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00:00Hello everyone, welcome back to Medical My Life. Today we will learn how to read chest x-ray.
00:07X-ray is a kind of thing that you will encounter throughout your medical profession, not only in radiology but in almost every department.
00:16So you should have basic knowledge of reading chest x-ray. So starting with the basics.
00:23In x-ray you can see some white areas and some black areas.
00:30The white areas we call area of opacity and the black areas we call area of lucency.
00:38What is this?
00:40The x-ray which is a beam which is passed through different structures.
00:46For example bones, heart, lungs and all these structures are different.
00:52So the x-ray beam which is a dense structure, for example bone, is not easily passed.
00:59This is why these structures are white appear.
01:03For example lungs, lungs are not dense because they are filled up.
01:09Here the x-ray beam is easily passed.
01:12How can our lungs look? Black appear.
01:15Next is always assume that the patient is facing you.
01:22Reason what is this?
01:23Right side of chest x-ray is to your left and left side of chest x-ray is to your right.
01:29So, see.
01:30This is the right side of chest x-ray.
01:32This is the right side of chest x-ray.
01:36This is the right side of chest x-ray.
01:38Sorry.
01:39This is the right side of chest x-ray.
01:44This is the right side of chest x-ray.
01:49This is the right side of chest x-ray.
01:52For this reason, you can assume that the patient is standing facing you
01:59Now you have a patient that has come to x-ray
02:03So you will not start to direct x-ray reading
02:06First of all, what do you confirm?
02:08Patient name, when it was taken, why it was requested and in which view it is
02:16For example, in x-ray these things are mentioned
02:20Name of patient, age, gender, unique id number, date, time
02:28And here it is mentioned, which is x-ray
02:32So now our third point was
02:35Third point was why it was requested
02:38This will not be known as x-ray film
02:42So this will be known as prescription
02:45Patient will be known as prescription
02:47Or you can ask directly to the patient
02:50If you have any problems
02:53Next is
02:55Next is
02:57Next is
03:07Next is
03:08Next is
03:09Next is
03:10Next is
03:11Next is
03:12Next is
03:13Next is
03:14Next is
03:15Next is
03:16Next is
03:17Now I am going to explain to you these three details
03:19Let's check the X-ray quality, first of all, rotation
03:24What is rotation?
03:25Our X-ray film, the patient is straight.
03:29If the patient turns the right side or left side, the X-ray will rotate.
03:35We call it rotation
03:37Now, to know that our X-ray is well-centered or not, what do we do?
03:43Here is our spinous process
03:46And these are clavicles
03:49So, clavicle's lateral border
03:53And spinous process
03:56We will see distance between the right side and left side of the clavicle
04:01And spinous process between the distance
04:03If it is equal
04:05This means, this is our X-ray
04:08This is well-centered X-ray
04:16So, if the distance between the lateral boundaries of the clavicle
04:24And the midline
04:26That is, spinous process is same on both sides
04:28Then it is well-centered radiograph
04:31Now, if the rotation is present, what will be different?
04:34Look, if the rotation is present
04:37For example, the patient left side is rotated
04:40The patient left side is rotated
04:42The left side of the clavicle and spinous process
04:46The gap will increase
04:48And the left side of the lung field will be darker as compared to the right side
04:55Next is exposure
04:59Exposure
05:01Exposure means
05:02The X-ray beam is adequate or not
05:06Exposure check
05:07To focus on the lower thoracic vertebrae
05:11So, lower thoracic vertebrae
05:14Margins are
05:15You can see
05:16Barely visible
05:17Clearly visible
05:19Not
05:20So, X-ray
05:21If you have lower thoracic vertebrae
05:24Margins barely visible
05:25This means
05:26X-ray is adequate exposure
05:28This X-ray is correct
05:31If our margins
05:34Clearly visible
05:36That means
05:37This X-ray is hyper exposed
05:39So, for adequate exposure
05:41Lower thoracic vertebrae margin should be barely visible
05:43If clearly visible
05:44Then it is hyper exposed
05:45And if not visible
05:46It is hypo exposed
05:47So, for adequate exposure
05:48Lower thoracic vertebrae margin should be barely visible
05:50If clearly visible
05:51Then it is hyper exposed
05:52And if not visible
05:53It is hypo exposed
05:54Next, how will we check quality check
05:56Third point is inspiration
05:58So, I have in the last video
05:59I have uploaded chest X-ray PA vs AP view
06:01Third point is inspiration
06:03So, I have in the last video
06:05Which I have uploaded chest X-ray PA vs AP view
06:08In that video
06:09I have also told you
06:11When we take patient X-ray
06:13To inspire the patient
06:15And to hold his breath
06:17This way
06:18Our lungs
06:19Inflate
06:20Now, we need to know
06:22That is
06:23Proper inspiration
06:24Is not
06:25That is
06:26Adequate inspiration
06:27Is not
06:28That is
06:29Adequate inspiration
06:30Is not
06:31That is
06:32So, criteria
06:33You should be able to see
06:345-6 anterior ends of rib
06:36And
06:378-10 posterior ends of rib
06:39Above the diaphragm
06:40Now, this is
06:41Anterior end of rib
06:42And posterior end of rib
06:43What is
06:44What is
06:45This is
06:46Vertebral column
06:48So, this is
06:49Vertebral column
06:50Vertebral column
06:51Vertebral column
06:52We have ribs
06:53And go anteriorly
06:54So, you can see
06:55Vertebral column
06:56We have ribs
06:57And go anteriorly
06:58So, this part is
06:59Part of ribs
07:00That is
07:01Posterior end
07:02And this part is
07:04This is anterior end
07:05So, adequate inspiration
07:07We have
07:085-6 anterior end
07:09Visible
07:11And
07:128-10 posterior end
07:14Visible
07:15Ribs
07:16Above the diaphragm
07:17So, let's count
07:18In this x-ray
07:19This is
07:251
07:26So, 1
07:282
07:293
07:304
07:315
07:326
07:337
07:348
07:359
07:36Posterior ends
07:37Visible
07:38This is
07:391
07:40This is
07:411
07:42This is
07:432
07:44This is
07:453
07:464
07:475
07:486
07:497
07:504
07:51More
07:52Than
07:53To
07:545
07:556
07:568
07:57To
07:5810
07:59Posterior ends
08:00So, for quality check, you have to check 3 things
08:03Rotation, Exposure and Inspiration
08:07After checking the quality of X-ray, let's learn how to interpret normal chest X-ray
08:13So, if you are watching a chest X-ray, for example this chest X-ray
08:18Here we are showing a pathology here
08:21There is no need to directly jump on this pathology
08:24Instead, you should read chest X-ray step-by-step before coming to any conclusion
08:30And for X-ray, you don't need to remember a mnemonic
08:34You have two approaches
08:36Either reading the chest X-ray from inside-out
08:39Or from outside to inside
08:42Here I am using the inside-out approach
08:50So, first of all, let's see Trachea
08:54Trachea is slightly tilted toward right due to aortic arch
08:59So, let's see in our X-ray
09:01This is our Trachea
09:05And Trachea divides into right and left main bronchus
09:09And our Trachea is in midline
09:12And slightly tilted toward right side due to aortic arch
09:17So, here is our aorta
09:20Trachea is slightly tilted toward right
09:24So, what do you see in Trachea?
09:25Trachea's position, foreign body and mass in Trachea
09:30Next is heart size
09:32Heart size is measured by Cardiothoracic ratio
09:36This is Cardiothoracic ratio
09:38What do you see in Trachea?
09:39Cardiac diameter divided by thoracic diameter
09:43So, C by T
09:47In PA view, if this ratio is less than 0.5
09:52Then it is normal heart size
09:54If it is 0.5 to 0.55
09:58Then it is borderline
10:00And if it is 0.5 or 0.5
10:03Then it is abnormal
10:06But if we talk about AP view
10:09Then we know
10:10AP view
10:11What do we see in AP view?
10:12False Cardiomegaly
10:14False Cardiomegaly
10:15False Cardiomegaly
10:16So, the ratio of the cutoff is less than 0.6
10:19So, it is normal
10:20If it is more than 0.6
10:22Or equal to 0.6
10:23Then it is abnormal
10:25So, you can see here
10:29This is False Cardiomegaly
10:31So, what do we see in Trachea?
10:33What do we see in Trachea?
10:35What do we see in Trachea?
10:36What do we see in Trachea?
10:37What do we see in Trachea?
10:38What do we see in Trachea?
10:39What do we see in Trachea?
10:40What do we see in Trachea?
10:41What do we see in Trachea?
10:42What do we see in Trachea?
10:43What do we see in Trachea?
10:44What do we see in Trachea?
10:45What do we see in Trachea?
10:46What do we see in Trachea?
10:47What do we see in Trachea?
10:48What do we see in Trachea?
10:49What do we see in Trachea?
10:50What do we see in Trachea?
10:51What do we see in Trachea?
10:52What do we see in Trachea?
10:53What do we see in Trachea?
10:54What do we see in Trachea?
10:55Atrium, right ventricle, left atrium and left ventricle
11:01So here is our right atrium
11:05Here is our left atrium
11:10This is our anteriorly, anteriorly what is our right ventricle
11:15And left side what is our left ventricle
11:19So this is our right side of the heart border
11:23Right heart border, right atrium
11:26And left heart border, left ventricle and small part of left atrium
11:33This is what we call atrial appendage
11:37Atrial appendage
11:40Because our heart left tilt, which is our right ventricle
11:47Where is our anteriorly face
11:50Hopefully this will be clear
11:52So now we have media stenome markings here
11:58What is our right atrium?
12:01Right atrium
12:02Right atrium, right atrium, right atrium and inferior vena cava
12:09Right atrium, right atrium, right atrium, right atrium and inferior vena cava
12:18We have left atrium, right atrium and left atrium and left atrium of the left atrium
12:23So here is our left ventricle
12:24This is the right atrium and this is the inferior when I say it.
12:37Now let's talk about our left side.
12:40What is our left ventricle?
12:45Here is our left ventricle.
12:48This is our left ventricle.
12:51The left ventricle is our left atrium.
12:55The left atrium is our pulmonary trunk.
12:59Here is our aorta.
13:01What is our trachea?
13:04The right atrium is our trachea due to aorta.
13:09Now let's talk about our left side media stenome markings.
13:14This is the left ventricle.
13:15This is the left ventricle.
13:20Aortic knuckle.
13:22This is our main pulmonary artery trunk.
13:26Left atrium appendage and left ventricle.
13:32So here is our aortic knuckle.
13:36Pulmonary artery.
13:38This is the atrial appendage.
13:42And left ventricle.
13:44So you will have the media stenome markings clear.
13:54Next is hilum.
13:56So what have we seen?
13:57What have we seen?
13:58We have seen trachea.
13:59We have seen trachea.
14:00We have seen heart size.
14:02And we have seen media stenome markings.
14:04Now we will see hilum.
14:06So you will see this portion.
14:08This is hilum.
14:10What is hilum?
14:13What is hilum?
14:14Where our bronchus, blood vessels and nerves enter our lungs.
14:19That point is hilum.
14:21Now let's talk about hilum.
14:24Hilum is our concave shape.
14:28Concave shape is laterally.
14:30And this is our right hilum.
14:32This is left hilum.
14:34Right hilum is lower than left hilum.
14:38Or this is on the same level.
14:40So if right hilum and left hilum are like this.
14:44This is also okay.
14:46Right hilum and left hilum are the same level.
14:49This is also right.
14:50But if right hilum is on the same level.
14:53This is pathology.
14:55I have told you that this is pathology.
14:57The other point that I have told you.
14:59How is hilum?
15:01How is hilum?
15:03It is concave laterally.
15:05It is concave shape.
15:07And this hilum is mainly formed by blood vessels.
15:12So left hilum is higher than the right hilum.
15:18And it can be at same level.
15:20And hilum is concave laterally.
15:22Next is diaphragm.
15:24Diaphragm is very easy.
15:26Diaphragm is very easy.
15:27Diaphragm is the right dome of diaphragm and left dome of diaphragm.
15:31Now the left dome of diaphragm is lower.
15:35So if you asked the question question.
15:37Why is left dome of diaphragm is lower?
15:40Why does not say this?
15:41You don't say this.
15:42You don't say liver.
15:43You don't say liver.
15:44And you need to have a sentence in your sentence.
15:46You must say that the left dome of diaphragm is lower.
15:48Why does left dome of diaphragm get lower?
15:50Because left dome of diaphragm's heart keep in the heart.
15:51So due to weight of heart, left dome of diaphragm is lower as compared to right dome of diaphragm.
16:00to right dome of diaphragm.
16:03This is stomach bubble
16:08which is in our stomach fundus region.
16:11There is gas and that appears as stomach bubble
16:14and it is normal finding.
16:18Diaphragm and stomach bubble
16:20after checking the costophrenic angle
16:23and cardiophrenic angle.
16:26What is the costophrenic angle?
16:27What is the cardiophrenic angle?
16:29This is the costophrenic angle.
16:30The costophrenic angle
16:33Chest wall and diaphragm
16:36which is the costophrenic angle
16:40and this will be the costophrenic angle
16:41and heart and diaphragm
16:44which is the cardiophrenic angle.
16:48What is the importance of this?
16:49For example, here is plural effusion.
16:53Plural effusion is the base of lungs.
16:54This angle is blunting.
16:58Blunting of lunging is the salivary of lungs.
17:02It means that this is losing ourselves.
17:04So it is the costophrenic.
17:06Now what is the costophrenic is the point
17:08at which chest wall and diaphragm
17:09meet loss of sharp angles
17:12that is blunting is usually caused by
17:13plural effusion.
17:14So as you can see in this x-ray, we have blunting here due to plural effusion
17:21What will you do?
17:24You will follow chest wall on both sides and compare both sides
17:28Compare both lungs and look for any pathology
17:32So first you have seen trachea
17:37So first you have seen trachea, then you have seen heart size
17:42Then you have seen media stenome, then diaphragm, then you trace the chest wall up to the top
17:56Right side and left side both trace and compare
18:00Then you compare the lung field to right side and left side
18:05And finally you will see bones
18:08So what will happen in your bones?
18:09Clavicles, ribs and scapula
18:14So finally your chest x-ray will complete
18:18So we have completed all the steps that how to interpret normal chest x-ray
18:24Maybe this will be a lengthy procedure
18:26But believe me
18:28Just like you have to read x-ray
18:32You will cover all these points in seconds
18:35So guys, if you have this video helpful
18:38Then please share it
18:40And if you are new to my channel
18:42Then subscribe to my channel
18:45Thank you so much
18:47We'll see you in the next video
18:49We'll see you in the next video
18:50We'll see you in the next video