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X-RAY-BASICS.pediatrics.medical collegeppt
- 1. X RAY BASICS Theinternational radiation symbol ‘’the trefoil’’ Discovery of X rays Father of radiology: Wilhelm roentgen 8th November 1895 © DR RALLAPALLI SPANDANA MD 10/10/2020
- 2. 1st ever xray image: of mrs bertha roentgen © DR RALLAPALLI SPANDANA MD 10/10/2020
- 3. © DR RALLAPALLI SPANDANAMD 10/10/2020 World radiology day 8th november
- 4. •Pediatric patients aremore radiosensitive than adults (i.e., the cancer risk per unit dose of ionizing radiation is higher); •Use of equipment and exposure settings designed for adults may result in excessive radiation exposure if used on smaller patients; •Pediatric patients have a longer expected lifetime, putting them at higher risk of cancer from the effects of radiation exposure.
- 5. For a childwe don’t talk about chest alone , we talk about chest and abdomen. Baby is small - chest and abdomen fit in one single film. Examine from trachea to periphery . Some prefer to read from periphery to the center. Look at heart and lungs last. Look both domes of diaphragm. Look at costophrenic and cardiophrenic angles.
- 6. In abdomen lookfor – stomach shadow Transverse colon Rectal gas shadow Near lung fields: All ribs Vertebrae Soft tissue shadows Upper part of femur and humerus also helps in diagnosis.
- 7. Chest x rayview Postero-anterior Most common view X ray beam passes from posterior to anterior Tube to film distance distance between tube and x ray film (6 feet/ 72 inches) Normal chest x ray Patient asked to embrace the casket with his arms or Hands on waist and drop his shoulders Scapula drawn laterally/outwards Scapula does not overlap over lung fields © DR RALLAPALLI SPANDANA MD 10/10/2020
- 8. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 9. Difference between chestx ray PA and AP view © DR RALLAPALLI SPANDANA MD 10/10/2020 CXR PA VIEW CXR AP VIEW TFD – 6 FEET TFD- Short Parallel X ray beams Divergent x ray beam Distance between heart and film - small Distance between heart and film - large Cardiac shadows not magnified Cardiac shadows – magnified False cardiomegaly Done for anterior chest wall Done for posterior chest wall Posterior elements of vertebrae Disc spaces/vertebral bodies Short exposure time More exposure time Causes motion artifacts
- 10. Chest x raylateral view Commonly done in older days Highest point of diaphragm located anteriorly Diaphragm dips down from anterior to posterior Most dependent part of pleural cavity lies posteroinferiorly. © DR RALLAPALLI SPANDANA MD 10/10/2020
- 11. Posterior costophrenic recess. Fluidcollection (pleural effusion) Normal finding in a lateral chest x ray 1) Retrosternal lucency 2) Retrocardiac lucency 3) Lucency along vertebral column must increase from top to bottom
- 12. © DR RALLAPALLI SPANDANAMD 10/10/2020 EXPIRED AIR FILM INSPIRED AIR FILM X RAY TAKEN AT THE END OF EXPIRATION X RAY TAKEN AT SUSPENDED END INSPIRATION DIAPHRAGM – HIGH UP ENLARGED CARDIAC SHADOWS FALSE CARDIOMEGALY NORMAL CARDIAC SHADOWS BASAL PORTION OF LUNGS – LEAST FILLED WITH AIR CROWDING OF BLOOD VESSELS BILATERAL BASAL OPACITIES LUNGS FILLED WITH AIR BLOOD VESSELS WALL SEPARATED NO BASAL OPACITIES
- 15. NECROTISING ENTEROCOLITIS Stage 2Definite NEC Air enters intestinal wall Divided into - iia: pneumatosis intestinalis AIR IN WALL AIR IN LUMEN
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- 17. Stage iii AdvancedNEC iiia: peritonitis , ascites
- 18. PNEUMOPERITONEUM STAGE IIIB NEC AIRUNDER DIAPHRAGM Adult
- 19. PNEUMOPERITONEUM STAGE IIIB NEC AIRUNDER DIAPHRAGM
- 20. The causes ofneonatal pneumoperitoneum are different from adult pneumoperitoneum and include: •perforated hollow viscus • necrotising enterocolitis (NEC): most common • meconium ileus in cystic fibrosis • Hirschsprung disease • intestinal atresia or web • peptic ulcer disease •iatrogenic • intubation/mechanical ventilation • rectal thermometer • enema
- 21. Radiographic features Although theseare essentially the same as in adults, erect chest X-rays are not obtained, and thus the diagnosis should be made with supine films. Additional horizontal cross table shoot through films or left decubitus shoot though films may be performed. Signs •football sign •Rigler's sign
- 22. © DR RALLAPALLI SPANDANAMD 10/10/2020 TRANSIENT TACHYPNEA OF NEWBORN PROMINENT BRONCHOVASCULAR MARKINGS/ SUNBURST APPEARANCE FLUID IN INTERLOBAR FISSURE
- 23. RESPIRATORY DISTRESS SYNDROME WHITEOUT LUNG/GROUND GLASS APPEARANCE OF LUNG/ reticulonodular appearance (due to absence of air entry into the lung) Air bronchogram (due to air in the bronchus and bronchioles)
- 24. Bilateral involvement Preterm Alveoli arenot expanded, air is entering all the airways even the smallest bronchioles
- 25. © DR RALLAPALLI SPANDANAMD 10/10/2020 Ground glass appearance can be seen also in 1)RDS 2)PULMONARY ALVEOLAR PROTEINOSIS 3)OBSTRUCTIVE TAPVC
- 26. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 27. •indistinct diaphragm with opacificationof part of or all the hemithorax (typically left sided) •scaphoid abdomen •deviation of lines 3 • endotracheal tube • nasogastric tube • umbilical arterial and venous catheters
- 28. Congenital diaphragmatic herniation canbe classified into two basic types on location: 1.Bochdalek hernia 1. most common fetal congenital diaphragmatic hernia 2.commoner on the left: 75-90% 3.posterolateral 4.large and associated with poorer outcome 5.presents earlier 6.mnemonic: BBBBB 2.Morgagni hernia 1. less common 2.anterior 3.presents later
- 29. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 30. Steeple sign Progressive narrowingof the upper airway
- 32. The thumb signin epiglottitis is a manifestation of an oedematous and enlarged epiglottis which is seen on lateral soft-tissue radiograph of the neck, and it suggests a diagnosis of acute infectious epiglottitis. This is the radiographic corollary of the omega sign. Thumb sign is a term also used in other conditions: •thumb sign (Marfan disease) (also known as Steinberg sign) : a clinical test in which the tip of the thumb is visible medial to the little finger when it is clasped in the clenched hand •thumb sign (chordoma): a radiological sign showing a clival tumour projection indenting the pons
- 33. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 34. © DR RALLAPALLI SPANDANAMD 10/10/2020 Radiological features of scurvy: Generalized osteopenia Cortical thinning: pencil thin cortex Periosteal reaction due to subperiosteal hemorrhage Scorbutic rosary: expansion of the costochondral junctions Hemarthrosis Wimberger ring: circular, opaque, radiological shadow surrounding epiphyseal centers of ossification, which may result from bleeding
- 35. Frankel line: densezone of provisional calcification Trummerfeld zone: lucent metaphyseal band underlying frankel line. Pelken spur: metaphyseal spurs which result in cupping of the metaphysis.
- 36. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 39. © DR RALLAPALLI SPANDANAMD 10/10/2020 In the growing skeleton, the deficiency of normal mineralisation is most evident at metaphyseal zones of provisional calcification where there is an excess of non-mineralised osteoid resulting in growth plate widening and abnormal configuration of the metaphysis: •fraying: indistinct margins of the metaphysis •splaying: widening of metaphyseal ends •cupping: concavity of metaphysis 6
- 40. It is notsurprising that these features are most prominent at the bones where growth is greatest: •knee: distal femur, proximal tibia •wrist: especially the ulna 1 •anterior rib ends: rachitic rosary As osteomalacia co-occurs with rickets, it is important to remember that even bones that appear mineralised are weak and result in bowing, most commonly seen in the lower limbs once the child is walking. The legs bow outwards with variable deformity of the hips (both coxa vara and coxa valga are seen 1).
- 41. Other bone deformitiesare also noted such as genu valga and vara as well as protrusio acetabuli . The lower ribs may also be drawn inwards inferiorly by the attachment of the diaphragm (Harrison's sulcus).
- 42. The differential forleg bowing in children includes : •developmental or congenital bowing •Blount disease •osteogenesis imperfecta •many others that are not usually a consideration (see leg bowing in children)
- 43. The differential forflaring of the metaphysis includes: •Anaemias •fibrous dysplasia •storage diseases •chronic lead poisoning •bone dysplasias
- 44. The differential forwidening of the growth plate includes: •Schmid-type metaphyseal chondrodysplasia •hypovitaminosis C (scurvy) •delayed maturation due to illness •endocrine disturbances • growth hormone excess • hyperparathyroidism • hypothyroidism
- 45. © DR RALLAPALLI SPANDANAMD 10/10/2020 Renal osteodystrophy (ROD), also known as uraemic osteopathy, is a constellation of musculoskeletal abnormalities that occur in patients with chronic renal failure, due to concurrent and superimposed: •osteomalacia (adults)/rickets (childre n) •secondary hyperparathyroidism: abnor mal calcium and phosphate metabolism • bone resorption • osteosclerosis • soft tissue and vascular calcifications • brown tumours •aluminium intoxication, e.g. if the patient is on dialysis
- 46. © DR RALLAPALLI SPANDANAMD 10/10/2020 Radiographic features Imaging findings are many and varied: •osteopenia: (often seen early) thinning of cortices and trabeculae •salt and pepper skull •demineralisation: usually subperiosteal, however, it may also involve joint margins, endosteal, subchondral, subligamentous areas, cortical bone, or trabeculae •subperiosteal resorption: characteristic subperiosteal resorption may be seen on radial aspects of middle phalanges of index and long fingers •bone sclerosis • diffuse bony sclerosis • rugger jersey spine: sclerosis of the vertebral body endplates •soft tissue calcification •amyloid deposition: erosion in and around joint •insufficiency fractures •Looser zone •brown tumours
- 47. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 49. BULLET SHAPED METACARPALS BEAKINGOF VERTEBRA – bullet shaped vertebra woth posterior scalloping
- 53. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 54. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 56. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 57. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 58. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 59. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 60. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 61. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 62. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 64. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 65. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 66. © DR RALLAPALLI SPANDANAMD 10/10/2020 Adder head appearance
- 67. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 69. Coin in theesophagus is round in appearance on the frontal view whereas coin in the trachea is usually seen on end and are linear in shape.
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- 73. SMALL BOWEL OBSTRUCTIONAND MEGACOLON
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- 77. © DR RALLAPALLI SPANDANAMD 10/10/2020 Double bubble sign
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- 81. © DR RALLAPALLI SPANDANAMD 10/10/2020
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- 93. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 95. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 96. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 98. Septic arthritis ofhip in infancy. Results in complete destruction of cartilaginous femoral head. Presentation is a child in his preschool age with painless limp. Affected limb is shorter. X ray shows complete absence of head and neck of femur.
- 99. RICKETS > RHEUMATOIDARTHRITIS
- 100. © DR RALLAPALLI SPANDANAMD 10/10/2020 Juxta articular osteopenia Decreased joint space Widening of intercondylar notch Squaring of patella
- 101. © DR RALLAPALLI SPANDANAMD 10/10/2020
- 102. While plain radiographsmay show joint effusions and a loss of soft tissue planes, there may not be an immediate indication of bone infection.7 It may take 10 to 14 days to show 30 to 50 percent of bone mineral loss before osteomyelitic changes are evident. A differential diagnosis for radiographic bony lesions should include osteomyelitis, leukemia, round cell carcinomas, Ewing’s sarcoma, metastatic neuroblastomas, eosinophilic granulomas, histiocytosis X and tuberculosis. If radiographs are normal and one suspects osteomyelitis, proceed to obtain technetium-99m bone scans. However, keep in mind that while this imaging is sensitive for certain bony conditions, it is not specific.
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- 116. Female>male 50% cases bilateral Defect-distal end of the radius growth plate fuses early Defect in growth (but ulna continues to grow normally) Deformity: Ulna is more prominent than the radius. Volar subluxation of hand – dinner fork deformity
- 118. Unsegmentation /defective segmentationof cervical spine No neck movement
- 119. Holt oram syndrome Fanconisyndrome
- 120. Congenital absence ofclavicle Both shoulder can be approximated to each other
- 121. Sail sign –thymus shadow
- 123. Hyperinflated lungs: increasedradiolucency of lungs Flattening of domes of diaphragm Pulmonary infiltrates Segmental collapse
- 125. Head , neckand spine Basilar invagination Wormian bones Kyphoscoliosis Verebral compression fractures Codfish vertebrae Platyspondyly Chest Pectus excavatumor carinatum Pelvis Protrusio acetabuli Coxa vara
- 126. General Severe osteoporosis Deformed bones Corticalthining Popcorn calcification: the metaphysis and epiphysis exhibit numerous scalloped radiolucent areas with sclerotic margins Zebra stripe sign : cyclic bisphosphonate treatment produces sclerotic growth recovery lines in the long bones. Formation of pseudoarthrosis at sites of healing fractures.
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- 128. Clinical presentation: h/o highgrade fever Difficulty in swallowing No h/o trauma Thickened prevertebral soft tissue Air density ++