RADIO ANATOMY

RESPIRATORY TRACT
AND MEDIASTINUM

Radioanatomy

Studies of human body seeing

through the roentgenologic
examination

Respiratory Tract
1. Upper air passage (Cav. Nasi and
pharynx)
2. Larynx
3. Trachea and bronchus
4. Lung + Vascular (lymph)
5. Thoracic wall + diaphragm
3,4,5 Chest x-ray
Lung !

Lung Anatomy-Right
Superior
Lobe

Apical Segment (1)

Posterior Segment (2)
Anterior Segment (3)

Medial
Lobe

Lateral Segment (4)

Medial Segment (5)

Inferior
Lobe

Apicobasal Segment (6)

Mediobasal Segment (7)
Anterobasal Segment (8)
Laterobasal Segment (9)
Posterobasal Segment (10)

Lung Anatomy-Left

Superior Apicoposterior Segment (1)

Anterior Segment (2)
Lobe
Lingula
Inferior
Lobe

Superior Segment (3)

Inferior Segment (4)
Apical (5)
Antero medial basal (6)
Latero basal (7)
Postero basal (8)

X-ray / Fluoroscopy
Indication

Contact person
Cough > 2 weeks
Recurrent respiratory infection
Hemaptoe
Ekstra pulmonary TBC
Erytema nodosum / conjuntivitis
phlyctenularis
Fissura/fistula anichronicum
DM
Precautionary indication

X-ray Examination

Routine : PA
Special :

Lateral
Left
Right
AP
Oblique
Left
Right
Lateral decubitus

Special methode of
examination
Tomografi
Bronchografi
USG
CT scan
MRI

PA Position

Place patient between film X ray source

Have the patient stand backward to the
X- ray source, chest close to film with
hand on the hip, with elbow
flexed.Distance between film and X-Ray
Lung 1,5 m
Heart 2 m
Ray concentrated at
- TH 6-7
- KV 50-60
- MAs 10-20

Good chest X-Ray

Depend on:
1.Good film quality
Depending on :
KV
Mas
Processing
2. Symmetry
3. All part of thorax are included
4. Identity /Marking
5.No artifact
6.No motion artifact
7. Maximal inspiration

What studied in chest xray

Soft tissue
Costae and clavicle
Trachea
Size, shape and position of heart
Lung

Hilum
Bronchovascular marking

Lung field :

Lung
Lung
Lung
Lung

apex
top field
middle field
lower field

Lateral chest film

Indication
To study abnormality that is not
visible on PA film
To study mediastinal disorder
Heart studies

Lateral chest procedure

Place patient between film and Xray source

Place lateral side of chest
(left/right) on film
Hands behind the head
Ray centered on Th 6-7

What studied on lateral

chest film

Trachea and main bronchial branch radioluscent

Heart, aortic arch, asc/ desc aortic
Left/ Right Lung bronchovascular
marking superposition
Retrosternal space
Retrocardial space
Costophrenic sinus
Cardiophrenic sinus

Antero posterior (AP) chest film

Indication :
Severely ill patient
Children / babies
Obese, pregnancy, ascites, abdominal
tumor
Procedure:
Place patient lying down on table with
elbow above head
Place film on patients back
Centered ray on Th 6-7

Top lordotic chest x-ray

Indication :
To studies disorder located on apex / medial lobe
- clavicle turn upward
Procedure:
Place patient between film and x-ray source,
have the patient face the x-ray source
Have the patient stand 30 cm in front with back
placed on the cassette
Set top part of the cassette 1 inch above the
shoulder
Centered ray on manubrium sterni

Oblique chest film:

Indication :
Heart studies
To study abnormality that is not yet clear
on PA studies
Procedure
Place patient between film and ray source
Put ventral left/right side of the patients
thorax on the cassette making 45 0 angle
Center ray on Vert. Th 6-7

Lateral Decubitus
Chest
Film
Indication :

To study fluid in pleural cavity that is around

100-200 cc
Or fluid accumulation that is not yet determined
on PA studies

Procedure
Have the patient lying down on left/right side
with elbow above the head
Center ray on vert. Thoracal 6-7 from anterior
/posterior aspect

Mediastinum
Studies
1. Radiograph :

Chest film: - PA.

Lateral.
Esophageal contrast studies.

2. Fluoroscopy :

To study pulsation
To study placement of organ in
chest cavity

To study mass relation with

adjacent organ
Diaphragm
Esophagus.
Heart and major vessel
To study pericardial effusion.

-To

study pericardial effusion.

3. Tomografi.
4. Angiographies
Usually with CT.
5. CT Scan / MRI.

6. USG : Mass close to

diaphragm
/ Pericardial effusion.
7. Nuclear med. Radioisotop.
Radio isotop angiogram.

To study localisation of tumor.

Eq : thymoma, thyroid, lymph node.

Mediastinum Borders
- Top
: Apertura thoracis sup.
- Dorsal : Vertebral Column.
- Ventral
: Sternum.
- Inferior
: Diaphragm.
- Lateral
: mediastinal pleura.

Mediastinum
1.
2.
3.
4.
5.
6.
7.
8.

Anterior superior med

Anterior medius med
Anterior inferior med
Superior medius med
Middle med
Posterior superior med
Posterior medius med
Posterior inferior med

Location

of mediastinal

disorder
Anterior superior med

Aneurisma.

Tymus Hyperpl

Lymphoma.

Intrathoracal Struma
Anterior middle med.
Dermoid.
Teratoma.

Ant. Inferior. Med

Thymoma.
Pericardial cyst.
Hernia diafragmatica.
Superior Mid. Med
Aneurisma.
Dermoid.
Teratoma.
Mediastinal trauma

Middle Mediastinal
Dermoid.
Teratoma.
Lymphoma.
Tumor metastasis

Post superior med.

Oesophageal disorder
Aneurism
Neurinoma,
neurofibroma.
Pancoast tumor.

Post medius med.

Neurogenic tumor.
Bronchial defect enteric cyst.
Post inferior med.
Neurogenic origin
primary tumor.
Hernia diaphragmatica.

Bibliography
Short textbook of clinical
imaging.,David Sutton, Jeremy W.R
Young, 1990
2. Rontgen sign in diagnostic imaging
col 4 (chest) Meschan Thn 1997
3. Essentials of Coffeys Pediatric Xray diagnosis, 1990.
1.