Bontrager Chapter 2 Workbook

The traditional CR centering technique for the chest is to place the top or the IR ______ inches above the shoulders

1.5 - 2"

What is the minimum number of ribs that should be demonstrated above the diaphragm on a PA radiograph of an average adult chest with full inspiration?

10 ribs

Chest radiography for the adult patient usually uses a kilovoltage range of

110 to 125 kV

The bony thorax consists of

12 pairs of ribs

The bony thorax consists of (posteriorly)

12 thoracic vertebrae

What exposure factors is recommended for a chest examination of a young pediatric patient?

70 to 85 kV, short exposure time

Why should a left lateral be performed unless departmental protocol indicates otherwise?

A left lateral better demonstrates the heart region

To prevent the clavicles from obscuring the apices on an AP projection of the chest, the central ray should be angled (A) _________ so that it is perpendicular to the (B) ___________.

A. Caudad (+/- 5 degrees) B. Sternum

Which of the following objects should be removed (or moved) before chest radiography? (Choose all that apply.) A. Necklace B. Bra C. Religious medallion around neck D. Dentures E. Pants F. Hair fasteners G. Oxygen lines

A. Necklace B. Bra C. Religious medallion around neck F. Hair fasteners G. Oxygen lines

List the four important structures located in the mediastinum

A. Thymus gland B. Heart and great vessels C. Trachea D. Esophagus

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 on the PA and lateral projections of the chest projection. Which additional projection(s) could the 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

Which chest projections/positions is recommended to detect calcifications or cavitations within the upper lung region beneath the clavicles?

AP lordotic

What position/projection would be used for a patient who is too ill or weak to stand for an AP lordotic projection?

AP semiaxial projection, central ray 15-20 degrees cephalad

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 projection can be taken to demonstrate the neoplasm clearly 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 demonstrate clearly the possible tumor.

What is a common radiographic sign seen on a chest radiograph for a patient with respiratory distress syndrome (

Air bronchogram

What is the term for the small air sacs located at the distal ends of the bronchioles, in which oxygen and carbon dioxide are exchanged in the blood?

Alveoli

The trachea is located ____________________ to the esophagus.

Anteriorly

Upper, rounded portion of lungs above the level of the clavicles

Apex (apices)

The three parts of the aorta are the:

Ascending aorta Arch Descending aorta

Collapse of all or portion of lung

Atelectasis

Lower, concave portion portion of lungs

Base

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? (More than one oblique projection will accomplish this goal.)

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

The vertebra prominens is

C7

What is the name of the prominence, or ridge, seen when looking down into the bronchus where it divides into the right and left bronchi?

Carina

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

Center the CR higher (T7); make sure the IR is centered to the CR and the top collimation light border is at the vertebra prominens.

Most common form of emphysema

Chronic obstructive pulmonary disease (COPD)

Collarbone

Clavicle

The bony thorax consists of two

Clavicles

Extreme, outermost lower corner of the lungs

Costophrenic angle

One of the most common inherited diseases

Cystic fibrosis

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 this patient?

Decrease the kV moderately (--).

What is the name of the structure that acts as a lid over the larynx to prevent foreign objects such as food particles from entering the respiratory system?

Epiglottis

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

Why do the lungs tend to expand more with the patient in an erect position than in a supine position?

Erect position allows abdominal organs to drop, allowing the diaphragm to move farther down and the lungs to aerate more fully.

Which positioning tip will help prevent the patient's chin and neck from being superimposed over the upper airway and apices of the lungs for a PA chest radiograph?

Extend the neck upward

True/False: Echocardiography and electrocardiography are basically the same procedure.

False

True/False: Generally, you do not need to use radiographic grids for adult patients for PA or lateral chest radiographs.

False

True/False: No lead shielding is necessary for male patients or women greater than age 65 during radiographic imaging of the chest.

False

True/False: Ultrasound is not an effective modality to detect pleural effusion.

False

True/False: A grid is not recommended for a LPO projection of the adult chest.

False (a grid is recommended)

True/False: CR centering for the PA chest projection on an obese patient is 1 to 2" lower than for a sthenic patient.

False (centering for obese patient is at the same location - T7)

True/False: The height, or vertical dimension, of the average-to-large person's chest is greater than the width, or horizontal dimension.

False (greater width)

True/False: Because the heart is always located in the left thorax, the use of anatomic side markers on a PA chest projection may not be necessary.

False (heart may be located in right thorax)

True/False: In general for an average patient, more collimation should be visible on the lower margin of the chest image than on the top for a PA or lateral chest projection.

False (should be equal)

How much separation of the posterior ribs on a lateral chest projection indicates excessive rotation from a true lateral position?

Greater than 1 cm (1/2-3/4")

Optimal technical factor selection ensures proper penetration of the:

Heart, great vessels, lungs, hilar

Central area in which bronchi and blood vessels enter the lungs

Hilum (hilus)

The ______________ bone is seen in the anterior portion of the neck and is found just below the tongue or floor of the mouth.

Hyoid

Which type of body habitus is associated with a broad and deep thorax?

Hypersthenic

Which of the following types of body habitus may cause the costophrenic angles to be cut off if careful vertical collimation is not used?

Hyposthenic and asthenic

A patient with a possible small pneumothorax. Routine chest projections (PA 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

Which of the following bony landmarks is palpated for centering of the AP chest?

Jugular notch

Which posterior oblique projection would best demonstrate the left lung - RPO or LPO?

LPO

How should the 14 x 17" IR be aligned for a hypersthenic patient?

Landscape

Voice box

Larynx

For certain studies of the heart, the _____ anterior oblique requires a rotation of 60 degrees.

Left

Which specific position would be used if a patient were unable to stand but the physician suspected that the patient had fluid in the left lung?

Left lateral decubitus

Where is the CR placed for a lateral projection of the upper airway?

Level of C6-C7, midway between thyroid cartilage and jugular notch

What are the recommended patient instructions when performing an erect PA chest on a female with large pendulous breasts?

Lift the breasts up and outward and them remove her hands as she leans against the chest board (IR) to keep them in position

List the divisions of the structure located proximally to the larynx that serve as a common passageway for both food and air.

Nasopharynx Oropharynx Laryngopharynx

The outer layer of the pleura (membrane adhering to the inner surface of the chest wall and diaphragm) is the ______________.

Parietal pleura

The divisions of the respiratory system are:

Pharynx, Trachea, Bronchi, Lungs

Which of the following devices should be used for the erect PA and lateral chest projections for an infant?

Pigg-O-Stat

Why is a PA chest preferred to an AP projection?

Places the heart closer to the IR to reduce magnification of the heart

The delicate, double-walled sac or membrane that contains the lungs is called the ___________________.

Pleura

The potential space between the parietal pleura & visceral pleura is called the ___________________.

Pleural Cavity

What is the name of the condition characterized by fluid entering the pleural cavity?

Pleural effusion

Inflammation of pleura

Pleurisy

Accumulation of air in the pleural cavity

Pneumothorax

What is the name of the condition characterized by free air entering the pleural cavity?

Pneumothorax

How should the 14 x 17" be aligned for an asthenic patient?

Portrait

Explain why the right lung is smaller that the left lung and the right hemidiaphragm is positioned higher than the left hemidiaphragm.

Presence of liver on right

Why is it important to raise the patient's arms above the head for lateral chest projections?

Prevents upper arm soft tissues from being superimposed over upper chest fields

Condition most frequently associated with congestive heart failure

Pulmonary edema

The inner layer (of the pleura) adhering to the ______________, or ______________.

Pulmonary or visceral pleura

Which specific position would be used if the patient were unable to stand but the physician suspected that the patient had free air in the left pleural cavity?

Right lateral decubitus (affected side up)

What circumstances or clinical indications suggest that an AP lordotic projection should be ordered?

Rule out calcifications or masses beneath the clavicles

Shoulder

Scapula

The bony thorax consists of two

Scapulae

The shoulders need to be rolled forward for the PA projection to allow the _________ to move laterally and be clear of the lung fields.

Scapulae

Careful collimation during a chest radiograph will improve image quality by decreasing _________ radiation to the IR.

Scatter

Describe the way optimum density (brightness) of the lungs and mediastinal structures can be determined on a PA chest radiograph

Should be able to see faint outlines of at least middle and upper vertebrae and ribs through heart and other mediastinal structures.

A form of occupational lung disease

Silicosis

What is another term for the condition termed visceral inversion?

Situs inversus

List four possible pathologic conditions that suggest the need for both inspiration and expiration PA chest radiographs

Small pneumothorax Fixation or lack of normal diaphragm movement Presence of a foreign body Distinguishing between opacity in rib or lung

Breastbone

Sternum

The bony thorax consists of (anteriorly)

Sternum

Which of the following anatomic structures is examine to determine rotation on a PA chest radiograph?

Symmetric appearance and location of sternoclavicular joints

This prominence, or ridge (carina), is approximately at the level of the ________________ vertebra.

T5

The CR is placed at the level of the _____ vertebra for a PA chest projection.

T7

If a person accidentally inhales a food particle, which bronchus is it most likely to enter, and why?

The Right bronchus because It is larger in diameter and more vertical.

A radiograph of a PA projection of the chest shows only seven posterior ribs above the diaphragm. What caused this problem, and how could it be prevented on the repeat exposures?

The lungs are under-inflated. Explain the need for a deep inspiration, and take the exposure on the second deep inspiration.

A radiograph of a PA view of the chest shows that the SC joints are not the same distance from the spine. The right SC joint is closer to the midline than is the left SC joint. What is the positioning error?

The patient is rotated into a slight RAO position.

Adam's apple

Thyroid cartilage

List and explain briefly the three reasons chest radiographs should be taken with the patient in the erect position (when the patient's condition permits).

To allow diaphragm to move down farther To show possible air and fluid levels in the chest To prevent engorgement and hyperemia of the pulmonary vessels

True/False: Because they have shallower (superior-inferior dimension) lung fields, the CR is often centered higher for geriatric patients.

True

True/False: Chest radiography is the most commonly repeated radiographic procedure because of poor positioning or exposure factor selection errors.

True

True/False: Long hair may produce an artifact when imaging with digital radiographic systems.

True

True/False: Multi-detector CT can produce high-resolution images of the heart on one breath-hold.

True

True/False: Single-photon emission computed tomography (SPECT) is frequently used to diagnose myocardial infarction.

True

True/False: With most digital chest units, the question of IR placement into either the portrait or the landscape position is eliminated because of the larger IR.

True

A contagious disease caused by an airborne bacterium

Tuberculosis

The two important bony landmarks of the thorax that are used for locating the central ray on a posteroanterior and anteroposterior chest projection are the

Vertebra prominens (C7) And Jugular notch

A recommended CR centering technique for a PA chest projection requires the technologist to palpate the __________ and measure down from that bony landmark ______ inches for a male and ______ inches for a female patient.

Vertebra prominens; 8"; 7"

Change in manual exposure factors for advanced emphysema

decrease (-)

Change in manual exposure factors for a left lung atelectasis

increase (+)

Change in manual exposure factors for respiratory distress syndrome (RDS) or adult respiratory distress syndrome (ARDS), known as hyaline membrane disease (HMD) in infants

increase (+)

Change in manual exposure factors for severe pulmonary edema

increase (+)

Change in manual exposure factor for pneumothorax

none (0)

Change in manual exposure factors for advanced asbestosis

none (0)

Change in manual exposure factors for lung neoplasm

none (0)

Change in manual exposure factors for primary tuberculosis

none (0)

Change in manual exposure factors for pulmonary emboli

none (0)

To ensure better lung inspiration during chest radiography, exposure should be made during the _________ inspiration.

second

Change in manual exposure factors for reactivation (secondary) tuberculosis

slight increase (+)

A radiograph of a PA and a left lateral projection of the chest show the mediastinum of the chest is under-penetrated. The technologist used the following factors: 72" SID, upright Bucky, full-inspiration exposure, 75 kV, 600 mA, and a 1/60-second exposure time. Which of these factors is the most likely cause of the problem? How can the technologist improve the image when making the repeat exposure?

78 kV is too low; recommended kV range is 110-125 Increase the kV and reduce the mAs for the repeat exposure

Irreversible dilation of bronchioles

Bronchiectasis

Acute or chronic irritation of bronchi

Bronchitis

A radiograph of a lateral projection of the chest shows the posterior ribs and costophrenic angles are separated more than 1/2" indicating excessive rotation. Describe a possible method for determining the direction of rotation.

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

Shortness of breath

Dyspnea

Which of the following is not a form of occupational lung disease?

Emphysema

Accumulation of pus in pleural cavity

Empyema

An erect chest PA radiograph aids the patient to achieve full inspiration and helps to prevent _____ and _____ of the pulmonary vessels.

Engorgement; hyperemia

A patient comes to the radiology department for a pre-surgical chest examination. 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 examination?

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

A patient with severe pleural effusion 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 this patient?

Increase the kV slightly (+).

Which anterior oblique projection would best demonstrate the left lung - RAO or LAO?

RAO

Explain the primary purpose and benefit of performing chest radiography using a 72" SID.

Reduces distortion and magnification of the heart and other chest structures

A patient enters the ER with a possible hemothorax in the right lung 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 patient with hemothorax (fluid), the side of interest should be down.