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On the lateral view the oblique fissure moves backwards, and with increasing collapse there is loss of definition of the right hemidiaphragm as well as increased density overlying the lower dorsal vertebrae (Fig. 10). Left upper lobe The main finding on the PA radiograph is of a veil-like increase in density, without a sharp margin, spreading outwards and upwards from the left hilum which is elevated. The aortic knuckle, left hilum and left heart border may have ill-defined outlines. As volume loss increases, the collapsed lobe moves closer to the midline and the lung apex may become lucent due to hyperinflation of the apical segment of the left lower lobe.

The left and right brachiocephalic veins THORACIC IMAGING 33 Fig. 4 a Normal lateral chest radiograph, b Normal structures visible on a lateral chest radiograph: 1, breast shadow; 2, sternum; 3, position of right ventricle: 4, right oblique fissure; 5, left oblique fissure; 6. hemidiaphragm7, descending aorta; 8, infenor angle of scapula; 9, dorsal vertebrae; 10. horizontal fissure; 1 1 , aortic arch; 12, trachea; 13, pulmonary artery. form an extrapleural bulge behind the upper sternum in about a third of individuals.

The summary should always contain adequate information for future audit and studies of patient care. AUDIT 'Audit* refers to the systematic and critical analysis of the quality of care. There are three main forms of audit: structure, process and outcome. 1. Structural audit examines the organization of resources within a certain area. g. a hospital's requirements for transcutaneous electrical nerve stimulation (TENS) machines, batteries and electrodes. 23 2. g. studying the methods of patient referral.

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