THORACIC RADIOGRAPH interpretation canine

Thorax xray

1. THORACIC RADIOGRAPHY POSITIONING AND PRINCIPLES OF INTERPRETATION BY M.ASHA MVM 23048 VSR(2023-24)

2. X Ray X rays are invisible electromagnetic energy beams to produce images of internal tissues, bones and organs on film or digital media. Air allows most of the X rays through the animal resulting in a dark image . Fat is next creating an image that appears lighter than air , lighter still is fluid or soft tissue. Structures that are very dense (example : bones ) block most of the photons and appear white on developed film.

3. Radiographic Densities

4. ANATOMY OF LUNGS Pulmonary parenchyma is made up of Interstitium ,which is a connective tissue between the other structure with in lungs Others are alveoli,bronchi,pulmonary vasculature. RIGHT LUNG Cranial Caudal Middle LEFT LUNG Cranial Caudal

5. Right lung

6. After taking out Right lung

7. Left lung

8. After taking out left lung

9. Anatomy of lung

10. NORMAL THORACIC STRUCTURE

11. WHY THORACIC RADIOGRAPHY?? Pulmonary pathology Quantification of Cardiac size, Cardiac Shape, Chamber size of heart.,

12. Positioning of pateint 2 D representation of a 3 D structure Superimposition of structure 2 views-Orthogonal views@ 90 ’ angle LATERAL VIEW (RIGHT or LEFT) VENTRODORSAL or DORSOVENTRAL In other views is sufficient,but in Thorax,ie ., Right lateral,Left lateral,Dv or VD

13. PULMONARY VASCULATURE Cranial pulmonary vessels on lateral view - artery @ dorsal part - vein @ ventral part Diameter of the vessel at the 4 th intercostal space should not exceed the diameter of the proximal portion of the 3 rd rib. Cranial pulmonary vessels on DV view - artery @ lateral - vein @ medial

14. Technical factors: potential for movement – low mAs High inherent contrast – low kVp

15. LATERAL POSTIONING OF THORAX Positioning Right lateral recumbency is preferred Forelimbs are extended cranially and Hind limbs extended caudally Place a foam pad under the sternum to avoid rotation and to maintain horizontal alignment of Sternum Neck is in natural position

16. Centering Caudal border of scapula Collimation Entire rib cage within the collimated area Cranial border ; Thoracic inlet Dorsal border;Spinous processes of Spinal column Ventral border is Xiphoid

17. Positioning of Lateral Radiograph

18. VIEWING OF LATERAL RADIOGRAPH Dorsal CRAINAL CAUDAL (LEFTSIDE) (RIGHT SIDE) Ventral

19. LATERAL RADIOGRAPH 2 Views RIGHT LATERAL RAIOGRAPH LEFT LATERAL RADIOGRAPH LEFT LATERAL RADIOGRAPH : Animal is lying on left side touching the casette on the table ie .,animal is in left side recumbency . IMAGE SEEN IS SHADOW OF THE RIGHT LUNG ,BECAUSE THE LEFT LUNG COLLAPSES XRAYS PASS THROUGH RIGHT SIDE TO LEFT SIDE

20. RIGHT LATERAL RADIOGRAPH : Animal is lying on right side touching the casette on the table ie .,animal is in right lateral recumbency IMAGE SEEN IS SHDOW OF THE LEFT LUNG ,BECAUSE THE RIGHT LUNG COLLAPSES X RAYS THROUGH LEFT SIDE TO RIGHT SIDE . In right lateral radiographwe can see the Lungs Heart Venacava (Anterior and Posterior) Arota Trachea Diaphgram

21. How to differentiate Right and left lateral radiograph LEFT LATERAL RADIOGRAPH Both crura or crust of the diaphgram takes a Y SHAPE RIGHT LATERAL RADIOGRAPH Both(left & right) crura /crust of the Diaphgram runs parallel

22. DV POSITIONING OF THORAX Positioning Sternal recumbency Forelimbs are extended slightly Cranial with carpus at level of ears Hindlimbs are in natural flexed position Superimpose sternum and spine

23. Centering Caudal border of Scapula Collimation Cranial border of the Thoracic inlet Lateral borders of Body wall

24. Positioning for DV view

25. VD PROJECTION OF THE THORAX Positioning Dorsal Recumbency Forelimbs are Extended Cranially with nose between Forelimbs Hindlimbs are extended caudally Use a V-trough to superimpose the sternum and spine

26. Centering Caudal border of the the scapula centered on midline Collimation Cranial border:Thoracic inlet V-Trough entirely within the collimated area Lateral borders:Body wall

27. Positioning of VD view

28. VIEWING OF DV OR VD VIEW Cranial(Uppermost) Left to right Right to left Caudal at Bottom

29. How to diffrentiate DV or VD DORSOVENTRAL Both the Crust/ crurs of the diaphgram takes a DOME SHAPE appearance VENTRODORSAL Crust/ crura of diaphgram takes MICKEY MOUSE SHAPE appearance

30. Inspiration vs Expiration

31. CONTRAST

32. MEDIASTINUM

33. Abnormalities in the mediastinum MASS SHIFT FLUID or AIR

34. Tumour mass in the mediastinum

35. Pneumomediastinum

36. Lung patterns BRONCHIAL PATTERN DONUTS(RINGS) TRAMTRACKS THICKENING OF THE BRONCHIAL WALL BRONCHITIS BROCHIECTASIS

37. DONUTS AND TRAMTRACKS

38. BRONCHIETASIS

39. BROCHIAL PATTERN

40. BRONCHIAL

41. ALVEOLAR PATTERN Infiltrate Interstitium Alveoli AIR IN THE ALVEOLI REPLACED BY FLUID PNENUMONIA AIR BRONCHOGRAM LOBAR SIGNS SILHOUETTE EFFECT (or) BORDER EFFACEMENT LACK OF VISULAIZATION OF PULMONARY VESSELS.

42. ALVEOLAR PATTERN

43. MILIARY PATTERN

44. NODULAR PATTERN 2 cm to 3 cm in size If is > 3 cm in size it is called as mass Metastsis (Mammary tumour/Prostate carcinoma/ OsteoSarcoma )

45. PULMONARY OSTEOMATA

46. VASCULAR PATTERN Enlarged vessels when increases soft tissue opacity Left side congestive Heart failure Heart worm disease Left to Right Shunt

47. VASCULAR PATTERN

48. Interstitial pattern Infiltrate Interstitium Increase in opacity Pulmonary vessels still visible Pulmonary fibrosis Viral pneumonia Interstitial patterns Neoplasia Ventral is pnemonia Dorsal and caudal is Oedema

49. INTERSTITIAL PATTERN

50. Diaphragmatic hernia

51. Cardiac X RAY Cardiac silhoutteis a summation shodow of all the four chambers Cardioac size and shape may vary with cardiac cycle The apparent cardiac size will vary with respiratory phase Thoracic confirmation

52. NORMAL HEART 2/3 is right side 1/3 in the left side If there is amy enlargement of this indicates enlargement.

53. CLOCK FACE ANALOGY OF HEART 11-1 : Arota 1-2 : Pulmonary artery 2-3 : Left auricle 3-6 : Left ventricle 6-9 : Right ventricle 9-11 : Right atrium

54. THORAX VD-CARDIAC SILHOUTTE

55. 2.5 TO 3.5 Intercostal space Normal contact having 3 sternbrae contact Right ventricular enlargement- Having more than Sternbrae indicates,Heart is sitting on the sternum.

56. Vertical height of the heart should not exceed 65% depth of the thoracic depth Width of the heart should not exceed 50% of the width of the chest at 8 th rib space

57. CARDIOMEGALY Is cardiomegaly is present? If present is right or left sided or generalized? It is limited to a specific chamber? Is there any enlargement of pulmonary veins,pulmonary arteries or both? Is there enlargement of the major vessels? Is there radiographic evidence LEFT SIDE CONGESTIVE HEART FAILURE-PULMONARY EDEMA RIGHT SIDED CONGESTIVE HEART FAILURE-PLEURAL EFFUSION

58. CAUSES Muscular hypertrophy Chamber dilatation Pericardial fluid accumulation.

59. Vertebral heart size(VHS) LABRADOR -9.9 to 11.7 BOXER -10.3 to 12.6 (MAX)

60. CARDIOMEGALY

61. Vertebral left atrail size(VLAS) Normal (VLAS)-2.3

62. PULMONARY VESSELS ENLARGEMENT

63. Dog with severe cough

64. PLEURAL EFFUSION Effacement , Retraction,Fissure lines

65. PLEURAL FISSURE

66. PULMONARY EDEMA

67. PERICARDIAL EFFUSION Pumpkin or coccer ball shaped cardiac silhoutte Cardiac silhoutte is enlarged Trachea is elevated

68. PNEUMOTHORAX Right heart enlargement due to pulmonary disease Pulmonary blood flow is obstructed leading to pulmonary hypertension Enlarged pulmonary vessels

69. What is your diagnosois ?

70. OESOPHAGEAL DIVERTICULUM

71. MEGAOESOPHAGUS Congenital Aquired Segmental Generalised Radiographic signs Aspiratory pneumonia

72. MEGAOESOPHAGUS

73. PRIMARY LUNG TUMOURS Usually large solitary. Caudual lung lobes usually. Adeno carcinoma. Bronchogenic carcinoma. Squamous cell carcinoma. Malignant histiocytosis .

74. Pulmonary Tumors

75. Pulmonary nodules

76. Metastasis

77. THANK YOU