x-ray ppt made bye Dr nishant this is the best pdf to understand x ray in aeasy manner

Best x ray ppt ...to understand it in easy way

1. X-RAY MADE BY – DR NISHANT TARALKAR MD SCHOLAR(ROG NIDAN) GUIDE- DR ANAND KALASKAR SIR MD(KAYACHIKITSA- VIKRITI VIGYAN) DIP.In YOGA DIP.MEDICO LEGAL SYSTEM

2. INTRODUCTION X-ray or x- radiations is a penetrating form of electromagnetic radiations. X-ray machine sends individual x-ray particles through body. The images are recorded on a computer or film. X-ray wavelength are shorter than UV rays & typically longer than gamma rays.

3. Invention- It was invented by a German Physicist Wilhelm Röntgen in 1895. He named it x-radiations to signify an unknown type of radiation . In many languages, x-radiations is referred to as Röntgen radiation.

4. X-ray tube Control box Photograph bed Bucky stand console

5. Types of x-rays. Plain x-ray or plain radiography. Computed tomography known as CT scanning . Fluoroscopy – Produces moving images of an organ. Mammography – X-ray of breast. Angiography- X-ray of blood vessels

6. U ses of x-ray Diagnostic use- X-ray is the most preferred tool for detecting bone related problems like fracture , tumor , degeneration, osteoporosis . It is also used to detect other cases like pulmonary tuberculosis, pulmonary effusion , pneumothorax etc. 2. Therapeutic use- It is used in cancer treatment to kill malignant cells .

7. INDICATIONS BONE CONDITION LUNG CONDITION BLOOD VESSEL PROBLEM BLOCKAGE OF BOWEL DETECTION OF FOREIGN OBJECTS CANCER (LUNG, BONE,BREAST)

8. General Principles Have a systematic approach Interpret the CXR in conjunction with the clinical findings Always compare with previous CXR if available to assess for change Ask yourself “does my interpretation make sense?”

9. Tissue Absorption from Least ( Air or Gas ) to Most Dense ( Metal ) How do things looks on xray ? 5 DENSITY IN AN X- RAY AIR – Black FAT – Dark Grey FLUID (Soft Tissue) – Light Grey CALCIUM – Off White METAL - White

10. CHEST X-RAY

11. BEFORE STARTING ON DIAGNOSIS- CHECK :- PATIENT NAME , HISTORY , PREVIOUS X- RAY 2. AP / PA VIEW OF X- RAY R- ROTATION I- INSPIRATION P- PENETRATION

12. ROTATION Ideally the clavicle should be equidistant from the centre. If overlap or not equidistant then most likely the patient was rotated while X ray was taken which will erect the diagnosis. clavicles equidistant from spinous processes of thoracic spine can just see lower thoracic spine

13. inspiration minimum Nine ribs are visible above the diaphragm means it an inspiratory X-ray 6 anterior ribs visible 10 posterior ribs visible in inspiratory x- ray expiration

14. penetration Outlines for vertical bodies should be just visible . 1.Should see vertebral bodies , ribs 2.Pulmonary vessels nearly to edges of lungs

15. Ap and pa view PA view is prefferd because – This view gives wider lung field 2. Gives clear picture of brochovascular shadow a Cardiac size seen more exaggerated Preferred in ICU/very sick pt – 1.Cardiac size seen more exaggerated 2.Obstructs a part of lund field

16. Lateral view 1.Left lateral film is one which is taken with left side of the patient chest placed next to flim 2. Lateral view is essential for the identification of lobes and segmental detailsof lung Such as pulmonary artery , right/ left ventricle Trachea and aortic notch.

17. Syetematic approach ABCDE A – AIRWAY B – BREATHING C – CIRCULATION D – DIAPHRAGM / DELICATES(bones) E – EXTRA (line, tubes, foreign body)

18. Airway Is a conduit which conducts air from the environment to the lungs Consist of ( Pharynx - Larynx - Trachea - divides in Principal bronchus - Bronchioles ) P oints to notice : Is trachea centrally placed or not ? Black in appearance? Trachea and its deviation Carina( trachea is divided into left and right principal bronchus) Carina angle

19. 6. Right bronchus is a direct continuation and left appears as a side branch Reasoning with an example- a) if the patient aspirates (gastric contents in trachea)the content goes and deposit in rt lower lobe. Hence known as lower lobe pneumonia. b) on the endotracheal intubation; the tube should be placed above the carina but if inserted further it goes to the right main brochus represented as as brochial intubation Deviation of trachea Pull Either pulling of trachea (due to collapse of lung or Atelecasis ) Push Psuhing of the trachea (due to tumor on the left will deviate Trachea on the rt side) Big pneumothorax, pleural effusion

20. Breathing So in breathing – how we have see lungs ? We will compare both lungs – example 1. If both lungs appears More black as looks in emphysema. 2. only one appears black than pneumothorax Comparing both lungs

21. Circulation On x ray; we visualize the cenral compartment as follows :- Heart (for cardiomegaly) Curved outlines of heart Aorta Chamber enlargement Percardial effusion Mediastinal shift

22. Cardiac Silhouette Is the shadows that allows the assessment of the size and shape of the heart and major vessels. Left side Aorta Portion of left ventricle Pulmonary artery Right side Superior venecava Right atrium

23. We need to see cardiothoracic ratio Heart should be less than 50 % of thorax if more , then known as cardiomegaly Cardiothoracic ratio This ratio should less than 50%

24. Old hypertensive patients visualizing x ray shows prominent aortic knob or knuckle shows untreated/ uncontrolled HTN. Left atrium can not be visible normally. Its visibility means l eft atrium enlargement left heart chamber appears concave with straight border called boot shaped heart. Aortic knob D iaphragm Normally, the left dome is down and the righgt dome is up beacause the liver is placed just below it. Things to look at x ray while observing diaphragm. Elevation Flattening Subpulmonory effusion.

25. Delicates Bones like ribs, clavicles, vertebra , fractures. Examples – 1. kyphosis 2. lordiosis 3. scoliosis EXTRAS Foreign bodies - jewelry, coins, etc. Tubes - Ryle's tube, endotracheal tubes and central line. Valves - Artificial heart valves and pacemaker

26. coin Ryles tube

27. ABNORMAL CONDITIONS AND ITS DIAGNOSIS 1 . CONSOLIDATION OF THE LUNG Defn - Refers to an area of homogenous increase in lung parenchymal attenuation that obscures the margins of vessels and airway walls. Diagnosis- A triangular homogenous opacity seen in rt upper and mid zone. Trachea and apex beat looks normal in postion . Consolidate part looks more white. Both costophrenic angles looks clear. AIR brochogram is present. ( means consolidate part becomes dense looks white and larger airways relatively looks less densed that is black)

28. 2. Pleural effusion- Defn- abnormal accumulation fluid within the pleural space (visceral and parietal pleura). Diagnosis:- Dense homogenous opacity seen on left chest at lower lobe appear more white. Left costophrenic angle obliterated/ blunt , relatively rt side. Cardiac shadow and trachea(lower part) shifted to right. Absence of air bronchogram . 300ml fluid req for radiological detection and 500 ml requires clinical detection Tracheal shift to rt side Pleural effusion with blunt angle

29. 3. Pneumothorax- Defn- abnormal collection of air in the plueral space ( visecreal and parietal pleura) . Diagnosis:- 1. Increased translucency on right side of the chest with absence of bronchovascular markings. 2. Sharp homogenous opacity seen lateral to cardiac border, indicates collapsed of lung. 3. Absesnce bronchovascular marking beyond collapsed lung. 4. Midiastinum should not shift away from pneumothorax unless tension pnemothrax Present. Collapsed lung

30. 4. Pulmonary Emphysema – Defn:- Abnormal permanent enlargement of the airspaces distal to the terminal bronchioles accompanied by destruction of the alveolar wall & without obvious fibrosis . Diagnosis:- 1. Chest shows hypertranslucency of both lungs 2. Large and prominent hilar shadows with diminished vascular pattern. 3.Few ‘bullae’ are seen as rounded areas of increased transluceny 4. No mediastinal shift.

31. 4. – Bronchiectasis- Defn- Is an abnormal, irreversible dilatation of brochi , impairs the natural drainage of brochial secretion which chronically infected and cause airway obstruction. Diagnosis :- Chest shows multiple ring shadows at both lower zone (left>right) produce gloved finger shadows . Areas of haziness or fibrosis is seen at bases Big bulla seen in right apex Right costophrenic angle is blunt No mediastibal shift

32. 5.Tuberculous Infiltration – Defn- an infectious bacterial diease charactersized by the growth of nodules(tubercles) in tissues of lungs Diagnosis :- 1. chest reveals multiple wooly opacities involving both the lung field. 2. Giving the x-ray flim ‘moth eaten appearance’ 3. Old T b/ healed T b – appears fibrosed , thickened, more whitish than normal which further gets calcified such as miliary tuberculosis. 4. Cavities appears as white border with air filled(black) in center represents numerous cavitary lesions

33. 6. Lung abscess – Defn- It is loacalized parenchymal destruction due to suppuration within the lung. Diagnosis :- Chest showing a big cavity occupying the left sided mid and lower zones with thick, rough, shaggy inner wall. the lower homogenous opacity with a horizontal level indicates fluid inside the cavity. Appears hypertranslucency , above the fluid level indicates air within the caivity Trachea and cardiac apex are in normal position . Lung abscess

34. Any Questions ??? NAME :- DR NISHANT SANJAY TARALKAR MD SCHOLAR (ROG NIDAN) Thank You