胸片讀片與心影改變

1、胸片閱讀與心影改變,譚洪毅,X-rays- describe radiation which is part of thespectrum which includes visible light, gamma rays and cosmic radiation.Unlike visible light, radiation passes through stuff.When you shine a beam of X-Ray

2、 at a person and put a film on the other side of them a shadow is produced of the inside of their body.,Different tissues in our body absorb X-rays at different extents:Bone- high absorption (white)Tissue- somewhe

3、re in the middle absorption (grey)Air- low absorption (black),Be systematic:,1) Check the quality of the film,Film Quality,First determine is the film a PA or AP view.PA- the x-rays penetrate through the back of

4、 the patient on to the filmAP-the x-rays penetrate through the front of the patient on to the film.All x-rays in the PICU are portable and are AP view,Film Quality (cont),Was film taken under full inspiration?-10

5、 posterior ribs should be visible.Why do I say posterior here?,When X-ray beams pass through the anterior chest on to the film Under the patient, the ribs closer to the film (posterior) are most apparent.,A really go

6、od film will show anterior ribs too, there shouldBe 6 to qualify as a good inspiratory film.,Quality (cont.),Is the film over or under penetrated if under penetrated you will not be able to see the thoracic vertebrae.,Q

7、uality (cont),Check for rotationDoes the thoracic spine align in the center of the sternum and between the clavicles?Are the clavicles level?,Verify Right and Left sides,Gastric bubble should be on the left,X線,一、心胸比:心

8、臟橫徑與胸廓橫徑之比. 正常值:<0.5,分為三度,0.51~0.55 為輕度、0.56~0.60為中度、大于0.60為高度增大。 缺點(diǎn):受體型,橫膈位置影響大,橫位心及垂位心較大誤差;不能反映心臟前后徑的增大。,心胸比測(cè)量示意圖一,心胸比等于：T1＋T2/Th；T1：右心緣距中線的最大距離；T2：左心緣距中線的最大距離；Th：胸廓橫徑，以通過右膈頂上緣測(cè)量胸廓橫徑為準(zhǔn)

9、。摘自>劉玉清主編,B：心臟橫徑，兩心緣最凸點(diǎn)垂直線之間的距離。A：胸廓最大橫徑。心胸比：B/A摘自>,心胸比測(cè)量示意圖二,二、心高比：,取右心房與大血管交點(diǎn)至右心膈角水平線垂直距離為右心房高，取主動(dòng)脈弓項(xiàng)至右心膈角水平線垂直距離為心高，兩者之比右心房一心高比率。平均0.46 ± 0.04,反映右心房增大.。,,,三、主，肺動(dòng)脈的測(cè)量,1．升主動(dòng)脈寬徑(A1)，以升主動(dòng)脈右緣最凸點(diǎn)至中線的垂直距離計(jì)(如果升

10、主動(dòng)脈外緣不清，可按上腔靜脈外緣計(jì))。100例青壯年的測(cè) 量(下同)：平均2.58±0.48cm。2．主動(dòng)脈結(jié)寬徑(A2)，主動(dòng)脈結(jié)最凸點(diǎn)至大氣管左線主動(dòng)脈結(jié)壓跡最凹的距離。平均2．76土0.28厘米。3．主動(dòng)脈長徑(A3)，自右心緣大血管與右心房交點(diǎn)至主動(dòng)脈結(jié)最凸點(diǎn)的距離。平均9．35土1．61厘米。,1．肺動(dòng)脈段基線(P1)；主動(dòng)脈結(jié)～肺動(dòng)脈交點(diǎn)與肺動(dòng)脈~左心房耳部(或左心室)交點(diǎn)的連線。平均4.88±0

11、.72cm。2．主肺動(dòng)脈干橫徑(P2)：自肺動(dòng)脈段最凸點(diǎn)（或最凹點(diǎn)，如平直則取其中點(diǎn))至正中線的垂直距離。平均3.86 ±0.53。3．肺動(dòng)脈段凸出度(P3)：自肺動(dòng)脈段最凸點(diǎn)(或最凹點(diǎn))至肺動(dòng)脈段基線的垂直距離，如果肺動(dòng)脈段為平直則其凸出廢為0，凸出者為正值，凹陷者為負(fù)數(shù)。平均－0.11±0.28cm。4.右下肺動(dòng)脈干橫徑(P4):右下肺動(dòng)脈干上端外緣至中間段支氣管外緣的距離,正常<1.5cm。,（摘