Normal Chest

X Ray
Basic anatomy
Lobes

Segmen

Lobules

Acinus

Alveoli
 Lungs

Right
Left
Upper Lobe
Upper Lobe
• Apical
• Anterior • Anterior
• Posterior • Apicoposterior

Middle Lobe Lingula

• Lateral • Superior Lingula
• Medial • Inferior Lingula

Lower Lobe
Lower Lobe
• Apical
• Anterior • Apicobasal
• Posterior • Anterobasal
• Medial • Posterobasal
• Lateral • Lateral
Radiographic anatomy
 Ascenden
Aorta
 Aortic Knob
 Left Pulmonary
Artery + Left
Atrium Auricle
 Heart waist
 Descenden
Aorta
CTR
L

Lung zones
Apex
Upper
Middle
Lower
Indications of CXR
 Screening
 Cough > 2 weeks
 Haemoptoe
 Fever
 Dyspnea
 Chest pain
 Trauma
 Metastases
 Symptoms of Lung TB/Malignancy
Before reading CXR
1. Identity
2. Marker (R/L)
3. Exposure dose (kV, mAs)
4. Position (PA/AP/Lateral/Oblique)
5. Film qualities (asymmetric, shaken,
inspiration/expiration)
6. Artifacts
R ID

kV  V Th. 3
PA or AP ?

PA AP
 1

Maximum 3

inspiration 4

5
6
 R

Trachea

Retrosternal space

Retrocardial space

Anterior sinus

Posterior
sinus
PA view
1. Position? enough
inspiration?
2. Soft tissue
3. Skeletal
4. Trachea (deviation?)
5. Sinuses and
Diaphragms
6. Mediastinum
 Heart (position, size,
configuration)
 Great vessels
7. Lungs
 Hila
 Vascular patterns
 Lung apices, pleural
line and fissures
Lateral view
 Anterior and
posterior sinuses
 Retro sternal
and retro
cardiac spaces
Thank You
Radiographic anatomy
 Trachea (midline)
 Carina level at V. Thoracic 5-
6
 Heart
 Position
 Size PA view ≤ 50%, AP view ≤
55%
 Configuration (apex, aortic
knob, pulmonary trunk, auricle
of left atrial, right atrial, SVC)
 Diaphragms
 Right diaphragm level at V.
thoracic 6-7
 Left diaphragm level at V.
thoracic 7-8
 Right is higher than left (2,5 cm)
Radiographic anatomy
 Right hilum:
 formed by the right main
bronchus and right
pulmonary artery, lobar
divisions
 Between the diaphragm
and lung apex
 V. thoracic 5-6
 Content: artery, vein,
bronchus, lymph
 Left hilum:
 V. thoracic 4-5
 Content: artery, vein,
bronchus, lymph
Radiographic anatomy
 Lungs
 Vascular pattern
 Lung apices
 Lung contours:
cardiac borders,
mediastinal margin
 Normal pleural line
and fissures are not
visible
 Normal minor fissures
 PA: level at V Th. 5/
Anterior ribs 4th
Pulmonary Vascular Patterns
 Normal: Right <2/3 of lung field,
Left <1/3 lung field
 Arteries branching vertically to
upper and lower lobes
 Veins running roughly
horizontally towards the lower
hila
 Upper lobe vessels smaller than
lower lobe vessels on erect CXR
 Right vessels more crowded
than the left vessels
 Vessels difficult to see in
peripheral 1/3 of the lungs
Radiographic anatomy
 Skeletal
 Clavicles, Scapulae,
Costae, Vertebrae
 Fractures
 Scoliosis
 Osteoporosis
 Lytic/blast lesions 
metastases/malignancy
 Soft Tissues
 Mass
 Subcutaneous
Emphysema