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xray

1. Role of X-rays in Otorhinolaryngology

2. With the advent and easy availability of excellent imaging modalities like CT scan and MRI, the actual indication for x-rays in ENT has decreased nowadays. Still there are indications for X-ray imaging in head and neck area , f or example X-ray soft tissue neck is rather vital in the assessment and location of foreign body in the aero digestive tract. X-rays also play a vital role in the assessment of tracheal air column as well as the position of trachea in relation to the midline of the neck. X-rays also clearly demonstrate fractures involving the nose and facial bones . They are of importance in primary and secondary level hospitals where the higher modalities of imaging are not available . check x-rays are done to confirm tubes or other devices placement in patients body. In certain cases it can reduce the load over the radiology department for CT and MRI by effectively screening out the clear cases. They are cheaper , quicker modalities of investigations.

3. Advantages of X-rays 1. It is very cheap (cost effective) 2. Easily available 3. Rapidly performed in emergency setting 4. Trained man power commonly available even in primary and secondary hospital setting.

4. The debate There is a long debate about whether we should expose the patients to x-rays and how much radiation we are giving to them. To understand this we have to compare radiological exposure with daily natural background radiation exposure. When radiation passes through the body, some of it is absorbed, this is patient's radiation dose. Measurement for whole body radiation dose is called " effective dose ," and unit of this is the millisievert (mSv). Naturally occurring "background" radiation - According to recent estimates, the average person in the cities receives an effective dose of about 3 mSv per year from natural radiation. Compared to this, the amount of radiation from one adult head x-ray is (0.025 to 0.05 mSv) which is about same as 3-7 days of natural background radiation .

5. The debate A plain CT scan brain- has an effective dose of 1.6 mSv which is equal to 7 months of natural background radiation . One adult chest x-ray gives 0.1 mSv ED (10 days) of background radiation V/S one CT Chest gives 6.1 mSv (2 years) of background radiation So the question is, should we expose the patient to x-ray – the answer is only if absolutely indicated and not to give undue exposure. We should also keep in mind that not to give CT exposure if we can get a good information with x-rays.

6. X-rays of nose and paranasal sinuses:

7. The various radiographic positions used to study paranasal sinuses are: 1. Occipito -mental view (Water's view)- commonest view used , in this view the maxillary sinuses, frontal sinuses and anterior ethmoidal sinuses are seen and the sphenoid sinus can be seen through the open mouth. 2. Occipital-frontal view ( Caldwel view) 3. Submento -vertical position ( Hirtz position) 4. Lateral view 5. Oblique view 39 Degrees oblique ( Rhese position)

8. Foreign body

9. X-ray soft tissue neck AP view showing radio opaque shadow in the left pyriform fossa area.

10. Soft signs for radiolucent foreign bodies On lateral neck radiography presence of abnormal air column lucency loss of cervical lordosis increased prevertebral soft-tissue thickness. These signs with positive f.b. ingestion history can give some idea about the impaction.

11. X-ray soft tissue neck

12. 1. Prevertebral soft tissue widening 2. Gas shadow seen over the prevertebral shadow . 3. Straightening of cervical spine (Ram rod spine) Prevertebral shadow widening should be considered if the thickness of prevertebral soft tissue exceeds ¾ the width of the body of corresponding vertebrae. Prevertebral shadow widening could be caused by: 1. Retropharyngeal abscess 2. Post cricoid growth 3. Impacted foreign body

13. Acute epiglottitis Laryngotracheobronchitis LTB BACTERIAL IN NATURE Viral no seasonal predilection the wintertime has a more acute onset Croup has a more gradual onset drooling and dysphagia + absence of drooling and dysphagia High -grade fever low-grade fever Both has inspiratory stridor, suprasternal, intercostal and substernal retractions and hoarseness

14. X-ray mastoids

15. Types of Mastoid XRay Law’s: 15 degree lateral oblique Schuller’s: 30 degree lateral oblique (commonly done) Myer Owen’s: 45 degree lateral oblique Advantage of schuller & owen : Better visualisation of key areas of mastoid (attic, aditus , antrum) Other views are - Towne's view: b/I A-P view showing both mastoids & IAC Stenver’s view: It is also called an anterior posterior oblique view Transorbital view: (posteroanterior /anteroposterior): Full axial view: ( Submentovertical view):

16. Differential diagnosis of cavity seen in Temporal bone: 1. Cholesteatomatous cavity: Radiologically this cavity will be surrounded by a rim of sclerosis. 2. Granulation cavity: Cavity will show hair line appearance 3. Operated cavity: Patient will give history of previous mastoid surgery. The margins of the cavity may be irregular and will not show sclerosis 4. Secondaries 5. Multiple myeloma 6. Tuberculosis 7. Eosinophilic granuloma 8. Large antral air cell - usually bilateral

17. Miscellaneous xrays

18. X-RAY SUBMANDIBULAR GLAND OCCLUSIVE VIEW

19. X-ray neck showing large larngocele

20. Barium swallow showing pulsion diverticulum/ pharyngeal pouches

21. Barium swallow showing achalasia cardia ("Bird's beak" appearance and " megaesophagus ", typical in achalasia.)

22. Barium swallow showing lower esophageal growth ("rat's tail“)

23. Thank you