PRACTICAL PROBLEM-BASED CHEST RADIOLOGY CONVENTIONAL CHEST FILMS Objectives: Upon completion of this series, the participant should be able to: 1. Systematically “read” any chest roentgenogram, beginning with assessment of the film for radiographic quality. 2. Discuss the chest film in terms of problem-solving: indications, sensitivity and specificity, cost-effectiveness in screening and other diagnostic situations. 3. Recognize normal and abnormal pulmonary anatomy on the chest film. 4. Delineate normal and abnormal cardiac anatomy on the chest film. 5. Synthesize clinical case information with basic skills in chest film interpretation to arrive at a problem assessment or “differential diagnosis.” Texts you may find useful on the basic chest film (old editions are as good as new editions): 1. Corne J, Carroll M, Brown, I, Delany, D. Chest X-ray Made Easy. London: Churchill Livingstone, 2000. 2nd edition. ($19.95 in AHSC Bookstore, pocket-sized, 127 pp.) (Excerpts are included in this manual.) Felson B. Chest roentgenology. Philadelphia: W.B. Saunders Co., 1973. Felson B. Principles of chest roentgenology, a programmed text. Philadelphia: W.B. Saunders Co., 1965. 2nd edition, 1999.
4. Forrest and Feigin. Essentials of Chest Radiology, W.B. Saunders Co., 1982. (Good basic text) 5. Lillington and Jamplis. A Diagnostic Approach to Chest Diseases: Differential Diagnoses Based on Roentgenographic Patterns. Baltimore: Williams and Wilkins Co., 3rd edition, 1987. Mettler F. Essentials of Radiology, W.B. Saunders Co., 1996. Squire, LF. Fundamentals of roentgenology (3rd ed.). (general principles). Cambridge: Harvard University Press, 1982 Squire, Colaice, and Strutynsky. Exercises in Diagnostic Radiology, Vol. 1: The Chest, 1972. (Paperback, problem oriented.) Mettler F. Essentials of Radiology, W.B. Saunders Co., 1996.
1.1 Basic interpretation is easy
Chest X-Ray Made Easy
Basicinterpretation of the chest X-ray is easy.It is simply a black and white film and any abnormalities can be classified into:
1. Toowhite. 2. Tooblack. 3. Toolarge. 4. In the wrong place. To gain the most information from an X-ray,and avoid inevitable panic when you see an abnormality, adopt the following procedure: 1. Check the name and the date. Do this before you put it on the screen - if you do not you are bound to forget.
Respiratory Physician, Queen's Medical Centre, Nottingham,
General Hospital. Southampton, UK
Fellow in Radiology,
MB BSFRCS FRCR
General Hospital. Southampton, UK
2. Check the technical quality of the film. (Explained in Chapter 1.2.)
Consultant FOREWORD BY
General Hospital, Southampton, UK
Professor of Respiratory Medicine and Vice Dean, Guy's, King's and St Thomas' School of Medicine, London, UK
3. Scan the film thoroughly and mentally list any abnormalities you find. Always complete this stage. The temptation is to stop when you find the first abnormality but if you do this you may get so engrossed in determining what it is that you will forget to look at the rest of the film. Chapter 1.3 expains how to scan a film. 4. When you have found the abnormalities, work out where they are. Decide whether the lesion is in the chest wall, pleura, within the lung or mediastinum. Chapter 2 explains how to localize lesions within the lung and the heart, Chapter 7 the mediastinum, and Chapter 8 the ribs.
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LIVINGSTONE MADRID MELBOURNE NEW YORK SAN FRANCISCO TOKYO 2002
5. Mentally describe the abnormality. Which category does it fall into: I Toowhite. n Tooblack. III Toolarge. IV In the wrong place. Chapters 3 to 10 will take you through how to interpret your findings. 6. Always...
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