Chapter 2 Chest Problem Solving

10. Situation : 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 projections could the technologist perform to locate the foreign body ?

AP and lateral upper airway projections

11. Situation : A routine chest series indicates a possible mass beneath the 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

14. Situation : A patient with a possible neoplasm of the right lung apex comes to 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 superimposition of the clavicle and the left left lung apex?

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

5. Situation : A patient with a clinical history of advanced emphysema comes into the radiology department for a chest x-ray. How should the technologist alter the manual exposure settings for this for a patient ? AEC will not be used. A. Do not alter them. Use the standard exposure factors . B. Decrease the KVp moderately ( - ) . C. Increase the kVp slightly ( + ) . D. Increase the kVp moderately ( ++ ) .

B. Decrease the KVp moderately ( - ) .

13. Situation: A patient with a history of pleurisy comes to the radiology department . Which of the following radiographic series should be performed? A. Soft tissue lateral of the upper airway B. Right and left lateral decubitus C. Erect PA and lateral D. CT scan of the chest

C. Erect PA and lateral

3. 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-inch (180-cm) SID, an upright Bucky, a full-inspiration exposure, 75-kVp and 800-mA, and a short exposure time . A. Which of these factors is the most likely cause of the problem ? Briefly explain . B. How can the technologist improve the image when making the repeat exposure ?

a. 78 kVp is too low. the recommended range is in between 110-125 kVp b. increase the kVp and reduce the mAs for the repeat exposure

15. Situation : 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 thorax. Which specific oblique projections will best elongate the left thorax? (More than one oblique projection will accomplish this goal.)

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

4. 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 ?

center the central ray higher (to the level of T7, 7-8 inches below vertebra prominens). make sure the IR is centered to the CR and the top collimation light border is at the vertebra prominens

8. A radiograph of a lateral projection of the chest shows the posterior ribs and costophrenic angles are separated more than 1 " 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

7. Situation : 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 marker on the image receptor, because the heart and other thoracic structures may be transposed from right to left

12. Situation : A patient has 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 lateral decubitus AP chest with affected side up

9. Situation : 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

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

rotation - the patient is rotated into a slight RAO position

2. A radiograph of a PA projection of the chest demonstrates 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