Chest X-Ray in Clinical Practice

ISBN-13: 9781848820982 / Angielski / Miękka / 2009 / 195 str.

Neil Crundwell; Rita Joarder

Opis

Thechestradiograph(chestX-ray)isthemostcommonly- questedexamination, anditisprobablythehardestplain?lm tointerpretcorrectly. Accurateinterpretationcangreatly- ?uence patient management in the acute setting. It is, h- ever, oftenperformedoutofhoursandtheinterpretationis undertakenbyrelativelyjuniormembersofstaffwithno- mediateseniorsupportorradiologicalinput. Despitethe- creasingavailabilityofmorecomplexradiologicalinvesti- tions, thechestX-raycontinuestoberequestedasa?rst-line investigationandthisislikelytocontinue. The structure of this book derives from many teaching sessions that have been given to junior doctors and me- calstudents. Theauthorshavefoundthat, ingeneral, tea- ingregardingchestX-rayinterpretationhadlackedaformal structuredapproach, andjuniordoctorsandmedicalstudents foundinterpretingachestX-raydif?cult. Givingthemastr- turedapproachallowedthemtofeeltheycouldtackleint- pretationwithmorecon?dence. Weaimtoprovideaportablehandbookforjuniordoctors. The structure is based upon those lectures that the authors havegiven. Thebookitselfisintendedtobeeasilyaccessible andtohelpthiswehaveincludedtablescontainingthekey teachingpoints, toalloweasyreference. Wehaveincluded- tensiveexamplesofcommonpathologies. Thisbookis, h- ever, notanexhaustiveworkofreference. WehaveincludedbasicinformationonhowachestX-ray isperformedandhowsuchperformancefactorscanaffectthe qualityoftheimage. Weconsidertheimplicationsofrad- tiondoseandgivedetailsofbasicnormalanatomy. Wethen explainwhynormalstructuresappearastheydoonthechest vii viii Preface X-ray. Theabilitytointerpretthenormaliskeytointerpr- ingtheabnormalandweexplainwhyabnormalitiescreatethe imagingfeaturestheydo. Using a structured logical approach, we focus on both anatomical abnormality and more generalized patterns of lungdisease. Our ultimate aim is to equip the reader with a con?dent, simplebutlogicalapproachtochestX-rayinterpretation. R. Joarder N. Crundwell Acknowledgments We would like to acknowledge Christina Worley for all her hardworkinpreparingthemanuscript. We would also like to acknowledge the following for their valuable contribution to this book: Steve Page, DCR, MSc, Conquest Hospital, St Leonards-On-Sea, East Sussex, UK, andAndrewDeveling, DipMDI, ConquestHospital, St Leonards-On-Sea, EastSussex, UK ix Contents Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix PartI 1 ChestRadiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1. 1. RadiographicTechnique . . . . . . . . . . . . . . . . . . . . 4 1. 1. 1. Postero-anterior(PA). . . . . . . . . . . . . . . . 4 1. 1. 2. Antero-posterior. . . . . . . . . . . . . . . . . . . . 6 1. 1. 3. Lateral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1. 1. 4. Obliques. . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1. 1. 5. PenetratedPostero-anterior . . . . . . . . . . 12 1. 1. 6. Inspiration/ExpirationPostero-anterior 12 1. 1. 7. ApicalLordotic . . . . . . . . . . . . . . . . . . . . . 12 1. 2. KeyPoints. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2 The Normal Chest X-ray: An Approach toInterpretation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2. 1. UnderstandingNormalAnatomy . . . . . . . . . . . . 17 2. 2. ReviewAreas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2. 3. Pseudo-abnormalitiesonaNormalFilm. . . . . . 24 2. 4. KeyPoints. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 PartII 3 TheMediastinumandHilarRegions . . . . . . . . . . . . . 31 3. 1. MiddleMediastinumandHilarRegions. . . . . . 34 xi xii Contents 3. 1. 1. CardiacAbnormality. . . . . . . . .

Spis treści

I.- Chest Radiography.- The Normal Chest X-ray: An Approach to Interpretation.- II.- The Mediastinum and Hilar Regions.- Basic Patterns of Lung Disease.- Consolidation.- Collapse.- Lines.- Nodules.- Rings and Holes.- The Pleura.- Pleural Abnormalities.- Pleural Thickening and Calcification.- Pneumothorax.- Soft Tissues and Bony Structures.- Foreign Structures and Other Devices on Chest X-rays.- III.- Computed Tomography: Technical Information.- Computed Tomography (CT): Clinical Indications.

O autorze

Rita Joarder, BSc.MBBS, FRCP, FRCR - Consultant Radiologist, Conquest Hospital in Hastings Neil Crundwell, MRCP FRCR - Consultant Radiologist, Conquest Hospital in Hastings

Blurb

Chest X-Ray in Clinical Practice brings a deeper understanding of chest x-rays to the forefront, enabling doctors to make confident and accurate diagnoses across a range of medical situations. The principles and practice of acquisition of the chest X-ray are discussed, raising awareness of technical factors that may limit the extent of interpretation, to ensure that doctors-in-training take every precaution in avoiding the common ‘pitfalls’ of misinterpretation.

The chest radiograph is a very commonly requested examination and it is probably the hardest plain film to interpret correctly. Accurate interpretation can greatly influence patient management in the acute setting. It is, however, often performed out of hours with interpretation undertaken by relatively junior members of staff, frequently with no senior radiological advice available.

Chest X-Ray in Clinical Practice concentrates on conditions commonly diagnosed in an acute setting, with special attention drawn to those areas of the image that are often overlooked. Whilst the main focus is upon the plain film, the increasing use of CT is recognised.

Providing content in a user friendly, logical structure and layout, this book gives the reader a reliable framework for chest x-ray interpretation. With 130 high quality annotated digital images, which assist reader to recognise common and important abnormalities, Chest X-Ray in Clinical Practice also provides key learning points in each chapter, consolidating the reader’s understanding, and consequently acting as a quick reference tool for all junior doctors.

Neil Crundwell, MRCP FRCR Consultant Radiologist, Conquest Hospital, Hastings, UK

Rita Joarder, BSc, MBBS, FRCP, FRCR, Consultant Radiologist, Conquest Hospital, Hastings, UK