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1、胸片閱讀與心影改變譚洪毅X-rays-describeradiationwhichispartofthespectrumwhichincludesvisiblelight,gammaraysandcosmicradiation.Unlikevisiblelight,radiationpassesthroughstuff.WhenyoushineabeamofX-Rayatapersonandputafilmontheothersideofthemashadowisproducedoftheinsideoftheirbody.DifferenttissuesinourbodyabsorbX
2、-raysatdifferentextents:Bone-highabsorption(white)Tissue-somewhereinthemiddleabsorption(grey)Air-lowabsorption(black)Besystematic:1)CheckthequalityofthefilmFilmQualityFirstdetermineisthefilmaPAorAPview.PA-thex-rayspenetratethroughthebackofthepatientontothefilmAP-thex-rayspenetratethroughthefronto
3、fthepatientontothefilm.Allx-raysinthePICUareportableandareAPviewFilmQuality(cont)Wasfilmtakenunderfullinspiration?-10posteriorribsshouldbevisible.WhydoIsayposteriorhere?WhenX-raybeamspassthroughtheanteriorchestontothefilmUnderthepatient,theribsclosertothefilm(posterior)aremostapparent.Areallygood
4、filmwillshowanteriorribstoo,thereshouldBe6toqualifyasagoodinspiratoryfilm.Quality(cont.)Isthefilmoverorunderpenetratedifunderpenetratedyouwillnotbeabletoseethethoracicvertebrae.Quality(cont)CheckforrotationDoesthethoracicspinealigninthecenterofthesternumandbetweentheclavicles?Aretheclavicleslevel
5、?VerifyRightandLeftsidesGastricbubbleshouldbeontheleftX線一、心胸比:心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量胸廓橫徑為準(zhǔn)。摘自<<臨床心臟x線診斷學(xué)>>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
6、胸比：B/A摘自<<影像診斷學(xué)[美]PeterArmstrong著邱健泰等譯>>心胸比測量示意圖二二、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)，
7、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±0.72cm。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
