Chest Reviews

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *RDS*?

+

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *advanced RDS*?

+

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *large pleural effusion*?

+

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *left lung atelectasis*?

+

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *severe cystic fibrosis*?

+

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *severe pulmonary edema*?

+

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *reactivation tuberculosis*?

+ (slight increase)

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *advanced emphysema*?

-

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *aspiration in upper airway (mechanical obstruction)*?

-

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *epiglottitis*?

-

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *severe emphysema*?

-

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *advanced asbestosis*?

0

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *advanced bronchiectasis*?

0

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *bronchitis*?

0

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *large pneumothorax*?

0

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *lung neoplasm*?

0

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *malignant lung neoplasia*?

0

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *mild COPD*?

0

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *pleurisy*?

0

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *pneumonia*?

0

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *pneumothorax*?

0

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *primary tuberculosis*?

0

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *pulmonary emboli*?

0

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *severe silicosis*?

0

Would exposure factors increase (+), decrease (-), or generally remain the same (0) for *tuberculosis (primary or secondary)*?

0

A correctly positioned lateral chest radiograph demonstrates some separation of the posterior ribs owing to the divergent x-ray beam. But a separation of greater than _____ cm indicated objectionable rotation from a true lateral.

1

The traditional (but inaccurate) central ray centering technique for the chest is to place the top of the image receptor _____ inches (_____ cm) above the shoulders

1.5-2 inches (5 cm)

A well-inspired healthy adult chest PA projection will have a minimum of ____ posterior ribs seen above the diaphragm.

10

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

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

110-125 kVp

What type of CR angle is required for the AP semiaxial projection of the apices of the lungs?

15° to 20° cephalad

The central ray for an anteroposterior supine, adult chest projection, should be centered:

3 to 4 inches (8 to 10 cm) below the jugular notch

To prevent the clavicles from obscuring the apices on an AP projection of the chest, the central ray should be angled _____° (caudad or cephalad) so that it is perpendicular to the _______________

5° caudad; sternum

A PA and lateral chest study shows a suspicious mass located near the heart in the right lung. The radiologist would like a radiograph of the patient in an anterior oblique position to delineate the mass from the heart. Which position or projection should the technologist use to accomplish this objection?

60° LAO

Which chest oblique position will best demonstrate the air-filled trachea, heart, and great vessels?

60° LAO

What kilovoltage and exposure time (long/short) should be used for a chest examination of a young pediatric patient?

70-85 kVp, short exposure time

A. Should the 14 x 17" IR be aligned in portrait or landscape orientation for a PA chest projection of a hypersthenic patient? B. For an asthenic patient?

A. landscape (crosswise) B. portrait (lengthwise)

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. the low kVp is likely the problem (not enough penetrating power) B. increase the kVp to the recommended 110-125 range; reduce mAs

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 the technologist perform to locate the foreign body?

AP and lateral upper airway projections

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

What chest projection/position is recommended to detect calcifications or cavitation 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 lordotic; CR angled 15° to 20° 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; CR angled 15° to 20° cephalad

What level is the vertebra prominens at?

C7

Most common form is emphysema

COPD

Persistent obstruction of the airways; causes difficulty emptying lungs of air

COPD

Which posterior oblique projection would best elongate the left thorax?

LPO

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?

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

What device should be used for the erect PA and lateral chest projections for an infant?

Pigg-O-Stat

Which anterior oblique projection would best elongate the left thorax?

RAO

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?

RAO and LPO

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 the heart and other mediastinal structures

What vertebral level is the jugular notch at?

T2-T3

At what level is the carina?

T4-T5

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

T7

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

air bronchogram sign

Small air sacs located at the distal ends of the bronchioles

alveoli

The structures within the lung in which oxygen and carbon dioxide gas exchange occurs are called:

alveoli

Is the trachea anterior or posterior to the esophagus?

anterior

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

apex

The three parts of the aorta

ascending, arch, descending

A narrow thorax that is shallow from the front to back but very long in the vertical dimension is characteristic of a(n) ________________ body habitus. Hypersthenic Sthenic Hyposthenic Asthenic

asthenic

A condition in which all or a portion of the lung is collapsed is:

atelectasis

Collapse of all or portion of lung

atelectasis

Lower, concave portion of the lungs

base

Manual analog exposure factors for a patient with a large pneumothorax should:

be reduced

Irreversible dilation of broncioles

bronchiectasis

Acute or chornic irritation of bronchi

bronchitis

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

carina

Which of the following structures is considered to be most inferior? Epiglottis Hyoid bone Carina Vocal cords

carina

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 CR and IR to T7; collimate to the vertebra prominens

Extreme, outermost lower corner of the lung

costophrenic angle

A condition in which secretions of heavy mucus cause progressive "clogging" of bronchi and bronchioles

cystic fibrosis

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 kVp moderately (--)

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 is more posterior or more anterior; the left hemidiaphragm can frequently be visualized by the gastric air bubble or the inferior heart shadow

Shortness of breath

dyspnea

Chronic lung disease in which air spaces in the alveoli become greatly enlarged; increased lung dimensions (barrel-chested)

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

"Lid" over the larynx

epiglottis

Which of the following structures is NOT considered as a mediastinal structure? Thymus gland Aorta Trachea Epiglottis

epiglottis

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

erect PA and lateral

What are the three reasons that chest projections should be taken in the erect position when possible?

erect position allows the diaphragm to move further down, exposing more ribs; potential air-fluid levels can be visualized; engorgement and hyperemia of the pulmonary blood vessels is prevented

Which of the following structures is considered to be most posterior? Larynx Esophagus Trachea Hyoid bone

esophagus

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

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

false

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

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 older than the age 65 during radiographic imaging of the chest

false

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

false

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

false

True/False: CR centering for the PA chest projection on an obese patient is 1 to 2 inches (2.5 to 5 cm) lower than for a sthenic patient

false (no change in centering)

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; equal collimation

Which of the following objects does NOT have to be removed or moved before a chest radiograph? Necklace Bra T-shirt Glasses

glasses

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

greater than 1 cm (0.25-0.5inch)

Central area in which bronchi and blood vessels enter the lung

hilum

Which dimension (vertical or horizontal) is greater in an average-to-large person's chest?

horizontal

What 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 body habitus may cause the 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 kVp slightly (+)

Which bony landmark is palpated for centering of the AP chest projection?

jugular notch

The most common landmarks for chest positioning are the:

jugular notch and vertebra prominens

Which lateral projection (left or right) would you perform for a patient with no chest pain or history of heart trouble?

left lateral

Which lateral projection (left or right) would you perform on a patient with severe pains in the left side of the chest?

left lateral

A patient enters the ER with a chest injury. The ER physician suspects a pneumothorax present in the right lung. The patient is unable to stand or sit erect. Which specific position or projection can be performed to confirm the presence of the pneumothorax?

left lateral decubitus

A patient with a history of pulmonary edema comes to the radiology department and is unable to stand. The physician suspects fluid in the left lung. Which specific projection should be used to confirm this diagnosis?

left lateral decubitus

What 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

For certain studies of the heart, the _________ (right or left) anterior oblique requires a rotation of _____ degrees

left; 60°

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

level of C6-C7; midway between the thyroid cartilage and the jugular notch

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

lift breasts upward and outward and place them against the chest board (IR) to hold them in place (remove hands)

New growth or tumor; benign or malignant

lung neoplasm

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?

lungs were underinflated because patient was not instructed to hold second inspiration during exposure; instruct patient to inhale, exhale, inhale again, and hold this inhalation during exposure

Three divisions of the pharynx

nasopharynx, oropharynx, laryngopharynx

Outer layer of the pleura which adheres to the inner surface of the chest wall and diaphragm

parietal pleura

The heart is enclosed in a double-walled sac called the

pericardium

Structure located proximally to the larynx

pharynx

What are the four divisions of the respiratory system?

pharynx, trachea, bronchi, lungs

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

place anatomic side marker on the correct side to avoid confusion

Why is a PA chest preferred to an AP projection?

places heart closer to IR to reduce magnification of the heart

Delicate, double-walled sac or membrane that contains the lungs

pleura

Potential space between the visceral and parietal pleurae

pleural cavity

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

pleural effusion

Inflammation of pleura

pleurisy

Inflammation of pleura (possible air/fluid levels)

pleurisy

Inflammation of the lungs that results in accumulation of fluid within certain sections of the lung

pneumonia

Accumulation of air in pleural cavity

pneumothorax

Air or gas that enters the pleural cavity results in this condition

pneumothorax

Partial or complete collapse of the lung, displaced from chest wall and no lung markings visible on radiograph

pneumothorax

Why is the right lung shorter and right hemidiaphragm positioned higher than the left?

presence of the liver on the right

A condition in which excess fluid builds in the lungs as a result of obstruction of the pulmonary circulation is termed:

pulmonary edema

Condition most frequently associated with congestive heart failure

pulmonary edema

Excess fluid within the lungs

pulmonary edema

A sudden blockage of an artery in the lung is called:

pulmonary emboli

Explain the primary purpose and benefit of performing chest radiography using a 72-inch (180-cm) source image receptor distance (SID)

reduces magnification and distortion of the heart and other structures

The trachea bifurcates and forms the

right and left bronchi

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

right bronchus due to it being wider and more vertical

Which lateral projection (left or right) would you perform for a patient with no chest pain but recent history of pneumonia in the right lung?

right lateral

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; fluid levels are best demonstrated with the affected side down when pleural effusion is present

A radiograph of a PA view of the chest shows that the sternoclavicular 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 into slight RAO position

A PA chest radiograph reveals that the left sternoclavicular joint is closer to the spine than the right joint. What specific positioning error has been committed?

rotation into the left anterior oblique (LAO) position

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

rule out calcifications or masses beneath the clavicles

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 quality be decreasing ________________ radiation to the IR

scatter

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

second

Dyspnea

shortness of breath

Occupational lung disease types

silicosis, anthracosis, asbestosis

visceral inversion

situs inversus

Which one of the following clinical indications often requires the inspiration/expiration chest series to be taken? Chronic asthma Small pneumothorax Pneumoconiosis Primary tuberculosis

small pneumothorax

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

Which structure is examined to determine rotation on a PA chest radiograph?

sternoclavicular joints

The bony thorax consists of:

sternum, 2 clavicles, 2 scapulae, 12 pairs of ribs, 12 thoracic vertebrae

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

the abdominal organs drop in the erect position, allowing the diaphragm to move further down and the lungs to aerate fully

Adam's apple

thyroid cartilage

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

to better demonstrate the heart region

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

to prevent superimposition of the arms

Why are the shoulders pressed downward and toward the IR for a PA projection of the chest?

to reduce chest rotation

Why are the shoulders rolled forward for a PA projection of the chest?

to remove scapulae from lung fields

What four important structures are located within the mediastinum?

trachea, esophagus, thymus gland, heart (and great vessels)

True/False: Because they have shallower (superior-inferior dimension) lung fields, the central ray 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: Multislice CT (MSCT) 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: The left bronchus is smaller in diameter than the right but is approximately twice as long.

true

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

true

A contagious disease caused by airborne bacteria

tuberculosis

A contagious disease caused by an airborne bacterium

tuberculosis

The correct term for the seventh cervical vertebrae is:

vertebra prominens

The upper margin of the lungs is at the level of the:

vertebra prominens

A recommended central ray centering technique 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 a male; 7 inches (17.5 cm) for a female

The two important bony landmarks of the thorax

vertebrae prominence and jugular notch

Inner layer of the pleura which adheres to the surface of the lungs

visceral/pulmonary pleura

A PA and lateral chest radiographic study has been completed. The PA projection shows the right costophrenic was collimated off, but both angles are included on the lateral projection. Would you repeat the PA projection?

yes; costophrenic angles must be included on both projections