NORMAL CHEST RADIOGRAPH
Ken Edward G. Zata, M.D.
Department of Radiological Sciences
Objectives:
1. To be able to recognize fundamental,
normal chest anatomy
2. Determine if a study is technically
adequate
5 Basic Densities in X-ray
SOFT
AIR FAT BONE METAL
TISSUE
Adequacy of a Chest Radiograph
P.R.I.M. Penetration
Rotation
Inspiration
Motion
Penetration
• Faint visualization of
the intervertebral disc
spaces
• Discrete branching
vessels can be
identified through the
cardiac shadow and
diaphragm
Penetration
Underpenetration (too light) – mistaken as having prominent PV or
infiltrates
Penetration
Overpenetration (too dark) – mistaken as having decreased PV or
hyperlucent lung disease (pneumothorax, emphysema)
Rotation
Inspiration
6
Inspiration
1 0
Rib
Inspiration
AGE OF CHILD OPTIMUM INSPIRATION
0-3 years 6th anterior rib, 8th posterior rib
3-7 years 6th anterior rib, 9th posterior rib
8 years + 6th anterior rib, 10th posterior rib
Motion
PROJECTIONS
TELERADIOGRAPHY
1. Tube-Film Distance of 6 Feet
2. Posteroanterior (PA) Projection
3. Upright
4. Full inspiration
PosteroAnterior (Standing)
• The patient is positioned
with the anterior aspect of
the chest in contact with a
cassette and their arms
encircling it
• Both shoulders should
touch the cassette to ensure
that there is no rotation
• The primary beam is
centered to the middle of
the area of interest
AnterioPosterior (Supine)
• The patient is positioned supine with the chin raised
and the arms flexed and held on either side of the
head to prevent rotation
• Lateral View
• aid in detection and localization of parenchymal and
cardiomediastinal processes
• investigate an area of interest seen on frontal projection
Portable Radiography
• Motion artifact
• Rotation
• Magnification
• Elevation of the diaphragm
• Prominence of vasculature
Views in Chest Radiography
• Posteroanterior
• Anteroposterior (Upright/Supine)
• Lateral (Right/Left)
• Oblique (Right/Left)
• Lateral Decubitus (Right/Left)
• Apicolordotic
ANATOMY OF THE
CHEST RADIOGRAPH
Trachea
> Vertically oriented
cylindric lucency
> 12cm long in
adults
> Diameter:
2.5cm in men
2.1cm in
womenwomen
Bronchi
> Main bronchi arise
from the carina
> Right main
bronchus:
- shorter
- wider
- more vertical
Fissures
Invaginations of the visceral pleura deep into the
substance of the lung
Complete or Incomplete
Appear as fine, white lines
on the right, 1 on the left
Fissures
Lungs
• Virtually ALL the
opacities in a normal
chest are vascular
markings
• As the vessels go to the
periphery from the
hilum, they should be:
• Branching
• Tapering
• Decreasing density
SYSTEMIC APPROACH
and
NORMAL FINDINGS
P.R.I.M. and Proper Technique
Systematic Approach
Thymus
A ir
B ones
C ardiac
D iaphragm
S inuses/Sulci
Thymus
Thymus
Sail Sign Notch Sign
8 mo. / M (AP )
• TRACHEA (bifurcation)
- T3 infant; T4 8 yrs
- Buckling
• LUNGS
- Symmetry
- Hyperlucency
- Opacity
Air
Bones
•Rib cage
•Clavicles
•Scapulae
•Proximal humeri
•Vertebrae
Cardiac
Cardiothoracic ratio = 0.65
• Right border
• Superior
vena cava
• Right atrium
• Inferior vena
cava
Postero-Anterior (PA) View
• Left border
• Aortic knob
• Main
pulmonary
trunk
• Left Atrial
Appendage
• Left ventricle
Postero-Anterior (PA) View
Lateral View
• Left atrium
• Left ventricle
Lateral View
• Right ventricle
Dome of the R Costophrenic/
costo-diaphragmatic
hemidiaphragm sulcus
= 1.5 cm Acute
Diaphragm & Sinuses
THANK YOU!