A description of a systematic method for examining a chest X-ray, and a review of the relevant thoracic anatomy.
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@giuseppetardini14243 жыл бұрын
TRANSCRIPT LEARNING OBJECTIVES: • to be familiar with the systematic approach to interpreting chest X-rays • to know the correlation between anatomy and normal shadows on the chest X-ray Before just presenting a systematic approach, we should mention a couple of IMPORTANT PRINCIPLES about it: • it is most important for the clinicians least experienced with reading chest X-rays, since it reduces the chance that important findings will be missed • all aspects of chest X-ray interpretation should be included • the individual elements of the approach should be examined in a sequence that is either logical and/or easy to remember • there is no one "best" system, though all should begin with an assessment of the film's technical quality We could informally call such a systematic approach the ABCDEF SYSTEM (each of the letters refers to a specific anatomic structure, but before the A we need to assess the technical quality): • A=AIRWAYS • B=BONES (and soft tissue) • C=CARDIAC SILHOUETTE (and mediastinum) • D=DIAPHRAGM (and gastric bubble) • E=EFFUSIONS (in other words, assessment of the pleura, which actually includes findings beyond just pleural effusions) • F="FIELDS" (i.e. lung fields) • lastly, although it is not explicitly part of the mnemonic, ASSESSMENT OF LINES, TUBES, DEVICES and PRIOR SURGERIES, such as sternotomies and valve replacements Aside from the fact that it is easy to remember, another nice thing about this mnemonic is that the lungs are examined near the end. This is a good idea because normally the lungs are the area of greatest interest and the most likely to be abnormal, therefore once the clinican find an abnormality there, it is very easy to forget examining the rest of the film (for example, overlooking a rib fracture because of a distraction over acute lung pathology) A is for the AIRWAYS. There are three anatomic airway structures that are typically visible on a normal X-ray: • TRACHEA, which is normally in the midline • RIGHT and LEFT MAIN BRONCHUS ○ the left main bronchus tends to take off from the trachea at a slightly more horizontal angle as compared to the right, which is why aspirated foreign bodies, if small enough, are more likely to end up in the right lung than the left, and it is also why endotracheal tubes, if advanced too far, end up in the right main bronchus, blocking off ventilation to the left rather than viceversa The next set of structures is the BONES. There are four types of bones, easily visualized on a PA and lateral X-ray set: • RIBS ○ there are two radiographic components of the rib on the PA film, the POSTERIOR RIB, which is easier to see and is oriented horizontally, and the ANTERIOR RIB, which is harder to see and oriented at a 45 degree angle • CLAVICLE • STERNUM (sometimes visible on the LATERAL film, but is often obscured by soft tissue in the anterior chest wall) • VERTEBRAL BODIES (more easily visible on the LATERAL film, but usually seen on the PA as well, provided that the technical quality is adequate) Then, there are the CARDIAC SILHOUETTE and the MEDIASTINUM, which should logically be evaluated together. There are a lot of anatomic structures that compose the silhouette (on the left side, AORTIC ARCH, LEFT PULMONARY ARTERY, LEFT ATRIUM, LEFT VENTRICLE, while, on the right side, ASCENDING AORTA, RIGHT PULMONARY ARTERY and RIGHT ATRIUM): • we should usually also be able to see another vertical line running just to the patient's left of the vertebral bodies, which corresponds to the LEFT SIDE OF THE DESCENDING AORTA • the one structure on the patient's left called the AORTOPULMONARY WINDOW may be unfamiliar to some: this is an important space between the aortic arch and the pulmonary artery where one will find the recurrent laryngeal nerve and lymphnodes It makes sense to evaluate the DIAPHRAGM and the PLEURA together: • RIGHT and LEFT DIAPHRAGM ○ they are clearly visible on the PA view ○ it is normal for the right hemidiaphragm to be slightly higher than the left, presumably due to the liver being directly beneath it ○ while looking at the diaphragm, it's important to remember that there aren't any truly flat structures in the body: for example, the hemidiaphragms are curved in three-dimensional space; as we might be able to appreciate from comparing the PA to the LATERAL, the hemidiaphragms seen on the PA really just represent the superior most aspect of the diaphragm • PLEURA ○ it is normally invisible due to its thinness ○ however, knowledge that the pleura is there is essential for diagnosing a pneumothorax, pleural plaques from asbestos exposure and pleural thickening • RIGHT and LEFT COSTOPHRENIC ANGLES (although SULCI would probably be more semantically accurate in most circumstances) ○ spaces on either side where the diaphragm meets the thoracic wall ○ these two spaces are usually seen on the PA • POSTERIOR COSTOPHRENIC ANGLE ○ space in the back on the LATERAL film • GASTRIC AIR BUBBLE ○ small pocket of air, visible under the left hemidiaphragm, usually representing air in the stomach ○ occasionally, it can be unclear whether the gas is in the stomach or in the intestines Next, we need to take into consideration the main anatomic structures of the LUNGS: • FISSURES BETWEEN THE LOBES ○ HORIZONTAL FISSURE § there is only one, and it is located on the right side § it is the only one of the three fissures that is commonly visible in normal X-rays, which is because a significant portion of the plain of the fissure is parallel to the direction of the X-ray beams § however, it is only visible on the PA § the right and left oblique fissures are not visible ○ LOBES § RIGHT UPPER LOBE § RIGHT MIDDLE LOBE § RIGHT LOWER LOBE □ because the oblique fissure runs obliquely, as seen in the lateral view, the lower lobe extends almost all the way to the apex of the lung (this will be true on the left side as well) □ as a consequence, if only the PA or AP views are presented without a lateral, it's almost impossible to tell in what lobe a visualized nodule or mass is located, unless it's seen in the uppermost part above the lower lobe's most superior extent § LEFT UPPER LOBE § LEFT LOWER LOBE
@lawlietlawliet3 жыл бұрын
You're a savior
@Mr.C0ffee2 жыл бұрын
THE MVP!!!
@Lsoldier096 жыл бұрын
My son is 5 and autistic. He loves human anatomy and xrays. These are the videos we watch together. Awesome video and info.
@anast93014 жыл бұрын
Greetings from Indonesia. This is the first radiolology lesson that's able to make me fully understand a CXR. It is very systematic and doesn't cause confusion
@carlosjoelgarcia32004 жыл бұрын
Phenomenal presentation with super imposing anatomy. Genius!!! Thank you for the clarity of explanation and please continue doing these videos. Disregard the haters....
@jamiebrown502810 жыл бұрын
I will be encouraging my students to review this and this available for review while out in clinic. Excellent video and very concise.
@StrongMed10 жыл бұрын
Thanks for sharing it! I'm always happy to hear feedback from fellow educators!
@lovelyroroa9 жыл бұрын
This is the first video of yours I have watched and it seems like I'll be seeing more of your awesome clear, made simple videos... I just need to say thank you! THANK YOU
@himushakya9 жыл бұрын
As a medical student,i found it very helpful to build my basic concepts. Thanks a lot sir !
@vd.matheusmacedo9 жыл бұрын
Thank you so much doctor! I watch all your videos and they are absolutely amazing! Please never stop
@n1cK0599 жыл бұрын
Greetings from France, you rock man. Your videos are among the most useful materials I could get ahold of.
@sweetbug9 жыл бұрын
Dr. Eric I appreciate you taking time out of your busy life in making these very educational videos. I am thankful that there are resources like you because my NP school sucks.
@mictheoc73017 жыл бұрын
Thank you very much for these videos , right from the start you got my attention. You are clear and concise. Most perfect teaching videos that I have watched on you tube.
@caseytrammell66739 жыл бұрын
You are a wonderful teacher. I'm finding your videos to be great help, in assisting me through PA school. Thank you!!
@amarnathbhadra62014 жыл бұрын
Your video series helps me a lot to understand the interpretation of the chest x ray and I am looking forward to the next step ,i am basically a science communicator and science graduate and the power plant experts.
@tabner1008 жыл бұрын
I Loved your video. The overlay was very helpful in showing what one is viewing in the X-ray.
@menisparaskevas87597 жыл бұрын
Excellent video on systematic evaluation of a cxr! Thank you for posting it!
@medicalmumbojumbo56224 жыл бұрын
That cardiac overlay was incredibly helpful. Thank you!
@aristotleasis86710 жыл бұрын
Thanks Eric... looking forward to the remaining videos... Cheers!
@albertrajadevaanbu340010 жыл бұрын
Thanks for posting this video. in this video is very useful for me and all medical students also. hope i am become a good radiographer. Once again thanx Mr. Eric's.
@peterthorne64318 жыл бұрын
Third year medical student. Your video series has been a great help for wards. Thank you!
@laurapadron32708 жыл бұрын
Excellent video series. Very helpful. Thank you for your great work !!
@dr.ahmetboran84554 жыл бұрын
MAY ALL PRAISES AND GLORY BE UNTO ALMIGHTY CREATOR, VERY GOOD EXPRESSION OF THOUGHTS.
@ashrazterrian88518 жыл бұрын
thank you so much! it's so helpful for basic understanding of chest x rays
@fredastaire61563 жыл бұрын
Thank you for such a detailed and thoughtful video. Dr. Strong.
@AlmaSouthAfrica9 жыл бұрын
Thank you sooooo much - from South Africa!
@priyankanamishra72904 жыл бұрын
Amazing explanation Dr. Strong. Many thanks
@skibitom10 жыл бұрын
Great and helpful Tutorial. Thank you for sharing.
@SuperStrangeThor8 жыл бұрын
ALL THE VIDEOS ARE VERY HELPFUL.. THANK U DOCTOR ERIC ..
@ladyheart51477 жыл бұрын
thanks again, these videos are helping me tremendously
@fareenazahari4 жыл бұрын
Great explanation. Thank you Dr Strong!
@flubu28164 жыл бұрын
Love the ABCDEF mnemonic, thank you for this high-yield series! I've seen it extended to G = gastric bubble, H = Hilum, I = instruments (lines, tubes, devices, etc.). A question: any plans to create a interpreting CT series? Would be very useful (and if not - any recommended free resources for med students?)
@francescodemaio376210 жыл бұрын
Thank you very much, you have been extremely helpful !
@muhammedamir14078 жыл бұрын
Thanks for educating us, so nice presentation
@abulc.49964 жыл бұрын
Sir, the quality of your teaching is SUPERB😍
@joliescoldbeans299 жыл бұрын
Eric, I'd love to see you do a video on how to systematically approach lung lesions of different appearances, + their common differentials. (I couldn't find one already on your channel, though I could have missed it; you have lots of videos!) Your videos are so systematic and relevant that I would specifically want YOU to do one!
@StrongMed9 жыл бұрын
Thanks for the vote of confidence! Sorry I"m taking so long to respond to this, and you may have already discovered this, but lessons 7 and 8 in this series on chest X-rays covers the differential diagnosis of various types of lung lesions. You can find the videos by going to my channel page and scrolling down to the playlist "Interpreting Chest X-rays".
@abdulazeez.987 жыл бұрын
Your videos are defenitely the best.
@DucVietNguyenPhD8 жыл бұрын
Great Thankful Appreciation for valuable lecture.
@kylewilson6535 жыл бұрын
LOVE your Chest Xray interpretation videos! Do you have videos for improving reading CT's or MRI's?
@damonspears77888 жыл бұрын
fantastic intro for novice learners, even experienced nurses and laymen
@epilepsyawarenessaidresear9302 жыл бұрын
Enriching and very informative! Thank you 😊
@how80872 жыл бұрын
Hello eric strong .... i really want to thank you ....... for your amazing vedios that's helped many of physician around the globe .....
@yajna-slayduop71383 жыл бұрын
Veey interesting and clear explanation. Thank you so much today i got to lern from you. And i recommend those who want to learn please go for it worth watching and very helpful, Thanks.
@Maddawg314152 жыл бұрын
I’m a paramedic taking ATLS audit in a few weeks. This was very helpful
@sinclair657 Жыл бұрын
Thank you very much. I am an RT and it is becoming imperative that I can identify the CXR abnormalities along with my assessments.🧐
@gregsbox4 жыл бұрын
Great video. What explains the darker regions on each side of the sternum, just below the clavicle?
@aliyilemecha35959 жыл бұрын
It is my first time to watch this video . it is helpful.
@chipomilambo58784 жыл бұрын
Thanks a lot for uploading this it has really helped me.Zambian student
@bobbybelarmino564910 жыл бұрын
Great explanation! Thanks you!
@aranthillainathan85686 жыл бұрын
Amazing explanation!
@ferdinandmiguelsenga11874 жыл бұрын
This is very good! more power sir!
@manu271909 жыл бұрын
thanks. This video gives me very use ful information about chest x rays.ABCDEF systems is very useful and easy to remember
@sunving4 жыл бұрын
Thanks ,I just learn from you more or less today.
@mohammadramishammah49779 жыл бұрын
Thanks a lot Dr ...really impressive job
@gladissemensato20616 жыл бұрын
The best! Thanks from Brasil.
@Katkiwi256 жыл бұрын
You are the absolute BEST!!!
@katef78483 жыл бұрын
you are amazing thank youuuuu!! we start radiology and it was very difficult for me to understand everything especially with the pandemic situation where we have our lessons online!! so really thank you , it made it very clear
@StrongMed3 жыл бұрын
Thanks for the comment! And you're in luck - I am planning on posting an approach to abdominal X-rays on Sunday!
@BabyIsa02 Жыл бұрын
@@StrongMed 😮
@basilal46719 жыл бұрын
Fantastic, easy to learn thanks.
@kingsleyokoro97987 жыл бұрын
Incredible videos!
@nightstormrain40378 жыл бұрын
this is very helpful. thanks.
@dr.msaqibhissan43703 жыл бұрын
A great Video. Thank you so much for effort.
@Paschimnepal20253 жыл бұрын
Hello sir I am a student of pcl diagnostic radiography in nepal I always watch your video to better understand where I study in my collage 🇳🇵🇳🇵thank you for your information video ❤️❤️❤️❤️always respect and love
@punleakpinmd78417 жыл бұрын
All excellent, I really love
@drtirthpatel52024 жыл бұрын
Very helpful video .... appreciate your efforts.thanks
@mariatileinge29026 жыл бұрын
These videos save my life in med school👌
@rockernoobsthurein9 жыл бұрын
Thanks a lot. I appreciate it a lot.
@saadnacheikhelmahdycardio17914 жыл бұрын
Thanks a lot this is so helpful ❤
@mustafamukaram74122 жыл бұрын
Very helpful video, thank you.
@tariqalziad37303 жыл бұрын
I am very benefited to see this video...
@Echooffeelings9 жыл бұрын
nice video... very well described, right diaphragm is higher as left diaphragm is pushed down by heart.. as right diaphragm is lower in patient with dextrocardia with normal situs
@nadiakharismalita53383 жыл бұрын
this is so worth it and a must watch lecture! thank you so much doc. and may i request for another lectures of radiology such as MRI CT or USG please? :3
@borhanzabaan6024 Жыл бұрын
How r you
@Darusiha62543 жыл бұрын
Good well explained chest x.ray thank u for your efforts
@drtoladingeta15547 жыл бұрын
thank you for this vedio and i hope u do more in the future! i have also seen ur vedio on urine dipstick and i realy found it use full! just i would like to say thanks! From HARAMAYA UNIVERSITY, ETHIOPIA!
@yirgalemfirisa50645 жыл бұрын
Wow you are the only till now continued
@32franss6 жыл бұрын
thank you for made this video
@ahmedsaidify9 жыл бұрын
thank you dr eric
@amyflamingo37615 жыл бұрын
please what is the basal wall hypoknesis... And in which case it happens... Thanks
@erciasequeira23805 жыл бұрын
Thank you so much for sharing
@ajazhussain7502 Жыл бұрын
Excellent Work
@manymarius9 жыл бұрын
thanks a lot for the video.I just started studing x-rays and at first i was really shocked...all i saw was black and white but you really helped me to understand the basics.Greetings from Romania
@ahadsaeed39735 жыл бұрын
Thanks a lot sir Lots of Respect from India
@wanyonyisam84452 жыл бұрын
I finally landed on what I have been looking for
@TheDaoke10 жыл бұрын
many thx for your great work, Eric. It's very very helpful. I'm wondering if you have any plan to interpret CT anatomies of neck, chest, abdomen and pelvics.
@StrongMed10 жыл бұрын
I'm very glad you've found them helpful! Unfortunately, I have so many other topics on my to-do list that I don't anticipate covering CT imaging in the near future. Perhaps much further down the road. For now, if you are wanting to study CT imaging on your own, I recommend www.radiopaedia.org - they have many great examples and mini-tutorials covering all radiographic modalities.
@khushbashdar66866 жыл бұрын
Thanks a lot sir...it is amazing...
@user-sm2lo8cy6z4 жыл бұрын
Thank you so much! From South Korea
@theroadtobliss10 жыл бұрын
Amazing overview of Chest Xrays. A life saver!
@doctorusmle19962 жыл бұрын
Great work , Go On 😍
@200312130010 жыл бұрын
sir ,its very interesting and helpful to gain lot of knowledge from your lecture.i watched ur lecture regularly and eagerly waiting for next video everytime.Sir could you start lecture series on bacteriology ,virology and mycology as it find difficult for me to understand in concise manner.Thanks a lot sir again for such wonderful teaching
@StrongMed10 жыл бұрын
I have a video series already posted on antibiotics, which covers a little bacteriology outside of the specific topic of antibiotic therapy, predominantly in lectures 1, 2, and 9. I plan to create a brief 2-3 video series on fungal infection and fungal treatment within the next month or so. I have less clinical experience with most viral diseases, so this will likely come along much later, but I plan to get to it at some point. Thanks for watching!
@sonalisubhadarsini24363 жыл бұрын
Thank you for helping 😊
@robertclaytoneugene8 жыл бұрын
Thank you most kindly
@jsachin31714 жыл бұрын
a query abt lat. view ?? when u tell lat view which side lat view right or left side of t chest?
@SonaliguptaSG3 жыл бұрын
Great work
@aalaaabduljalil84552 жыл бұрын
Very useful,thanks
@HollyWoodall235 жыл бұрын
awesome video thank you
@gabi.melotti4 жыл бұрын
So amazing video
@benjaminnyirenda73367 жыл бұрын
great place to start
@mdshowkathali73065 жыл бұрын
Thank you so much from Bangladesh.
@zj93383 жыл бұрын
Very nice videos keep up doctor 💕
@pedromaciel30585 жыл бұрын
How can i differentiate the pulmonary vessels from the bronquios?