Ch.2 Workbook Review
Irreversible dilation of bronchioles
Bronchiectasis
Most common form is emphysema
Chronic obstructive pulmonary disease (COPD)
One of the most common inherited diseases
Cystic fibrosis
Which one of the following is not a form of occupational lung disease?
Emphysema
The heart is enclosed in a double-walled membrane called the
Pericardial sac or pericardium
Inflammation of pleura
Pleurisy
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
The height, or vertical dimension, of the average-to-large person's chest is greater than the width, or horizontal dimension. (T/F)
True
The trachea is located________________________(anteriorly or posteriorly) to the espophagus
Anteriorly
Collapse of all or portion of lung
Atelectasis
Dyspnea
Shortness of breath
The traditional central ray centering technique for the chest is to place the top of the image receptor (IR) _____inches (____ cm) above the shoulders.
1 1/2 inches to 2 inches (5 cm)
The three parts of the aorta are the
1. Ascending 2. Arch 3. Descending
Which one of the following sets of exposure factors is recommended for a chest examination of a young pediatric patient?
70 to 85 kV, short exposure time
For patients with the following clinical histories, which lateral projections would you perform--right or left? A. Patient with severe pains in left side of chest B. Patient with no chest pain but recent history or pneumonia in right lung C. Patient with no chest pain or history of heart trouble
A. Left B. Right C. Left
A. Which anterior oblique projection would best demonstrate the left lung--right anterior oblique (RAO) or left anterior oblique (LAO)? B. Which posterior oblique projection would best demonstrate the left lung--RPO or LPO?
A. RAO B. LPO
Fill in the correct terms for the following portions of the lungs: A. Lower, concave portion B. Central area in which bronchi and blood vessels enter the lungs C. Upper, rounded portion above the level of the clavicles D. Extreme, outermost lower corner of the lungs
A.Base B. Hilum C. Apex D. Costophrenic angle
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 one of the following chest projections/positions is recommended to detect calcifications or cavitations within the upper lung region near 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 to 20 degrees cephalad.
What is a common radiographic sign seen on a chest radiograph for a patient with respiratory distress syndrome (RDS)?
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
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
Which one of the following bony landmarks is palpated for centering of the AP chest projection?
Jugular notch
For certain studies of the heart, the ______________________(right or left) anterior oblique requires rotation of _____________________°.
Left, 60
The outer layer of this membrane adhering to the inner surface of the chest wall and diaphragm is the
Parietal pleura
Explain the primary purpose and benefits of performing chest radiography using a 72-inch (183-cm) source image receptor distance (SID)
Reduces distortion and magnification of the heart and other structures
What circumstances or clinical indications suggest that an AP lordotic projection should be ordered?
Rule out calcifications or masses beneath the clavicles
A form of occupational lung disease
Silicosis
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 underinflated. Explain to the patient the need for a deep inspiration, and take the exposure on the second deep inspiration.
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
Because they have a shallower (superior-inferior dimension) lung fields, the central ray is often centered higher for geriatric patients. (T/F)
True
Chest radiography is the most commonly repeated radiographic procedure because of poor positioning or exposure factor selection errors. (T/F)
True
In general, for an average patient more collimation should be visible on the lower margin of the chest image than on top for a PA or lateral chest projection. (T/F)
True
With most digital chest units, the question of IR placement into either vertical or crosswise positions is eliminated because of the larger IR. (T/F)
True
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 patient comes to the radiology department for a presurgical 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 right or left anatomic side marker on the imaging receptor, because the heart and other thoracic structures may be transposed from right to left.
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 causes abdominal organs to drop, allowing the diaphragm to move farther down and the lungs to more fully aerate
Which positioning tip will help you 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
Echocardiography and electrocradiography are basically the same procedure. (T/F)
False
For most patients, the central ray level for a PA chest projection is near the inferior angle of the scapula. (T/F)
False
Generally, you do not need to use radiographic grids for adult patients for PA lateral chest radiographs. (T/F)
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 (T/F)
False (situs inversus may be present)
How much separation of the posterior ribs on a lateral chest projection indicates excessive rotation from a true lateral position? (Note: less separation than this is caused by the divergent x-rays)
Greater than 1 cm (1/2 to 3/4 inch)
The _____________________ bone is seen is the anterior portion of the neck and is found just below the tongue or floor of the mouth.
Hyoid
What type of body habitus is associated with a broad and deep thorax?
Hypersthenic
Accumulation of air in the pleural cavity
Pneumothorax
List three divisions of the structure located proximally to the larynx that serve as a common passageway for both food and air
1. Nasopharynx 2. Oropharynx 3. Laryngopharynx
The four divisions of the respiratory system are
1. Pharynx 2. Trachea 3. Bronchi 4.Lungs
List four possible pathologic conditions that suggest the need for both inspiration and expiration PA chest radiographs
1. Small pneumothorax 2. Fixation or lack of normal diaphragm movement 3. Presence of foreign body 4. Distinguishing between opacity in rib or lung
List four important structures located in the mediastinum
1. Thymus gland 2. Heart and great vessels 3. Trachea' 4.Esophagus
List three reasons chest radiographs should be taken with the patient in the erect position
1. To allow diaphragm to move down further 2. To show possible air and fluid levels in the chest 3. To prevent engorgement and hyperemia of the pulmonary vessels
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 employs a kilovoltage peak of________________ to _______________ kV
110 to 125
Why should a left lateral be performed unless departmental protocol indicates otherwise?
A left lateral better demonstrated 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)____________________(caudad or cephalad) so that it is perpendicular to the (B)_____________________.
A. Caudad B. Sternum
A. Should the 14- x 17-inch (35- x 43-cm) image receptor be aligned lengthwise or crosswise for a PA chest projection? B. For a hyposthenic patient?
A. Crosswise B. Lengthwise
The bony thorax consists of (A) the single ________________ anteriorly, (B) two ______________________, (C) two_________________, (D) twelve pairs of ___________________, and (E) twelve _____________ posteriorly.
A. Sternum B. Clavicles C. Scapulae D. RIbs E. Thoracic vertebrae
A radiograph of a PA and left lateral projection of the chest reveals the mediastinum of the chest is underpenetrated. The technologist used the following factors for the radiograph: a 72-inch (183-cm) SID, an upright Bucky, a full-inspiration exposure, 75-kV and 600 mA, and a 1/60 second exposure time. A.Which one of these factors is the most likely cause of the problem? B.How can the technologist improve the image when making the repeat exposure?
A. The 75 kV is too low. The ideal kv range is 110 to 125. B. Increase the kV and reduce the mAs
Identify correct anatomic terms for the following structures: A. Adam's apple B. Voice box C. Breastbone D. Shoulder blade E. Collar bone
A. Thyroid cartilage B. Larynx C. Sternum D. Scapula E. Clavicle
The two important bony landmarks of the thorax that are used for locating the central ray on a posteroanterior (PA) and anteroposterior (AP) chest projections are the (A)____________________ and (B) _______________________________ respectively.
A. Vertebra prominens B. Jugular notch
A young child enters the emergency room 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 be taken to locate the foreign body?
AP and lateral upper airway projections
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 clearly demonstrate the neoplasm and eliminate the superimposition of the clavicle and left lung apex?
AP semiaxial projection; CR is angled 15 to 20 degrees cephalad to project the clavicles above the apices and clearly demonstrate the possible tumor.
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 oblique positions will best demonstrate or elongate the left lung.
Acute or chronic irritation of bronchi
Bronchitis
A radiograph of a PA projection of the chest reveals the top of the apices are cutoff and a wide collimation border can be seen below the diaphragm. In what way can this be corrected during the repeat exposure?
Center the central ray higher (to the level of T7, which will be found 7 to 8 inches below the vertebra prominens). Make sure the image receptor is centered to the central ray and the top collimation light border is at the vertebra prominens.
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 (--)
A radiograph of a lateral projection of the chest reveals the posterior ribs and costophrenic angles are separated more than 1/2 inch, or 1 cm, indicating excessive rotation. Describe a possible method of 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.
Accumulation of pus in the 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
No lead shielding is necessary for male patients or women greater than age 65 during radiographic imaging of the chest. (T/F)
False
Single-photon emission computed tomography (SPECT) is frequently used to diagnose myocardial infarction. (T/F)
False
Ultrasound is not an effective modality to detect pleural effusion. (T/F)
False
A grid is not recommended for a LPO projection of the adult chest. (T/F)
False ( a grid is recommended)
Optimal technical factor selection ensures proper penetration of the
Heart, Great vessels, Lung regions, Hilar region
Which one of the following types of body habitus may cause costophrenic angles to be cut off if careful vertical collimation is not used?
Hyposthenic and asthenic
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 settings for this patient?
Increase the kV slightly (+)
A patient has a possible small pneumothorax. Routine chest projections (PA and lateral) fail to reveal 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 specific position would be used if a patient were unable to stand but the physician suspected the had fluid in the left lung?
Left lateral decubitus
Where is the central ray placed for a lateral projection of the upper airway?
Level of C6-C7, midway between the thyroid cartilage and jugular notch.
What are the recommended patient instructions when performing an erect PA chest on a female patient with large pendulous breasts?
Lift the breasts up and outward and then remove her hands she leans against the chest board (image receptor) to keep them in position.
Which of the following objects should be removed (or moved) before chest radiography?
Necklace, Bra, Religious medallion around neck, hair fasteners, oxygen lines
Which one 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 image receptor to reduce magnification of the heart.
The delicate, double-walled sac or membrane containing the lungs is called the
Pleura
What is the name of the condition characterized by fluid entering the pleural cavity?
Pleural effusion
What is the name of the condition characterized by free air entering the pleural cavity?
Pneumothorax
Explain why the right lung is smaller than the left lung and the right hemidiaphragm is positioned higher than the left hemidiaphragm
Presence of liver on the right
Why is it important to raise the patient's arms above the head for lateral chest projections?
Prevents upper arm soft tissue from being superimposed over upper chest fields
Condition most frequently associated with congestive heart failure
Pulmonary edema
The inner layer adhering to the surface of the lungs is the
Pulmonary or visceral pleura
Which specific position would be used if the patient were unable to stand but the physician suspected the patient had free air in the left pleural cavity?
Right lateral decubitus (affected side up)
A patient enters the emergency room with a possible hemothorax in the right lung caused by a motor vehicle accident (MVA). 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.
A radiograph of a PA view of the chest reveals the sternclavicular (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?
Rotation. The patient is rotated into a slight RAO position.
Careful collimation during a chest radiograph will improve image quality by decreasing__________________ radiation to the IR.
Scatter
To ensure better lung inspiration during chest radiography, exposure should be made during the _____________________inspiration.
Second
Describe the way optimum density 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
Which one of the following anatomic structures is examined to determine rotation on a PA chest radiograph?
Symmetric appearance of sternoclavicular joints
The CR is placed at the level of the ________ vertebra for a PA chest projection.
T7
A contagious disease caused by an airborne bacterium
Tuberculosis
A recommended central ray centering for a PA chest projection requires the technologist to palpate the ________________________ and measure down from that bony landmark______ inches (_____ cm) for a male and ______ inches (_____ cm) for a female patient.
Vertebra prominens, 8 inches (20 cm) for male, 7 inches (18 cm) for female