look at the bones
and soft tissues starting with the spine
looking at each of the particular bodies
I look at the ribs both the anterior
ribs and the posterior ribs
I generally screen
he's quickly looking screening the
clavicles the scapula here in any parts
of the shoulders we can see as well as
the soft tissue is taking a quick look
for any obvious gas or high-density
material once I've looked at all of
these things I have four checkpoints at
places where people commonly miss things
the first is the apices small
pneumothoraces and small masses are
often missed here two is the hila get
used to what these normal hila look like
I look at the retro cardiac region again
again a common place for Mis pathology
and then the retro diaphragmatic regions
of the lungs as a brief aside I did
mention that I would briefly touch on a
couple of quality things first to tell
if the patient is rotated I look at the
medial aspects of the clavicles in
comparison to the spinous processes here
the spinous processes should be more or
less halfway between the medial aspect
the clavicles in order to determine if
the patient had a good enough
inspiration we generally want to see six
anterior ribs or ten posterior ribs
projecting over the lungs so here we
have one two three four five six at
least anterior ribs and several
posterior ribs as well so this is a good
inspiration lastly when someone says a
film is overexposed it means that too
many x-rays got through and were
detected on the film so if a film is
overexposed it generally means that it
looks too dark and an underexposed film
usually looks brighter so it's the
opposite of what we usually think with
photography to review this approach
again we have lines and tubes we have
the heart remember borders size position
things that are too bright things that
are too dark mediastinum same thing
borders size position things that are
too bright namely classifications and
metal things that are too dark
looking for gas looking at the lungs
making sure to compare and not remember
the blot and not forget the blind spots
looking at the pleura looking at the
upper abdomen the bones and soft tissues
screening them and then looking for our
check points again the apices the hila
the retro cardiac region and the retro
diaphragmatic region
this is a normal lateral film there are
a lot of different things that you can
look at and we talked about the anatomy
and I'll briefly orient you again so
this is the spine here there's the
trachea here that you can see very well
you see lucency and you see the right
pulmonary artery here that's lighter
anteriorly and the left pulmonary artery
posterior superior lis remember there's
a relative paucity of density in this
inferior region here get used to what
that normal high-low looks like because
the lateral can be very helpful to
determine if there is true adenopathy
because beginners are usually a little
bit worse at looking at the lateral
films compared with the PA films I'm
gonna give you a very simplified
approach to the lateral chest x-ray
we're gonna look at five main things
that I'll mention a few others but if
you remember those five things you're
well ahead of the curve okay
I look at the retrosternal airspace
which should be loosened here it's
brighter that's up at the top because
the patient's arms are here but in
general this should be loosened and if
it's not I can indicate pathologies such
as most commonly an anterior mediastinum
mass I look at the retro cardiac area
which should be loosened here I then
look at the spine signs so I'm looking
at the spine itself but also looking at
the lungs over line so the lungs should
get more and more loosen as you move
more inferior lis oftentimes if you have
consolidation in either of the lower
lobes you're gonna see that that does
not happen and there is something here
that makes it look brighter I then look
at the hila and we talked about that
Anatomy again just now looking for
evidence of lymph adenopathy mainly and
then looking at the cost over neck
angles remember that the lateral film is
more sensitive for plural
fusions than the frontal film so again a
simplified lateral chest x-ray includes
looking at the retrosternal air space
the retro cardiac air space looking at
the spine sign and the spine itself
looking at the hilar anatomy and making
sure there's not lymph adenopathy and
looking at the costophrenic angles now
that we've gone through the normal
anatomy and you have a basic approach
you're getting to know what normal looks
like when you go through your approach
you're gonna need to pick up things that
are abnormal this is gonna come with
practice we're gonna go through an
example now in the next video is
exclusively dedicated to picking up
those abnormalities in my experience
when people first start reading x-rays
they're more often oversensitive but
calling things that are normal abnormal
but the more you practice and the more
you see the better and more confident
you're gonna get you're also gonna get
to know what the most common pathologies
look like so in the next video we're
gonna apply our approach to several
bread-and-butter
cases and things that you shouldn't miss
let's finish off this video by reading
this chest x-ray this is a 60 year old
smoker so I'm gonna start looking for
lines and tubes there's no lines or
tubes looking at the heart this is a
portable film but it's not unlocked it's
in normal position the borders are okay
I don't see anything bright I don't see
any gas the mediastinum size position
contours are okay ap window is normal
there is calcification in the aorta
suggestive or in keeping with calcified
a fish aquatic disease and then look at
the lungs comparing both sides and then
zigzagging up each of the lungs looking
for more subtle abnormalities I look at
the pleura
there's no pleural effusion or
pneumothoraces there's some scarring at
the apices here no pneumothorax no
pleural effusion look at the abdomen
nothing to comment on bones and soft
tissues look okay I then look at my
checkpoints so the apices the hila these
are normal Hilah the
retro cardiac region and the retro
diaphragmatic region okay for those of
you that were paying attention you'd
pick up on this abnormality here this
ended up being a lung cancer so it's
obviously very important that it was
picked up on this chest x-ray okay so
that's the end of this video the main
things I wanted you to take away are the
basic anatomy a basic approach to
frontal and lateral chest x-rays and
really getting used to what normal looks
like the best way to get better at chest
x-rays is to keep practicing and keep
looking at cases the next video as I
mentioned a couple times is going to
review several cases to help you
practice your chest x-ray skills
تصفح المزيد من مقاطع الفيديو ذات الصلة
How to Interpret a Chest X-Ray (Lesson 2 - A Systematic Method and Anatomy)
ABCs of Reading a Chest X-ray - How to Read a Chest X-Ray (Part 2) - MEDZCOOL
Radiology of Thorax (Chest)
How to Interpret a Chest X-Ray (Lesson 5 - Cardiac Silhouette and Mediastinum)
Assessment of CXR Positioning & Views - How to Read a Chest X-Ray (Part 4) - MEDZCOOL
COMO AVALIAR QUALQUER RAIO X DO TÓRAX COM SEGURANÇA? O ABCDE DO TÓRAX I VOCÊ RADIOLOGISTA
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