胸腔放射检查技术和x线解剖

1、Technique and Radiographic Anatomy of the Thorax胸腔放射检查技术和 线解剖Prof. dr. Paul Barthez, DipAVCR, DipECVDITechnique 放射技术 Radiographic parameters X线摄影参数 Positioning 摆位Technique 放射技术:Radiographic ParametersX线摄影参数 Pulmonary airsoft tissue=> good natural contrast 肺内气体与软组织结构=>良天然对比度 Motion : respirator

2、y and cardiac 移动伪影：呼吸和心跳Settings参数, Tools Voltage 管电压Dogs 90 - 120 kVp (high voltage) 犬 90120 kVp（高千伏） Cats 50 - 60 kVp 猫 5060 kVp Short exposure time (<0.06 s) 短时间(<0.06 s) Thickness 厚度> 10 cm : Grid + medium speed screens使用虑线栅+中速增感屏< 10 cm : no grid +screens 不用虑线栅+低速增感屏=> Cats usual

3、ly table top technique 猫通常使用桌面技术Procedure 摄影程序 2 orthogonal views 2个垂直的 Left (or right) side down lateral view 左侧（或右侧）卧侧位 Ventro-Dorsal (or Dorso-Ventral) view 腹背位（或背腹位）Why 2 orthogonal views ?为什么需要2个垂直Lateral view 侧位 Dog in lateral recumbency 犬侧卧 Thoracic limb in extension 前肢伸展 Head and neck in neu

4、tral pos.头颈自然状态 Beam center投照中心 : caudal border of the scapula肩胛骨后缘 ventral third of the thorax胸腔下三分之一 Field of view : thoracic inlet to last rib投照范围：胸腔到最后肋骨 R or L marker 进行R 或 L 标记 Exposure at end of inspiration在吸气末Lateral View : Quality Control侧位：质量 Entire lung field on the film 相片中可见整个肺野 Thoraci

5、c limbs out of the thorax前肢影像未出现在胸片Lateral View : Quality Control侧位：质量 No rotation 未发生旋转: Superposition of the ribs at their origin 各肋骨起点重合 Deep inspiration : diaphragm intersects spine in dogs at T12-T13, in cats at L1-L2深吸气时：在犬，膈与脊柱交于T12T13;在猫，交于L1L2T10T11T12T13Dorso-Ventral View (not easy)背腹位（） D

6、og in sternal recumbency 犬趴卧 Neck in flexion between thoracic limbs 颈部屈卧于前肢之间 Check symmetry 两侧对称 Beam center : caudal border of scapulae on midline投照中心：肩胛骨后缘连线中点 Open field to include shoulders 投照范围肩关节 R or L marker 进行R 或 L 标记 Exposure at the end of inspiration在吸气末Dorso-Ventral View ：Quality Contro

7、l背腹位：质量 Entire lung on the film相片中可见整个肺野 Symmetrical 对称 Vertebrae and sternebrae superimposed椎骨和胸骨重合 Diaphragm superimposed over 8 ththoracic vertebra膈覆盖第8胸椎Other Views 其他 Left side down versus right side down左侧位与右侧位 VD or DV腹背位与背腹位 Lateral view in expiration呼气状态下的侧位 Horizontal beam水平投照Radiographic

8、Anatomy线解剖 Extra-thoracic bony structures 胸腔附属骨性结构 Diaphragm 膈 Pleural space 胸膜腔 Mediastinum 纵隔 Lungs 肺Extra-Thoracic Structures胸腔附属结构 Ribs 肋骨 Vertebrae 椎骨 Sternebrae 胸骨 Thoracic limbs 前肢Repeat radiographswith bone technique (medium kVp)使用骨骼摄影技术（中等kVp ）再次进行投照Extra-Thoracic Structures胸腔附属结构Diaphragm

9、膈 Shape and position depend on 形态与位置取决于: Species 动物种类 Breed (conformation) 品种（构造） Degree of inspiration (thoracic volume)吸气程度（胸腔体积） X-ray beam position X线束投照方向 Right or left side down 右侧或左侧卧 VD or DV 腹背位或背腹位Right or left side down ?右侧卧或左侧卧The cranial crus is the dependent one前是影响因一Right or left side

10、 down ?右侧卧或左侧卧 Right side down 右侧卧: Caudal vena cava blends in with right crus 右前遮挡前腔静脉 (Crura parallel to each other) 两前相互平行Right or left side down ?右侧卧或左侧卧 Left side down 左侧卧 Gastric air bubble just caudal to the left crus胃内气体刚好位于左前后方 (Crura not parallel to each other) 两侧前不能相互平行Dorso-Ventral versu

11、s Ventro-Dorsal View背腹位与腹背位 Ventro-Dorsal (VD) view 腹背位 2 diaphragmatic crura visible : "ey mouse »2个横膈脚呈“米老鼠”样 Ideal for evaluation of the lung field 可以理想的评价肺野Dorso-Ventral versus Ventro-Dorsal View背腹位与腹背位 Dorso-Ventral (DV) view 背腹位 Ventral cupula visible : dome shaped 腹侧膈顶呈：圆拱形 Ideal fo

12、r the evaluation of the heart 可以理想的评价心脏Pleural Space 胸膜腔 Not visible if normal 正常时不可见 Lung borders adjacent to the ribs肺的边缘紧贴肋骨 No separation between lung lobes肺叶间裂隙不明显 Pleural thickening common in old dogs在老年犬，生胸膜增厚Pleura 胸膜 Cats : Soft tissue opacity between caudal lung lobes and caudal thoracic v

13、ertebrae,lumbar muscles 猫：肺尾叶和最后胸椎、腰肌之间，呈现软组织阴影CatDogMediastinum 纵隔 Cranial 前纵隔 Dorsal 背侧 Ventral 腹侧 Central 中间纵隔 Caudal 后纵隔Cranial Mediastinum 前纵隔 Dorsal 背侧 : Esophagus 食道 Trachea Large vessels : carotids, cranial vena cava大：颈动脉，前腔静脉 Lymph nodes 淋巴结 Ventral 腹侧 Thymus 胸腺 Vessels Sternal lymph node 胸

14、淋巴结Cranial Mediastinum 前纵隔 Dorsal 背侧 Wide 宽 In midline 位于中间 Ventral 腹侧 Narrow 狭窄 Oblique direction : right cranial - left caudal倾斜方向：右前左后Cranial Mediastinum 前纵隔 Ventral limit of the cranio-dorsal mediastinum :cranial vena cava 前纵隔背侧的腹侧缘：前腔静脉Cranio Ventral Mediastinum前纵隔腹侧 Thymus in animals less than

15、 1 year of age小于1岁龄的动物可以见到胸腺Cranio Ventral Mediastinum前纵隔腹侧 Thymus in young animals 幼龄动物可以见胸腺 Thin line in normal adults 成年动物呈细线状 Right-cranial to left-caudal direction on VD view在腹背位影像中呈右前至左后方向Cranio Ventral Mediastinum前纵隔腹侧Thymus in young animals 幼龄动物可见胸腺 Thin line in normal adults 成年动物呈线状 Cranial

16、-Right to caudal left direction on VD view在腹背位影像中呈右前至左后方向 Separating left cranial from right cranial lung lobe on the lateral view (well seen inobese animals)在侧位影像中，右侧肺前叶与 左侧前叶分离（在肥胖动物更加明显）Cranio Dorsal Mediastinum前纵隔背侧 Wide 较宽: Brachycephalic dogs 短头犬 Obese dogs 肥胖犬 Narrow 较窄: Cat 猫Cranio-dorsal Me

17、diastinum :Trachea前纵隔背侧： Transparent tube Midline or slightly curved to the right位于中线或轻微向右侧弯曲 Shape depends on neck positioning and respiratory phase形态取决于颈部摆位和呼吸状态TracheaCranio-dorsal Mediastinum :Trachea前纵隔背侧： Redundent dorsal tracheal wall背侧壁遮挡 : apparent decrease in tracheal diameter看起来直径变窄Very c

18、ommon in normal dogs在正常犬非常常见Cranio Dorsal Mediastinum :Esophagus前纵隔背侧：食道 Usually not visible 通常不可见 Sometimes 有时 : Air stripe dorsal to the trachea背侧出现空气条纹 Tubular soft tissue opacity between aorta and CVC主动脉与前腔静脉之间出现管状软组织阴影Central Mediastinum :Heart中间纵隔：心脏 Well contrasted by pulmonary air在肺内空气衬托下可以良

19、好显示 Rounded structure on both projections两个摄影时，均呈现圆形结构 Soft tissue opacity 软组织阴影 Cardiac silhouette 心脏轮廓Heart 心脏: Size 大小 Subjective evaluation compared to thoracic volume与胸腔体积进行比较 Empirical rule 经验评估 : Lateral 侧位:Less than 3.5 intercostal spaces in dogs,在犬，小于3.5个肋间隙less than 2.5 intercostal spaces

20、in cats在猫，小于2.5个肋间隙 DV 背腹位 : 2/3 of thoracic width 胸腔宽度的2/3 Size compared to thoracic vertebrae 大小与胸椎比较 Vertebral Heart Scale椎体心脏比分 - JW BuchananVertebral Heart Scale (VHS)椎体心脏比分 Measure width + height of the cardiac silhouette测量心脏轮廓的宽度+高度 Compare to length of thoracic vertebrae between T4 et T8与第4和

21、第8胸椎间胸椎长度比较 Dogs 犬: 9.7 ± 0.5 Cats 猫 : 7.5 ± 0.3 (6.9 - 8.1)Variations in Cardiac Size and Shape心脏大小和形态的变化 Species 动物种类 Breed 品种 Age Body condition 身体状态 Cardiac phase (systole-diastole)心动周期（收缩期舒张期） Respiratory phase 呼吸周期(inspiration - expiration) （吸气呼气） X-ray beam orientation X射线投照方向Heart

22、: Cavities and Great Vessels心脏：腔室和大Right versus left heart 心脏右侧与左侧 Take lateral view 侧位摄影 Draw line betweentracheo-bronchial bifurcation and apex of the heart支分叉至心尖连线 2/3 cranial is right heart头侧2/3为右心 1/3 caudal is left hear尾侧1/3为 Dorsal half : atriaL背侧1/2处：主动脉R Ventral half : ventricles腹侧1/2处：心室He

23、art : Cavities心脏：腔室 Left atrium房 Left ventricleHeart : Cavities心脏：腔室 Right atrium 右心房 Right ventricleHeart : Large Vessels心脏：大 Main pulmonary artery主要肺动脉 Aorta 主动脉Heart : Location of Cavities and Great Vessels心脏：腔室和大的位置Right atrium右心房Aorta主动脉Main pulmonaryartery 主要肺动脉Left auricle耳Left ventricleRight

24、 ventricleLeft atrium房Heart : Projection of Different Cavities and Great Vessels心脏：不同腔室和大的检查程序Right atrium右心房Right ventricleAorta主动脉 Main pulmonaryartery主要肺动脉Left auricle耳Left ventricleLeft atrium房Tracheobronchial Bifurcation支分叉 Main stem bronchi 主支干 Tracheo-bronchial lymph nodes支淋巴结Caudal Mediastinum 后纵隔 Mediastinal fold on the left 后纵隔在左侧发生折转 Caudal Vena cava on the right 后腔静脉在右侧Lungs Overall transparent整体透射线 Opaque structures不透射线结构 : Vessels Inte