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Radiology of the Chest and Abdomen - #20661


Abdomen
Chest

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Anita L. Manne, DC, DACBR
Professor

2.5
45.0
2.0
1.0
With an early emphasis on recognizing normal anatomy and normal variants, the students are presented with various pathological processes in the chest and abdomen. Laboratory, physical exam findings and pathological features, when appropriate, will be correlated.
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    Graduates will acquire, appraise and apply scientific information. Graduates will contextually organize and synthesize relevant information to address an issue or problem.
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Course Objectives
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  1. knowledge of the normal radiographic anatomy depicted on plain films of the chest and abdomen.
  2. familiarity with supplemental imaging modalities of the chest and abdomen.
  3. ability to identify radiographic features of normal variants and congenital anomalies.
  4. develop a concise and comprehensive search pattern for standard chest and abdomen radiographs.
  5. ability to recognize gross pathological changes on chest and abdomen films.
  6. ability to correlate pertinent clinical data with chest and abdomen films.
Materials
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A. Required Text(s):
  • Squire's Fundamentals of Radiology, Robert A. Novelline, MD

    B. Recommended Text(s):
  • Chest Radiology-the Essentials, Collins and Stern
  • The Abdominal Plain Film, Baker
  • Clinical Radiology, Daffner
  • Fundamentals of Diagnostic Radiology, Brant and Helms
  • Principles of Chest Roentgenology, Felson
  • Plain Film Approach to Abdominal Calcifications, Baker & Elkin
  • Essentials of Roentgen Interpretation, Juhl & Crummy
  • Radiologic Diagnosis of Chest Diseases, Sperber

    OTHER RESOURCES:
    Chest and Abdomen radiographs in Room 202 (Radiologic Learning Lab). Hours as posted.
    Commercial web site for thoracic imaging: www.auntminnie.com; click on thoracic imaging heading. Though this site is free, you must register.

    C. Required Materials for Lab:
  • None
    • Assignments
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    Attendance
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    Students are strongly encouraged to attend lecture and lab. When absent, the student is responsible for obtaining material covered. Information pertaining to lecture and/or lab changes, i.e. postponement or cancellation is often transmitted via email. Students are expected to check their NWHSU email accounts for such announcements.

    Unexplained absence from exams (no-show) will result in a loss of a minimum of 10% points on the made-up exam.
    Grading Criteria
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    1. A total of four exams will be given--two written exams and two practical exams. The written midterm examination will be given during Midterms Week; the practical midterm will be given directly following Midterms Week. The final examinations are comprehensive, with approximately 25% of the material prior to the midterm included.
    2. Anyone taking an exam at other than the previously scheduled time will pay a fee of $30 per test. This is subject to the prior approval of the instructor and will be arranged at least two days prior to the scheduled exam. The special test may be essay and short answer format.
    3. Each written exam is worth 20% of your course grade; each practical exam is worth 30% of your course grade.
    4. Grades will be posted on eNorthwestern in a timely manner, however, the accuracy of grade transcription is not guaranteed.

    Guaranteed grades are as follows:

    A = 92-100%
    B = 82- 91%
    C = 74-81%
    D = 66-73%
    F = </= 65%
    Course Competencies
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    --

    COGNITIVE DOMAIN


    Students will be able to:
    1. discuss the limitations of regular spine x-rays for diagnosis of cardiopulmonary and abdominal conditions.
    2. discuss the differences between films exposed with technical factors for bone detail, and those used in chest and abdomen radiography.
    3. identify, know indications for, and discuss the methods of acquiring, various supplemental plain films for the chest: apical lordotic, lateral decubitus, oblique, expiration view, low kV bone detail spot views; and special studies of the abdomen: upper and lower GI, IVP, cholecystography, sonography, computed tomography, angiography.
    4. understand the positioning of PA and lateral chest radiographs, and upright and recumbent AP abdominal x-rays.
    5. evaluate and critique films of varying diagnostic quality.
    6. identify normal radiographic structures and relationships using standard views of the chest and abdomen.
    7. identify a variety of normal variants, anomalies, and projectional artifacts of the chest and abdomen and determine the clinical significance and diagnostic differentials for them.

    Students will be able to discuss the differences and similarities between thoracic spine views and the PA chest radiograph.

    a. exposure factors f. contrast scale
    b. focal film distance g. use of grid/bucky
    c. collimation h. osseous detail
    d. respiratory phase i. orientation of film on view box
    e. arm and shoulder placement j. parenchymal, hilar, vascular, mediastinal detail

    Students will understand the basic positioning steps and indications for standard and supplemental views of the chest.

    a. PA chest x-ray d. lateral decubitus
    b. lateral chest x-rays e. low kV x-ray
    c. apical lordotic f. air-gap technique

    Students will understand the basic methods and indications for standard and special studies of the abdomen.

    a. AP upright abdomen e. intravenous and retrograde pyelography
    b. AP supine abdomen f. cholescystography
    c. upper GI g. angiography
    d. lower GI  

    The student will understand and be able to apply concepts of the basic diagnostic signs of pulmonary disease to pneumonia, lung masses, lobar and lobular volume loss, pleural based tumors and metastasis, rib metastasis

    a. silhouette sign d. pleural effusion
    b. air bronchogram sign e. extrapleural sign
    c. atelectasis f. opacification


    Conditions:
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    PSYCHOMOTOR DOMAIN


    The student will be able to identify elements of normal radiographic anatomy and anatomical relationships on the PA and lateral radiograph.

    a. cardiac moguls/chambers g. trachea, mainstem bronchi
    b. great vessels h. chest wall/muscles/breast shadows
    c. pulmonary veins i. osseous components
    d. interlobar arteries j. upper abdomen
    e. hemidiaphragm k. interlobar fissures
    f. costophrenic/cardiophrenic sulci l. retrocardiac/retrotracheal clear spaces

    In addition, the student will be able to identify normal variants, anomalies, and projectional artifacts on standard PA and lateral chest radiographs.

    a. accessory fissures g. pectus excavatum
    b. diaphragmatic eventration, partial and complete h. anterior extrapleural line
    c. costal cartilage calcification i. mastectomy
    d. rhomboid fossae j. breast implants
    e. cervical ribs/hyperplastic transverse processes k. confluence of shadows
    f. indistinct lower rib edges  


    AFFECTIVE DOMAIN


    Students will conduct themselves in a manner befitting a professional and demonstrate respect, sensitivity and compassion between one another and with the instructor.
    Weekly Calendar of Learning Objectives
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    Week Dates Topics/Learning objectives
    Week 1 -

    Lecture: Introduction, course notes, class conduct, required textbook presented, other resources. Introduction to PA/Lat. cxr--technical considerations, comparison with AP/Lat. thoracic views. How to view cxr vs. spinal views. Supplemental radiographs of chest with indications for their use. Demonstrate organized search pattern in context of in depth presentation of normal radiographic anatomy. Discuss interlobar fissures. Present normal variants.

    Lab: Identify various radiographs of chest and thorax. Compare numerous examples of normal subjects' x-rays to demonstrate wide variation in normal anatomy and how technical factors can contribute to false appearances. Normal variants.
    Week 2 -

    Lecture: Diagnostic signs of respiratory disease--silhouette sign, air bronchogram sign, signs of volume loss, pleural effusion, extrapleural sign, interstitial vs. alveolar/airspace disease.

    Lab: Show examples of diagnostic signs presented in lecture.
    Week 3 -

    Lecture: Acute pulmonary infections. Radiographic and clinical presentation of bacterial, viral, fungal, protozoan infections. Presentation of "burnt-out" granulomatous disease. Discussion of endemicity.

    Lab    : Show examples of acute and chronic pulmonary infections.
    Week 4 - Lecture: Pulmonary tuberculosis--historical perspective, clinical features, endemicity, public health concerns, healthcare worker protection, radiographic appearance of primary, reactivation, hematogenously disseminated TB, Rhanke complex. Pulmonary sarcoidosis -- racial prevalence, clinical features, radiographic findings, prognosis.

    Lab    : Show examples of TB, sarcoidosis.
    Week 5 - Lecture: Tumors of lungs, bronchi and pleura. Classification, metastatic lung disease, primary lung carcinoma -- small cell and non-small cell, radiographic and clinical features. Solitary pulmonary nodule -- how to decide probability of benign vs. malignant, appropriate work-up, management, doubling time phenomenon. What to tell patients. Relative incidence of SPN's. Limitations of plain films and dismal performance of spine x-rays compared with cxr. Use of advanced imaging. Pleural based tumors. Asbestos-related lung disease. Mediastinal masses -- review of anatomical mediastinal boundaries, common mediastinal masses, clinical features, radiographic features.

    Lab    : Show examples of lung masses. Discuss strategies for working up and/or referral of patients with various lung masses. Show examples of pleural based tumors, mediastinal masses, discuss concept of barium swallow to confirn space occupying mass.
    Week 6 - Lecture: Pneumothorax -- causes and complications, gender incidence, radiographic and clinical features, prognosis. Chronic obstructive pulmonary disease -- types, clinical and radiographic features, complications. Atherosclerotic heart disease -- radiographic features, implications for chiropractors. Thoracic aortic aneurysms. Congestive heart failure.

    Lab    : Show examples of disorders discussed in lecture.
    Week 7 - Lecture: Miscellaneous conditions. Introduction to radiology of the abdomen. Methods of examination including KUB, upper GI, lower GI, double contrast, intravenous pyelography, oral cholecystography, ultrasonography, computed tomography, angiography.

    Lab    : NO LABS DURING MIDTERMS WEEK.
    Week 8 - MIDTERMS WEEK CONTINUES
    Week 9 - Lecture: Normal radiographic anatomy of the abdomen. Organomegaly. Abdominal calcifications -- concretions, conduit wall, cystic, solid mass. Concretions -- phleboliths, gall stones, mil-of-calcium bile, kidney and ureteral stones, appendicolith, pancreatic calculi, prostatic calculi, bladder stones

    Lab    : Review normal radiographic anatomy. Show examples of organomegaly, abdominal concretions.
    Week 10 - Lecture: Conduit wall calcifications -- abdominal aortic atherosclerosis, splenic artery, vas deferens. Cystic calcifications -- porcelain gall bladder, abdominal aortic aneurysm, splenic artery aneursym. Calcification within solid organ -- lymph node, injection granulomas, uterine leiomyomas, kidney, adrenal glands, ovarian masses. Miscellanous calcifications and densities.

    Lab    : Show examples of conduit wall, cystic and solid mass calcifications; miscellaneous calcifications.
    Week 11 - Week 10 - Continued
    Week 12 - Lecture: Abnormal collections of abdominal gas: obstruction, ileus, pneumoperitoneum, volvulus, intussusception, hiatal hernia.

    Lab: Show examples of abnormal collections of abdominal gas.
    Week 13 - REVIEW and/or CATCH-UP
    Week 14 - FINALS WEEK
    Week 15 - FINALS WEEK cont.
    Please Note
    This schedule of lecture and lab topics and quizzes and exams may be changed during the course of the trimester as circumstances require. Whenever possible, such changes will be announced in class before the date and time in question. You are responsible for anything that transpires during lectures and labs, even when you are unable to attend. In the event that you miss a class session, make sure you check with a classmate about any announcements or schedule changes which may have been made. Makeup exams are allowed only according to the policies described in the current student handbook, which is available in the Student Affairs office.
    Maintained by Dr. Anita L. Manne
    Last updated: 5 January, 2007
     

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