Subagia Santoso MD.

Medical Faculty
Pelita Harapan University
1
Basic Conventional Imaging
We do conventional imaging s basic

Imaging : Black and white
Contrast In Imaging





Black // white
Radio lucent // R Opaque
Hypo echoic // Hyper echoic
Hypo intens // Hyper intens
Lucent
Intermediate
Semi-Lucent
Semi-Opaque
Opaque
Position photo processing
1. AP / PA
2. Right or Left lateral
2. Oblique , RAO , RPO , LAO and LPO
3. Tangensial : soft tissue
4. Rekumben : prone or supine
5. Dekubitus : X ray horizontal direction
6. Semi erect : semi supine
Photo position diagram
Chest X Ray
The most important information in conventional
respiratory imaging
Ro Imaging Anatomi





14
Mediastinum
Borders of mediastinum:
Right : Right Lung
Left : Left Lung
Anterior : Sternum
Posterior : Vertebrae

15
Mediastinum structures
Anterior : Thymus, lymph node
Medial : Heart
Posterior : Oesophagus, Trachea
16
Mediastinum abnormalities
Pneumomediastinum
In patient with COPD, the air can out from alveolus into
surrounding broncovascular structures and finally enter
mediastinum through pulmonal hilum.
PA and lateral films show longitudinal lines and
radioluscent bubles.
17
Mediastinum abnormalities
Mediastinum mass
Many variants of tumor origins from mediastinum.
To facilitate you in recognizing the possible mass arises
from mediastinum, so mediastinum is divided into 3
areas:
Anterior : Upper level : tiromegaly, timoma, teratoma,
adenopathy, aneurysm.
Lower level : pericardium cyst, Morgagni hernia
Middle : bronchogenic cyst, hiatal hernia, esophageal
lesions, adenopathy and aneurysm.
Posterior : neurogenic tumors, adenopathy, aneurysm

18
Heart
Normal anatomy of the heart;

19
RA LA
RV LV
Normal Cardiac Photo

20
How to Measure Cardiac Size
Standard
method of
measuring CTR
using a
Posteroanterio
CXR.
CTR=(A+B)/C

21

a b

24
Normal Blood Pressure Increase Pulmonal Congestion
A. Pulmonal Hypertesion Post-Stenosis Pulmonal Blood Pressure Decrease
25
Left Atrium Enlargement Left Ventricle Enlargement
Right Atrium Enlargement Right Ventricle Enlargement
Pericardial effusion

Water bottle apperance
in PA film is a spesific
sign of pericardial
effusion.
26
Coronary arterial disease
Not so useful
But can help to detect the dilatation of heart and
congestion of the lung vessels.
We can see coronary heart disease w/ MSCT or heart
cath.
27
Left heart failure

Left ventricular hyperthopy
Cardiomegaly sign
28
Dilatation of superior lobes blood
vessels

Normally in erect position superior lobe vessels is
smaller than inferior. And more peripher more sharp.

29
Dilatation of superior lobes blood
vessels
Increasing of flows
Etiology
Right to left shunt
Conditions that make Cardiac Outout increase eg anemia,
tirotoksikosis
30
Dilatation of superior lobes blood
vessels
Congestion of Pulmonal Veins
Etiology
Mitral stenosis
Left heart failure
Atrial myxoma
31
Interstitial oedema
Pathopysiology
Interstitial oedema can occur due to consistent atrial
pressure that make transudation. Transudate fluids flow
into interstitial space and interlobularis connective
tissue and make a line. The line that made is called
Kerley line.





32
Interstitial oedema
33
Kerley lines
There are 3 types of Kerley lines
Type A : long, unbranched, and go to the hilum
Type B : short, tine, best showed at costophrenic angle
Type C : soft, reticular form
34
Kerley B Lines
35
Interstitial oedema etiologies
Pulmonal arterial hypertension
Etiology
COPD
Recurent pulmonal emboli
Post-stenosis dilatation
Reducing of flows


36
Intra-alveolar oedema
Is a continue from interstitial oedema. The fluids will
accumulate at alveolar space.
37
38