 Hello, everyone. Welcome to this session on radiological anatomy of thorax. In this particular session, we will be discussing all the probable radiographs that you may be asked in practical examination. So, let us begin. These are the list of radiographs in thorax out of which the chest X-ray postero anterior view is the most frequently asked radiograph in exam and the other diagrams as well, chest X-ray anterior posterior view. In contrast diagrams, this barium solo is the most frequently asked. Then, there is a procedure called as bronchogram and lastly, HR3T test. So, we will see all these one by one. Let us begin with the chest X-ray postero anterior view. So, first of all, why the chest X-ray is required? For that, there are many indications that the patient may present with any trauma or if you want to detect any congenital conditions, then there is infection in the chest, for example, tuberculosis, then degenerative due to age there may be certain degenerative changes, then if there are cancerous conditions, neoplastic conditions. So, there are many indications for describing a chest X-ray to a patient. Here, we can see the chest X-ray. Usually, R is written on the diagram. Most of the times, we use the word X-ray and X-ray, but this film is actually called as diagram or also it is also referred to as radiograph. These are the two correct terms which you should be using while describing the diagram in an exam. X-rays were the rays used to produce this film, but the film itself is called as diagram or radiograph. So, once you know the indications for prescribing a chest diagram, you should also know how to prescribe a chest diagram. For example, you are sitting in a clinic and you want to prescribe the chest diagram to a patient. So, how will you write in the prescription side? So, you can simply write as chest X-ray. I sense it is also abbreviated as CXR. So, this is how the prescription of the chest X-ray is given. Then, you have to describe the diagram. So, a patient presents you with this diagram. So, the next step is how to read the diagram. So, for that, we have a simplified pro forma of how to read a diagram. So, this is the plane's diagram. So, how to start reading the diagram? This is the plane's diagram of one refers to the region, which region you are describing and two is the view. Either it is anterior posterior view or either it is posterior anterior view or there may be lateral and oblique views as well. Then, showing which structures. So, you should explain the structures one by one. Explain the Boney issue, which is seen, the Swarth issue, which is seen and the air shadows, which are seen. So, this ideal pro forma you can remember. So, this is a plane's diagram. So, this example is given here. You all can read this. There is a plane's diagram of the chest, posterior anterior view showing Boney shadows of red, clavicle, vertebrae. So, red, clavicle. Then, in the midline, there is vertebrae. Then, soft tissue shadows of heart, lungs, then domes of the diaphragm. Then, air shadows of lungs, trachea, pundas of the stomach. Pundas of the stomach may have some air in this region. This is a very small view. Let us cover the chest diagram in detail. This is the chest diagram, posterior anterior view. So, how to describe this diagram? There is a plane's diagram, posterior anterior view of the chest region showing Boney shadows. So, bones are, the ribs are visible. I will change the color. The ribs are visible. Then, clavicle bone is visible here. Then, in the midline, there is, bodies of the vertebrae are visible. The bodies of the vertebrae are visible here. Then, soft tissue shadow of the heart is visible. Then, air shadows of the lungs. Then, air shadow will be here as well in many diagrams. The air shadow of the air in the pundas of the stomach. Then, also, air in the trachea. That is also visible here. And, there are few specific structures which are to be described in a plane's diagram that the region which is here, that this is referred to as the postoprenic angle. And, the region here, this is referred to as the cardioprenic angle. See, these two angles are important because in cases of pleural effusion, when the fluid gets filled between the parietal pleura and the visceral pleura, these angles get obliterated first. So, these are the indications in this diagram that there is pleural effusion. So, there will be blunting of this angle here. We can see a sharp angle. In pleural effusion, this angle may be like this. It will be blunted. Then, in the cardiac shadow, borders of the heart are important. Structures forming the right border, structures forming the left, left border. That we will see in subsequent slide. And, in air shadow, the high-large shadow which is seen here. This region is the hylum of the lungs from which the trachea divides into the various bronchi and enters into the lungs. So, bronchovascular markings are seen here. White shadow is the bronchovascular marking. And, at times, there may be enlarged lymph nodes which may be seen here. The high-large lymph nodes. Then, counting of the ribs is important. So, here we can see this is the first rib, then second rib, third rib. So, like this we have to count from posterior to anterior aspect. It has the ideal method for counting of the ribs. Then, this is the scapula which is seen here. Then, head of the humerus, the lateral end of the clavicle articulating with the acromion process of the scapula. So, what all structures are visible? We will have to speak in the exam. Let us cover the cardiac border with structures from the right border of the heart. So, from superior to inferior, if you see, there is right brachycephalic vein. This region shows the right brachycephalic vein, then superior vena teva, and right atrium. So, these three structures are forming the right border of the heart. Let us see the structures forming the left border of the heart. So, again from superior to inferior, three structures are listed. One is the aortic knuckle. So, it is the bending of the arch of aorta and continuation continuing as the descending thoracic aorta. So, that region is referred to as the aortic knuckle that forms the left border of the heart and there is left oracle and left ventricle. So, three structures are marked here. And then we say right border and left border of the heart in radiology. It is the radiological right border and radiological left border. Because in gross anatomy while describing the border, structures are little different. So, here when we describe, we should specifically say this is the radiological right border of the heart. This is the radiological left border of the heart. Let us identify the various structures and this labeled image. So, again while describing the chest diagram, we should start in this manner. This is the plains diagram, postero anterior view of the chest region showing bony shadows. So, bones are the ribs, clavicle and all, capula, then humerus. All these are the bones which are visible in the midline vertebral bodies. Then we should talk about the soft tissue shadows. The soft tissue is the heart, the right border, left border. Then specific structures in the lung, a claustrophrenic angle, cardiophrenic angle and also the domes of the diaphragm are labeled here. This is the right hemidiaphram, this is the left hemidiaphram. Right dome of the diaphragm is slightly at a higher level because the large liver which is present just below it. And here they have shown the spinous process, spinous process of the vertebra. Ideally, the spinous process of the vertebra should be equidistant from the medial ends of the clavicle. So, that diagram which we will say as this is the bell-centralized diagram. In cases of medial senile shift, here we can see the air shadow which is seen, that is trachea. So, air shadow will be debuted towards the right, towards the right or towards the left depending upon the deviation of the medial senile. For example, medial senile, if it is debuted towards the right, what may be the probable causes? There may be some tumor from the left side which is pushing the medial senile towards the right. Or else there may be fibrosis of this lung itself, so this lung shrinks, so the medial senile is pulled towards that side. There may be multiple reasons of shifting of the medial senile. And medial senile shift is identified by shifting of the air shadow of the trachea. Then, hilum is shown here, the right pulmonary hilum, the left pulmonary hilum. Then, if it is a female test diagram, the breast shadow will be visible, so that also you can speak in the soft tissue shadows. This was about the describing of the plane Skyagram postero anterior view. So, what all difference is there between a test diagram of postero anterior view and test diagram of antero posterior view. In this image, we can say this is a postero anterior view and this image is an antero posterior view. Just take two seconds and try to differentiate what major difference can you appreciate between these two Skyagrams. One major difference is the cardiac shadow. Just appreciate the length of the cardiac shadow in a PA view and in AP view. That is spurious cardiomegaly which is seen in antero posterior view. The rays are passing from the anterior aspect and the plate is behind. So, heart shadow is slightly enlarged in an antero posterior view. That is heart shadow is normal in postero anterior view because the plate is right in front of the test and the rays are coming from behind. So, exact size of the heart is seen clearly in postero anterior view. And in antero posterior view, capula obstructs the lung free. Can you appreciate this medial border of this capula? There is a medial border of this capula which is seen on each side. Whereas in postero anterior view, capula is seen widely separated. Most of the time, the Skyagram postero anterior view is recommended. Antero posterior view is done in very rare cases. For example, there is a critical patient who cannot come to the X-ray room and go for the X-ray. So, for a critical bed-read and patient, portable X-ray is done and the X-ray is passed from the anterior aspect towards the posterior aspect. So, that is an AP view. And children's also AP view may be taken. The most common indication is the critical patient for AP view. This was about differences between postero anterior view and antero posterior view. And in the Skyagram, the basic difference which we will see is the difference in the size of the cardiac shadow. And the capula will be seen here, the medial margin of this capula that will obstruct the lung. Whereas separate slide on counting of the ribs. The ribs are counted from postero anterior to anterior. First rib, second, third, fourth, fifth, sixth. So, the Skyagram shows counting of the ribs. We should count from posterior to anterior aspect. Then there is something called as cardiothoracic ratio. That is the cardiac shadow compared with the shadow of the entire thorax. Ideally, it is 0.5 or less than that. If it is increased, cardiothoracic ratio, if it is increased, that means it is cardiomegaly. For example, if this is 5 centimeter and this is 10 centimeter, just for example, 5 by 10 is 0.5. If the cardiac shadow is 7 centimeter and this is 10, this will be more than 0.5. That means it is cardiomegaly. That is how cardiothoracic ratio is important to determine whether there is cardiomegaly or not. Now, let us cover the contrast diagrams of the thorax. This is the most frequently asked contrast diagram. It is the Barian swallow. You might have also learned about the Barian meal, the barium follow-through. We have the various steps in the barium procedure. The patient is asked to eat the barium-based suspension. When he swallows it, the x-ray trends are taken. That is referred to as barium swallow. In barium swallow, it is a phagocytine. When the barium reaches the stomach, the x-ray trends are taken. That x-ray will be referred to as barium meal. When the barium reaches the small intestine, that will be referred to as barium follow-through. When the barium is passed through the large intestine, through the rectum, it is referred to as barium enema, in which the barium is directly pushed through the rectum. Let us see the barium swallow. In the barium swallow, it will be asked about the esophagus. We will have to identify the esophagus. Then the various curvatures of the esophagus may be asked. Various curvatures as well as constrictions of the esophagus. Let us see the constrictions of the esophagus. There are four constrictions which are described. One is the cervical constriction, then aortic constriction, then bronchial constriction, and diaphragmatic constriction. These distances from the upper incisor teeth are important because while passing a gastric tube or a riled tube, these distances are measured and we will have to take precautions while the gastric tube passes through these levels. The cervical constriction is 6 inches from the incisor teeth. Aortic constriction is 9 inches from the incisor teeth. The bronchial constriction is 11 inches from the incisor teeth. And diaphragmatic constriction is 15 inches from the incisor teeth. These are the constrictions. And also there are curvatures in the esophagus. Curvatures are two left-sided curvatures. One passes through the thoracic inlet. And one crosses the descending thoracic aorta. So these two left-sided curvatures are there in the esophagus and there are four constrictions. Constrictions are narrowing of the esophagus. Let's cover the next contrast diagram. This is referred to as bronchogram. An endotracheal tube may be passed inside the trachea or a catheter may be passed inside the trachea and iodine-based dye are injected directly into the trachea. Because that the contrast material spreads out. There is a little invasive procedure. So it is not done nowadays. It's an old procedure. But in some colleges, this diagram may be kept in practical examination. So if such type of diagram is shown, then you have to label it as bronchogram. And in this Viva question, you may be asked about the bronchial tree and the bronchopulmonary segment. So this I have just included for the sake of covering. In clinical practice nowadays it is not performed because advanced techniques like CT scans are now available. As it is the most advanced technique to study the lung fields, so multiple sections will be taken and the lung shadow will be studied. And while studying the CT scan, we should remember that all views which are seen, those are seen from the inferior aspect. So it has to give orientation to this image. This anterior posterior is the left side and this is the right side. CT scan MRI sections are viewed as this. We are viewing it from the inferior aspect. So while studying growth anatomy section, try to read sections which are shown from the inferior aspect. So we will be able to easily correlate those sections with the HR CT scan or any MRI scan. This is the left lung. This is the right lung. This is the cardiac shadow which is seen. This is the vertebral body. This is the lung field which is seen and the branching of the bronchi. Let's summarize what we have covered in this particular session. We have covered the plane test diagram in detail. So there may be multiple views in this. AP and PA view we covered. Most frequently asked is the PA view and the most frequently which we will describe for patient is the PA view. Then there may be lateral and oblique views as well. And whenever there is a test diagram, we should be able to identify the trachea, the various cardiac borders, aortic muscle. Then the two angles, cardiophonic, phosphophonic angle, the bronchovascular marking, high-large lymph nodes at the present, then breast shadows and females, the two domes of the diaphragm. Then we should be able to count the rate. Then these are the contrast diagrams, barium swallow, bronchograms. And this is the latest technique, that is the CT scan. This was all about this particular session. So if you all want PDF handout, you all can request me at this WhatsApp number. And please do watch other sessions of this YouTube channel. Thank you.