The Plain Chest Radiograph in the Assessment of Cardiac Disease
Wilhelm Roentgen discovered X-rays on 8 November 1895, and was the first to take a radiograph on 22 December 1895 of his wife’s fingers [1]. Roentgen labelled the unknown ray X, and hence the term X-ray was coined. Soon after this the chest radiograph was
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The Plain Chest Radiograph in the Assessment of Cardiac Disease
6
Nicola Mulholland
6.1
Contents
6.1 6.2 6.2.1 6.2.2 6.2.3 6.2.4 6.2.5 6.3 6.3.1 6.3.2 6.3.3 6.3.4 6.3.5 6.3.6 6.4 6.5
History and Introduction . . . . . . . . . . . . . . . . Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Posteroanterior Projection (PA) . . . . . . . . . . Anteroposterior Projection (AP) . . . . . . . . . . Lateral Projection . . . . . . . . . . . . . . . . . . . . . . Assessment of Radiograph Adequacy . . . . . . Pitfalls and Normal Variants . . . . . . . . . . . . . Clinical Applications . . . . . . . . . . . . . . . . . . . . Assessment of Heart Size . . . . . . . . . . . . . . . . Pulmonary Oedema . . . . . . . . . . . . . . . . . . . . Cardiac Calcifications . . . . . . . . . . . . . . . . . . . Radiological Assessment of Pacemakers and Implantable Cardiac Defibrillators (ICD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Pulmonary Arterial Hypertension . . . . . . . . . Congenital Heart Disease . . . . . . . . . . . . . . . . Future Trends in Chest Radiography . . . . . . Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . .
History and Introduction
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Wilhelm Roentgen discovered X-rays on 8 November 1895, and was the first to take a radiograph on 22 December 1895 of his wife’s fingers [1]. Roentgen labelled the unknown ray X, and hence the term X-ray was coined. Soon after this the chest radiograph was used and this has become a first line investigation in patients with suspected heart disease. An appreciation of the technique and anatomy, as well as common variants, is vital to the correct interpretation of the chest radiograph. The technique of chest radiography will be described, together with details of the chest radiograph adequacy. Following a description of the normal anatomy and potential pitfalls in interpretation due to normal variants, the clinical applications of the chest radiograph in the assessment of cardiac disease is discussed. Finally, a short discussion on the future trends in chest radiography is given. 6.2
Technique
The traditional chest radiograph is produced using an analogue system, the film-cassette system. Several projections may be used, commonly posteroanterior, anterior and less commonly lateral or lateral decubitus. The patient is encouraged to take a full inspiration, and expiratory films are useful to look for pneumothorax. 6.2.1
Posteroanterior Projection (PA) The patient stands facing the film cassette/Bucky and grid with the X-ray tube at a distance of 180 cm. The cassette is positioned 5 cm above shoulder height and the stripped patient stands with the shoulders laterally rotated to touch the cassette, the arms forward and the dorsum of the hands on the iliac crests posteriorly. The horizontal central ray is centred at the sternal angle and
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Nicola Mulhol
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