How to Interpret a Chest X-Ray (Lesson 4 - Airways, Bones, and Soft Tissues)

An overview of how to assess the airways, bones, and soft tissues on chest X-ray, including the important etiologies of common radiographic abnormalities.
Video includes following images (among others):
Left atrial enlargement, downloaded from Radiopaedia.org, originally provided by Alexendra Stanislavsky.
Cervical ribs, downloaded from Radiopaedia.org, originally provided by Jeremy Jones.
Rib notching, downloaded from Radiopaedia.org, original uploader undetermined (image can no longer be located on site).
Sources for other images may include Wikimedia Commons, radiologypics.com, and Jose Caceres' wonderful radiology blog: Caceres Corner (blog.myesr.org/category/cacere...)

Пікірлер: 86

  • @curvedcut
    @curvedcut8 жыл бұрын

    Thank you for your selfless contribution to medical education. An inspiration!

  • @Macsooder
    @MacsooderАй бұрын

    This is by far one of my favourite channels to watch and I just wish I had found it earlier in my studies. Thank you so much for your excellent resources. I now recommend your channel to everyone I know.

  • @StrongMed

    @StrongMed

    Ай бұрын

    You're very welcome!

  • @cheechee12345
    @cheechee1234510 жыл бұрын

    Dr. Eric, I recently discovered these videos - they are 'awesome'. I am an intern and love having this as a quick review on key concepts. I'm anxiously waiting for lesson 5! Take care and thanks for everything you seem to be doing for us in training.

  • @modernsamurai86
    @modernsamurai867 жыл бұрын

    I'm studying med and this is a great and informative series for understanding X rays which looked pretty intimidating at first. Love how you hinted at the brand of the furniture with the colours you displayed.

  • @nicholascain594
    @nicholascain5944 жыл бұрын

    Thank you for this series. I have been struggling understanding x-rays and these videos really break it down.

  • @borisyadershik
    @borisyadershik3 жыл бұрын

    Thank you for this great lecture series!

  • @bryan1598
    @bryan159810 жыл бұрын

    Keep making videos doctor, they are great! :)

  • @christianijeoma2609
    @christianijeoma26093 жыл бұрын

    Excellently presented and even easy for a beginner to recall

  • @manu27190
    @manu271909 жыл бұрын

    thank dr.Eric this is very good video

  • @nobzstudio1372
    @nobzstudio13727 жыл бұрын

    very interesting presentation, very easy to understand.

  • @markolucijanic1179
    @markolucijanic117910 жыл бұрын

    thank You Dr. Eric

  • @niamatullah4442
    @niamatullah44424 жыл бұрын

    Thank you sir. Great job ,,,appreciated

  • @btuesday
    @btuesday4 жыл бұрын

    Excellent lesson.

  • @samratspeaks
    @samratspeaks5 жыл бұрын

    Outstanding lecture :)

  • @kadderley8676
    @kadderley86764 жыл бұрын

    Life saver. Thank you

  • @faxm9061
    @faxm90613 жыл бұрын

    I love u, Dr.Eric!

  • @cristianbindar5393
    @cristianbindar53933 жыл бұрын

    Brilliant! Thank you!

  • @ayyuce7120
    @ayyuce71202 жыл бұрын

    Thanks this is great for radio lessons

  • @bakrimalek4696
    @bakrimalek4696 Жыл бұрын

    Absolutely the best 👌

  • @kimhappy1249
    @kimhappy12497 жыл бұрын

    this is very interesting, I have pain on my left side of ribs and I have a feeling that the pain is coming from my ribs not my organs, iv had this pain for a few months it first started as one Mitty sharp in it was very intense and over time the pain is still there and it as spread it goes around the left side of my rids, what could it be

  • @mustafamukaram7412
    @mustafamukaram74122 жыл бұрын

    Thank you so much.

  • @amritpandey4600
    @amritpandey46005 ай бұрын

    Masterclass ❤❤

  • @kamalpreethara3233
    @kamalpreethara323310 жыл бұрын

    very informative lectures dr.eric. can you please upload some more xrays of sclerosis and lytic lesions.

  • @StrongMed

    @StrongMed

    10 жыл бұрын

    I'm glad you found them helpful. The next couple of videos on X-rays will be covering abnormalities of the heart, mediastinum, and pleura. However, I plan to conclude the X-ray series with a review of some "unknown" films, and will include some more sclerotic and lytic lesions then.

  • @ayoubbasham4984
    @ayoubbasham49842 жыл бұрын

    Insanely useful. I'm grateful living in internet era

  • @mohamadigbarea5764
    @mohamadigbarea57648 жыл бұрын

    it's great thank you very much

  • @HafizahHoshni
    @HafizahHoshni6 жыл бұрын

    Thank youuu so much! 11/11/2017 ✨

  • @vishubaba11
    @vishubaba1110 жыл бұрын

    Thanks !

  • @duongcaovan3643
    @duongcaovan36439 жыл бұрын

    thank you Dr Eric !

  • @quiksilver545
    @quiksilver5457 жыл бұрын

    Awesome job! Love this!

  • @miriami7
    @miriami78 жыл бұрын

    thank you

  • @vannithlong3585
    @vannithlong3585 Жыл бұрын

    thanks sir! Thanks

  • @ha-med8677
    @ha-med86773 жыл бұрын

    Great ☄️

  • @srinivasaraosirasapalli5104
    @srinivasaraosirasapalli51044 жыл бұрын

    excellent

  • @balqees9214
    @balqees92149 жыл бұрын

    great ,,, thank you doctor :)

  • @akshitajain5724
    @akshitajain57243 жыл бұрын

    Thanks 😊

  • @dicksonjohn3755
    @dicksonjohn3755 Жыл бұрын

    6:40 Thank you for this video. But at 6:40 you are saying numerous fractures on left posterior ribs. As this is an AP view, the fractures are on anterior ribs, correct?

  • @shammosunni5755
    @shammosunni57559 жыл бұрын

    Thanx for replying. You said the risk is very very very small of getting cancer from chest xray and people get the same radiation by a incontinent flight. If so why is chest X-rays radiation on the breast cancer risk list and not flight traveling? Is there not a difference in X-ray radiation and space radiation. Like X-ray radiation does space radiation go through your body too?and does it affect your breasts or cells in the same way a chest x-ray would affect your breasts or cells? How much have I increased my risk by having chest X-ray? less than 1%? is it something to worry about?Or am I the same risk as my sister who hasn't had a xray but has travelled on a flight for 7 hrs?

  • @rashadovchuyev4326
    @rashadovchuyev432610 жыл бұрын

    very helpfull

  • @shivani4862
    @shivani48623 жыл бұрын

    Thank u so much.. really amazing and can you include vedios about CT , ECG, EMG interpretation

  • @StrongMed

    @StrongMed

    3 жыл бұрын

    I have roughly 20 videos on ECG interpretation. No videos on CT yet, but hopefully at some point in the next 1-2 years (abdominal). Regarding the interpretation of EMGs, they are outside the scope of my clinical practice and expertise.

  • @shivani4862

    @shivani4862

    3 жыл бұрын

    @@StrongMed thank u sir

  • @alexphongbui8734
    @alexphongbui87349 жыл бұрын

    Hi Dr. Eric! As a hospitalist, how often do you find yourself consulting with a radiologist? Or do you prefer to read most thing on your own if you feel comfortable with it?

  • @StrongMed

    @StrongMed

    9 жыл бұрын

    Alex, this will be a mildly lengthy answer, but you've posed a question that may be more interesting than you might realize... It depends greatly on the specific type of study, and what you mean by "consulting with a radiologist" (e.g. delaying a clinical decision until the official report becomes available in the electronic medical record, or physically walking to the radiology department to review the images face to face with a radiologist). On one extreme, for chest and abdominal x-rays, I make decisions immediately based on my own read, but will double-check with the report once it's available. I'll only discuss the study with the radiologist if I disagree with the final report in a way that is highly clinically relevant. For example, last week a CXR showed a reticulonodular interstitial pattern, but was officially read as "airspace opacities likely due to pulmonary edema", prompting a visit to the radiology reading room. On the other extreme, for MSK films, they come up infrequently enough on the medicine wards that testing myself and practicing reading them is of low enough yield that I usually don't bother looking at the films themselves unless the report describes something unusual or dramatic. In the middle of the road are CTs of head, chest, and abdomen/pelvis, brain MRIs, and most nuclear medicine studies. For these, I always look at the scan first (largely for practice, but also on the off-chance that I catch something critically time-sensitive), but usually defer making an actual decision until either the report is available (if low suspicion of an abnormality) or after I track down the radiologist right away in person (if high suspicion of an abnormality). There's also an interesting dilemma when it comes to reading studies on your own patients. While it would seem like the bedside clinician is the best person to interpret the study (assuming they are qualified to do so), in a formal scientific sense, they are the least appropriate. Using any test to rule in or rule out a diagnosis requires both a pretest probability of disease, as well as knowledge of the test's sensitivity and specificity (or positive and negative likelihood ratios, if you prefer). However, studies in the literature which establish the sensitivity and specificity of certain radiographic modalities for diagnosing specific diseases almost always use interpreters who are blinded to the clinical history. Therefore, if I as the bedside clinician who interviewed and examined the patient am the one who interprets the x-ray or CT, the interpretation is no longer blinded, and the published sensitivity and specificity of the radiographic test is no longer valid. Without a valid estimate of the test's sensitivity and specificity, there is no way to determine the post-test probability, and from a statistical and scientific standpoint, the test therefore cannot be used in the diagnostic process. Of course, this is an academic point only; in practice, no one ever uses this as an argument against looking at studies on their own patients. This is seemingly paradoxically due to a combination of a lack of appreciation for simple biostats, and an appropriate appreciation for how limited formal biostats are in most real-life situations. However, I have seen it argued (and occasionally argued by myself) that there is value in requesting the radiologist make an initial interpretation of a study without knowing anything about the clinical history which might compromise the objectivity of the interpretation. Radiologists usually don't like to do this because it can make them feel like their clinical knowledge is unappreciated, but from a formal statistical point of view, they really should be interpreting studies blinded, and perhaps only as a second step, give an updated unblinded impression once the clinical history is revealed. This is probably most relevant with interpretation of V/Q scans, in which I have seen more than one scan miscategorized (i.e. read as "mod probability for PE" instead of "low probability for PE") due to the fact that the interpreter was swayed by information provided in the chart.

  • @alexphongbui8734

    @alexphongbui8734

    9 жыл бұрын

    Eric's Medical Lectures Thank you for the great and in-depth reply! I surely did not expect such a detailed explanation but I really appreciate it as a medical student. I meant consulting as in how much do you depend on the radiology report. Do all medical studies go to the radiologist or do you review them first and if you have a good grasp on it, you'll call that case closed and move on without the radiologist reading. With all that being said, what do you believe is the main value of a radiologist? Are radiologists supposed to be an unbiased opinion as you mentioned about them reading initial reports as "blind"? You mentioned about CTs, MRs, etc. is that the main modality that you will defer to a final read? How about other subspecialties in orthopedic or neurology that can read MSK and neruoimages? Sorry for all the questions.. I just find this partnership of clinician to diagnostic specialties (radiology and pathology) very interesting. Thank you again Dr. Eric!

  • @shammosunni5755
    @shammosunni57559 жыл бұрын

    Hi Eric are chest X-ray's radiation safe. I had a chest xray 4 days ago( just to check everything is fine, and it was). I just recently was looking at a breast cancer risk list and one of the risks of breast cancer is radiation on chest and it also said 60 people who had chest X-rays ended up with radiation caused breast cancer! I'm now worried! Have I increased my risk of breast cancer by having a chest x ray? Or have I missunderstood the text? I noticed you have xray images of a 3 year old child, are the radiation doses the same for adults and children ? Is it common for people especially women to get chest X-rays and am I right to be worrying of wrong?

  • @shammosunni5755

    @shammosunni5755

    9 жыл бұрын

    Oh I forgot to mention I'm 29 now and have had an xray on my head to check for broken nose at age 10 and also had tooth xray last year. Should I be worried about the radiation I've received? I'm very worried about the chest xray coz of the reason explained above.. If you could reply quickly please. 😰

  • @StrongMed

    @StrongMed

    9 жыл бұрын

    Shammo, while I cannot give you specific advice about your own medical situation, here is what I can say. The amount of radiation given to you by a chest X-ray is very very small, and has a very very very small risk associated with it. Specifically, a standard adult X-ray gives a person about 0.1 milisieverts (the standard measure of the biological effect of ionizing radiation), which is approximately the same amount of extra radiation people receive from space when taking an intercontinental flight (e.g. San Francisco to London) - and almost no one ever gets concerned about radiation while flying (except for the body scanners at the airport). While there is no "safe" level of radiation in the sense that any amount of radiation will theoretically increase your risk of cancer, for a chest X-ray, the increase is trivially small (1 in a million). For example, in the US, the lifetime risk of dying from cancer is approximately 23%. The lifetime risk from dying from cancer after receiving a chest X-ray is therefore something on the order of 23.000001%. This is a negligible increase that you shouldn't worry about. (X-rays of the skull are of similar degree of negligible risk) Other radiology tests can vary quite a bit in terms of how much radiation they give a person. For example, the worst conventional radiographic study is probably a CT of the abdomen and pelvis with contrast, which increases the risk by about 1 in 1000. But even this would only increase lifetime cancer risk from 23% to 23.001% - still a very small difference. It's an interesting academic question as to whether the presence of breast tissue in the chest should necessarily result in different thresholds for getting chest X-rays in men and women, since the added risk to women would theoretically be greater than the added risk to men, but once again, the difference are so extremely small that from a practical standpoint, it doesn't (and shouldn't) change how doctors order X-rays. The major exception to this principle is performing CT scans in pregnant women, which should be avoided if at all possible, due to the substantially higher amount of radiation, and the substantially higher susceptibility of fetuses to chromosomal/genetic damage from radiation. Hope that helps to ease your mind.

  • @drhashim1985

    @drhashim1985

    9 жыл бұрын

    chest x-rays causes 1 cancer per 1 million chest x-rays, if 60% of women who had chest x-rays ended up with cancer, it would be illogical to continue using this technology, one info I read that might ease your worries: women who had CT angiography of the lungs (has a radiation dose of more than 2000 times that of chest x-ray) during pregnancy (where the breast tissue is sensitized to radiation injury) had a life time risk of breast cancer of around 14% (as I remember)

  • @erincasey514
    @erincasey5148 жыл бұрын

    Do you have these presentations available as a PDF or powerpoint? They are great!! Thank you!

  • @StrongMed

    @StrongMed

    8 жыл бұрын

    Erin Casey I have some available as a PDF (e.g. antibiotics, electrolyte disorders, hypertension, thyroid disease, PFTs, and cardiac auscultation). Unfortunately the chest X-ray videos were created directly in Premiere, and can't be easily exported in a printable format.

  • @abdihakimaden934

    @abdihakimaden934

    7 жыл бұрын

    Erin Casey 9wi

  • @lovelyroroa
    @lovelyroroa9 жыл бұрын

    Again I send youmy thanks

  • @kartace1
    @kartace12 жыл бұрын

    Amazing lecture, thank you so much- technically it's a porcelain fused to metal crown on that tooth though, you can tell by the contour of the radiopaque metal core and the overlying, relatively radiolucent porcelain superstructure ;) (just because i know radiologists love to be pedantic!) haha

  • @kartace1

    @kartace1

    2 жыл бұрын

    It may actually even just be an amalgam filling and not a crown at all, hard to tell for sure

  • @fredastaire6156
    @fredastaire61563 жыл бұрын

    On to lesson 5!

  • @venkybly
    @venkybly4 жыл бұрын

    Tq sir

  • @vuxteam90
    @vuxteam904 жыл бұрын

    do x-ray can see if i inhaled a lil bbq peanut ? if not how i can be healed and spotted? i know it sound weird but i need more knowedge on that ! is it critical or as a adult its okay

  • @StrongMed

    @StrongMed

    4 жыл бұрын

    This isn't something I've personally encountered before (aspiration of a peanut), but one study I found reported that about 1/2 of children who inhaled a peanut had it visible on X-ray, though it is likely lower in adults. If you are concerned that you personally inhaled a peanut, I would speak with your physician ASAP. I'm sorry, but I cannot give more specific individualized medical advice on here.

  • @benjaminazumah9833
    @benjaminazumah9833 Жыл бұрын

    Notched superior surfaces of ribs; caused by intrinsic bone abnormalities Notched inferior surfaces of ribs; caused by vascular abnormalities especially those involving the great vessels.

  • @shreyashjhunjhunwala3021
    @shreyashjhunjhunwala30212 жыл бұрын

    I laughed so hard when at the end he told that it was a hair braid in the xray

  • @user-yc2cm5co3h
    @user-yc2cm5co3h2 жыл бұрын

    cxr which was clear but quite tall, meaning please

  • @billyrubin1342
    @billyrubin13422 жыл бұрын

    4:20 The spinous process here does not bisect the clavicles suggesting rotation around the Z axis. How can we make a judgement about tracheal deviation?

  • @StrongMed

    @StrongMed

    2 жыл бұрын

    Thank you for this excellent point. I don't know of a strictly applied rule about this, but since the trachea is more-or-less halfway between the clavicular heads and the spinous processes, I would say that *very roughly* the trachea should run along an imaginary vertical line that is halfway between the bisection of the clavicular heads and the spinous processes. Although this is just an approximate rule-of-thumb, in the two examples @4:20, the trachea is deviated significantly enough to still make the associated conclusions about possible underlying pathology.

  • @billyrubin1342

    @billyrubin1342

    2 жыл бұрын

    @@StrongMed That makes sense. Thank you for your explanation Doctor.

  • @sushmamahat9995
    @sushmamahat99953 жыл бұрын

    What is means of soft tissue

  • @Tutanero97
    @Tutanero973 жыл бұрын

    Why is it that in the foreign body aspiration x-rays the patient's arms are up?

  • @StrongMed

    @StrongMed

    3 жыл бұрын

    I'm not a pediatrician, but I think this is sometimes done for young children to keep them still while the film is being taken. (A person holds their arms up against their head).

  • @Tutanero97

    @Tutanero97

    3 жыл бұрын

    @@StrongMed It make sense. Thank you for answering!

  • @HasanAlKharfan
    @HasanAlKharfan3 жыл бұрын

    At 9:44 am I just dum or are the airways really not visible?

  • @StrongMed

    @StrongMed

    3 жыл бұрын

    The trachea and right mainstem bronchus are visible. The left mainstem bronchus not so much.

  • @mohammadkuolhasn8705
    @mohammadkuolhasn87057 жыл бұрын

    👍

  • @abdallahrallam6167
    @abdallahrallam61674 жыл бұрын

    is there a hand out for this course

  • @StrongMed

    @StrongMed

    4 жыл бұрын

    I'm very sorry, but there currently isn't one. Something I hope to work on in the future.

  • @abdallahrallam6167

    @abdallahrallam6167

    4 жыл бұрын

    @@StrongMed it's ok you doing great thank you

  • @TCBRCB
    @TCBRCB10 жыл бұрын

    Very didatic and in a good academicism.

  • @doodzy2
    @doodzy25 жыл бұрын

    as a 1st year medical student, you've interested me in radiology

  • @stephaniecummings9494

    @stephaniecummings9494

    3 жыл бұрын

    3rd year now?

  • @1rrrrrrrrrrr544f
    @1rrrrrrrrrrr544f8 ай бұрын

    Even after zooming in the rib fx,i still didn't see it😢

  • @elsasana224
    @elsasana2244 жыл бұрын

    superp

  • @tilak231
    @tilak2314 жыл бұрын

    That’s not easy to find the Lighter and Darker areas as you say!! You are changing the contrasts to highlight the pathology, in general we don’t have the power!

  • @shirinaminoroaya3171
    @shirinaminoroaya31714 жыл бұрын

    wooooowwwwwww

  • @Sku11Hax
    @Sku11Hax3 жыл бұрын

    5:40 must be some Ukrainian furniture shop.. :D //Swedish guy

  • @keilistradling9945
    @keilistradling994510 жыл бұрын

    I am a PA student and whenever I need extra clarification or have extra time I watch your videos they are truly amazing! Thank you so much!

  • @tilak231
    @tilak2314 жыл бұрын

    That’s not easy to find the Lighter and Darker areas as you say!! You are changing the contrasts to highlight the pathology, in general we don’t have the power!