IT report- Human Anatomy Presentation...

IT report- Human Anatomy Presentation...

1. A PRESENTATION ON STUDENT’S INDUSTRIAL WORK EXPERIENCE SCHEME UNDERTAKEN AT [NAME OF PLACE] NUMBER , PORT HARCOURT, RIVERS STATE BY [NAME] [MAT. NO.] SEPTEMBER, 2023

2. INTRODUCTION PRINCIPLES DOCUMENTING/INSTRUCTING PATIENTS EQUIPMENTS IDENTIFYING AND INTERPRETING A GOOD PA CHEST X-RAY FEATURES OF A NORMAL CHEST X-RAY CHEST X-RAY ABNORMALITIES OUTLINE 1 2 3 4 5 6 7

3. A company established in 2016, Old Diagnostics consists of 2 units: the Radiology Unit and the Laboratory. I trained in the radiology unit and the focus of this report is CHEST XRAY, a common imaging technique used to diagnose and monitor various conditions affecting the chest. INTRODUCTION

4. Chest X-rays, invented in 1895 by Wilhelm Röntgen, are produced by focusing a high energy beam of electrons unto a tungsten target and then passed through the patient unto a detector mechanism. (Clarke and Dux, 2011). These x-rays are absorbed differently by the different tissues in the body, depending on their density/thickness (Fig. 1) PRINCIPLES Fig. 1 Tissue density/ thickness on Xray

5. CHEST XRAY VIEWS In a chest X-ray, a variety of views are necessary to obtain a much clearer assessment of the heart, lungs, pleura, etc. Among them are: Postero-Anterior view - This is a standard view and the most common in diagnosing issues of the chest and therefore the best reference when comparisons with initial results need to be done. The patient stands facing and leaning unto the plate with their shoulders rotated forwards. Antero-Posterior - To obtain this view, the patient sits facing away from the plate or they lay supine. This is an alternative view, recommended for patients who are too ill or unable to stand. (Clarke & Dux, 2011). Lateral - This view is obtained to supplement èither of the above. It's taken to provide a clearer picture of the lungs and pleura. With this view, the patient is positioned to face the right or the left, with their arms raised and lateral side facing the plate. A lateral decubitus view - is obtained in cases such as pleural effusion. This help to determine how much fluid is present in the pleural space.

6. CHEST XRAY VIEWS Lateral decubitus view Source: Radiology Key PA view Source: Radiology Key AP view Source: Radiology Key Lateral view Source: Radiology Key

7. Chest x-ray has few contraindications, as it is a safe and low-cost procedure. However, some situations may limit its use or require precautions, such as: Pregnancy: Chest x-ray should be avoided or minimized in pregnant women, as it may expose the fetus to radiation. If necessary, a lead apron should be used to shield the abdomen and pelvis. Allergy: Chest x-ray may require the use of contrast agents to enhance the visibility of certain structures, such as blood vessels or airways. Some contrast agents may cause allergic reactions in some people, such as iodine-based agents. Therefore, a history of allergy should be obtained before administering contrast agents. Metal implants: Chest x-ray may be affected by metal implants in the chest, such as pacemakers, defibrillators, stents, or valves. These implants may obscure or distort the image of the underlying structures and cause artifacts. CONTRAINDICATIONS

8. Proper documentation is necessary for interpreting an xray image and ruling out or identifying a medical condition. It is important to get the following information from the patient: Name Age Gender Medical History Allergies; if a contrast medium is to be administered Indications (productive cough, shallow breathing, pain on one side of chest) DOCUMENTATION Patients are advised to bare their top/upper halves and put on an exam gown Accessories/Jewelries are taken off PREPARATIONS/INSTRUCTIONS

9. Old diagnostics is adequately equipped with a DDR (Dynamic Digital Radiography) machine used to assist with image analysis. This machine can help to enhance image penetration and measure structures . The presence of a storage system known as PACS (Picture Archiving and Communication System) is responsible for storing and transferring x-ray images.(Clarke & Dux, 2011) EQUIPMENT

10. Taking a chest Xray is not as simple as taking a photo and calling it done. How do you recognize a good PA chest Xray: Penetration : An underpenetrated image won't show the thoracic vertebrae through the superimposed heart. An over penetrated image will cause the lung markings to be difficult to see.(Mowery & Singh, 2022) Modern advancements, have made it possible for the penetration to be regulated from the monitor after image has been taken. Rotation : The thoracic spinous processes should be equidistant to the medial ends of the clavicles. Rotation might cause trachea to appear deviated when its not and misinterpretation of lung density. (Lloyd-Jones,2020) Inspiration : A quality chest ray image taken upon deep inhalation will show about 8-9 ribs at minimum. If upon deep inspiration, <8 ribs appear, it might be indicative of a medical condition such as pleural effusion or enlarged liver. IDENTIFYING A GOOD PA CHEST XRAY Source: Radiology Masterclass

11. For this, we're going to be using the ABCDE approach: A - Check the Airways (trachea, carina, main bronchi, lung fields) for obstructions and deviations B - Check the Bones for fractures and lesions. C - Check the Cardiothoracic silhouettes for abnormalities such as unfolded aorta, and measure to make sure the cardiothoracic ratio does not exceed 0.5 D - Check the Diaphragm and the costophrenic angles E verything else- Lung fields, mediastinum, apices, foreign bodies, gastric bubbles, extrathoracic soft tissues, blood vessels, hilum INTERPRETATION OF A PA CHEST XRAY

12. A NORMAL PA CHEST XRAY (Source: Kenhub, 2023) Airway showing lungs Costophrenic angles Cardiothoracic silhouette Gastric Bubble

13. Airway- In a normal PA CXR, the lungs appear dark because of the presence of air. The trachea is centered at the midline and the carina and main bronchi are void of foreign bodies. Bones- A normal PA CXR is symmetrical and boasts a lack of lesions, breaks, irregularities and masses Cardiothoracic silhouettes- It’s important to note the position of the heart which—predominanly lies in the left hemithorax—and its size (less than 0.5). Diaphragm and the costophrenic angles - A normal diaphragm appears curved with sharp costophrenic angles. A flattened diapgragm could indicate chronic asthma or COPD. Blunt costophrenic angles indicate mild pleural effusion Everything else - A normal PA CXR typically has a lack of foreign bodies, gastric bubble on the left ,and hilar void of masses. INTERPRETATION OF A NORMAL PA CHEST XRAY (Solomon, 2023)

14. This can be defined as the enlargement of the heart. This is when the transverse diameter of the cardiac silhouette is greater than or equal to 50% of the transverse diameter of the chest, according to Amin and Siddiqi (2022). Cardio thoracic ratio = Transverse diameter of cardiac silhouette Transverse diameter of chest CHEST XRAY ABNORMALITIES - 1 Cardiomegaly Cardiothoracic ratio Source: Radiology Masterclass

15. Pleural effusion is the collection of fluid in the pleural cavity. Like fluid, it moves depending on the patient's position. It causes blunting of the costophrenic angles and increased density in the lung fields. Lateral decubitus view is the best view for assessing this condition. Physical findings Loss of weight Shortness of breath Pleural Effusion(Lloyd-Jones, 2019) Source: Radiology Masterclass CHEST XRAY ABNORMALITIES - 2

16. A pneumothorax happens when air gets trapped in the space between the lung and the chest wall, known as the pleural space. This can happen spontaneously or due to an underlying lung condition. Trauma is the most common cause, particularly when a fractured rib punctures the visceral pleura. If the distance between the edge of the lung and the inner chest wall is more than 2 cm at the hilum level, it's considered 'large.' Pneumothorax(Lloyd-Jones, 2019) Source: Radiology Masterclass CHEST XRAY ABNORMALITIES - 3

17. Pneumonia: This is an infection that inflames the air sacs in one or both lungs. On a chest X-ray, it appears as an area of increased density or 'whiteness'. Lung Cancer: Chest X-rays can reveal abnormal masses or nodules, which could indicate lung cancer. Tuberculosis: This is a serious bacterial infection that mainly affects the lungs. It can cause changes in the lung tissue visible on an X-ray. COMMON PATHOLOGIES THAT CAN BE DIAGNOSED ON AN XRAY IMAGE

18. Over the course of my internship at Ol d Medical Diagnostics, I've gained invaluable insights, specifically the use and analysis of chest X-rays. I've seen firsthand how these imaging tests can aid in diagnosing a wide range of conditions, from pneumonia to lung cancer. The experience has not only honed my technical skills but also deepened my understanding of patient care. It's shown me the challenges that come with interpreting these images and the critical role radiologists play in a patient's healthcare journey. In conclusion, this internship has been a significant step in my career. It has broadened my horizons and provided clearer lenses to see through. CONCLUSION

19. THANK YOU FOR YOUR ATTENTION

20. Amin H, Siddiqui WJ. (2022) Cardiomegaly. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542296/ Clarke C, Dux A. (2011) About Xrays . Chest Xrays for Medical Students. First Edition. Carlson L. (2021) Radiographic positioning. Radiology Key . Available from: https://radiologykey.com/radiographic-positioning/ Mowery ML, Singh V. (2022) X-ray Production Technical Evaluation . StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564332/ Lloyd-Jones G. (2020) Chest X-ray Quality . Radiology Masterclass. Available from: https://www.radiologymasterclass.co.uk/tutorials/chest/chest_quality/chest_xray_quality_rotation Solomon N. (2023) How To Read A Normal Chest X-ray. Ken Hub. Available from: https://www.kenhub.com/en/library/anatomy/normal-chest-x-ray Lloyd-Jones G. (2019). Chest X-ray Abnormalities. Radiology Masterclass. Available from: https://www.radiologymasterclass.co.uk/tutorials/chest/chest_pathology/chest_pathology_page4 Lloyd-Jones G. (2020). Chest X-ray Anatomy. Radiology Masterclass. Available from: https://www.radiologymasterclass.co.uk/tutorials/chest/chest_home_anatomy/chest_anatomy_page8 REFERENCES