for download go to

1. Chest Xray

2. Different tissues in body absorb X-rays at
different extents:
• Bone- high absorption (white)
• Tissue- somewhere in the middle absorption (grey)
• Air- low absorption (black)

4. CXR - PA Vs AP view.
PA- the x-rays penetrate through the back of the
patient on to the film
AP-the x-rays penetrate through the front of the
patient on to the film.

6. Penetration / Exposure
 Able to see ribs
through the heart
 Barely see the
spine through the
heart
 Pulmonary vessels
can be traced
nearly to the edges
of the lungs

7. Underpenetrated Film
Hemi diaphragms are obscured
Pulmonary markings more prominent than they actually

8. Over penetrated Film
 Lung fields darker than
normal—may obscure subtle
pathologies
• See spine well beyond the
diaphragms
• Inadequate lung detail

9. Positioning / Rotation
Does the thoracic spine align in the center of the
sternum and between the clavicles?
Clavicles – equidistant from spine

11. Determine side – ? L/R
 Gastric bubble should be on the left ( normally )

12. Look at
 Soft tissue
 Bony cage

13. Soft tissue and bony structures
 Check for
 Symmetry
 Deformities
 Fractures
 Masses
 Calcifications
 Lytic lesions

17. Look at the diaphram:
-Tenting
-free air
-abnormal elevation
 Margins should be
sharp
(the right hemidiaphram is
usually slightly higher than
the left)

18. Heart
 Size
 Shape
 Silhouette-margins should be sharp
 Diameter (>1/2 thoracic diameter is
enlarged heart)
 AP views make heart appear larger than it
actually is.

20. Costo-phrenic / cardiophrenic angles
Margins should
be sharp

21. Lung fields
 Infiltrates
 Increased interstitial markings
 Masses
 Absence of normal margins
 Air bronchograms
 Increased vascularity

34. Cannon ball appearance- DDS
Osteogenic sarcoma
Thyroid (follicular)
Testicular carcinoma
Kidney
Choriocarcinoma
Prostate
Malignant melanoma, Some GI, Some very
advanced nasopharyngeal, and pharyngeal
carcinomas
Breast
Lymphangitis carcinomatosa