Bontrager Chapter 2 Chest Situational Questions

A young child enters the ER with a possible foreign body in one of the bronchi of the lung. The foreign body, a peanut, cannot be seen in the PA and lateral projections of the chest. Which additional projection(s) could be technologist perform to locate the foreign body?

AP and Lateral upper airway projections

A routine chest series indicates a possible mass beneath a patient's right clavicle. The PA and lateral projections are inconclusive. What additional projection(s) could be taken to rule out this condition?

AP lordotic

PA and left lateral projections demonstrate a suspicious region in the left lung. The radiologist orders an oblique projection that will best demonstrate or "elongate" the left lung. Which specific oblique projections will best elongate the left lung?

Both the LPO and RAO oblique positions will best demonstrate or elongate the left lung

A patient with a history of pleurisy comes to the radiology department. Which of the following radiographic series should be performed?

Erect PA and lateral

A patient has a possible small pneumothorax. Routine chest projections (AP and lateral) fail to show the pneumothorax conclusively. Which additional projections could be taken to rule out this condition?

Inspiration and expiration PA projections and/or a lateral decubitus AP chest with affected side up

A patient enters the ER with a possible hemothorax in the right ling caused by a motor vehicle accident. The patient is unable to stand or sit erect. Which specific projection would best demonstrate this condition and why?

Right lateral decubitus. In a PT with hemothorax the side of interest should be down.

A radiograph of a PA and a left lateral projection of the chest demonstrates the mediastinum of the chest is underpenetrated. The technologist used the following factors for the radiograph: a 72 in SID, an upright bucky, a full-inspiration exposure, 75 kVp and 800 mA and a short exposure time. 1. Which of these factors is the most likely cause of the problem? 2. How can the technologist improve the image when making the repeat exposure?

1. 72 kVp too low, needs to be 110-125 2. Increase kVp, reduce mAs

A patient with a possible neoplasm in the right lung apex comes to the radiology department for a chest examination. The PA and lateral projections do not clearly demonstrate the neoplasm because of superimposition of the clavicle over the apex. The patient is unable to stand or sit erect. Which additional projections can be taken to demonstrate the neoplasm cavity and to eliminate the superimposition of the clavicle and the left lung apex?

AP semiaxial projection, CR is angled 15-20 degrees cephalad to project the clavicles above the apices and to clearly demonstrate the possible tumor

A radiograph of a lateral projection of the chest shows the posterior ribs and costophrenic angles are separated more than 1in or 2.5 cm, indicating excessive rotation. Describe a possible method for determining the direction of rotation.

Determine which hemidiaphragm (right or left) is more posterior or more anterior. The left hemidiaphragm can frequently be identified by visualization of the gastric air bubble or the inferior heart shadow, both of which are associated with the left hemidiaphragm

A patient comes to the radiology department for a presurgical chest exam. The clinical history indicates a possible situs inversus of the thorax (transposition of structures within the thorax). Which positioning step or action must be taken to perform a successful chest exam?

Ensure the placement of the correct right or left anatomic side marker on the IR because the heart and other thoracic structures may be transposed from right to left

A radiograph of a PA projection of the chest demonstrates the top of the apices is cut off and a wide collimation border can be seen below the diaphragm. How can this be corrected during the repeat radiograph?

IR needs to be centered to CR & light at vertebra prominence

A patient with severe pleural effusion comes to the radiology department for a chest x-ray. Automatic exposure control (AEC) will not be used. How should the technologist alter the manual exposure for this patient?

Increase the kVp slightly (+)

A patient with a clinical history of advanced emphysema comes to the radiology department for a chest x-ray. AEC will not be used. How should the technologist alter the manual exposure settings for the patient?

decrease the kVp moderately (--)