Positioning and Related Anatomy Situations - Chapters 2&3

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?

Anterior posterior and lateral upper airway projections

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. Which additional projection(s) could the technologist perform to locate the foreign body?

Anterior posterior and lateral upper airway projections

A patient is erect with her back to the IR. The CR enters the anterior aspect and exits the posterior aspect of the body. which projection has been performed?

Anteroposterior

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 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 image 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 one of the following radiographic series should be performed?

Erect PA and lateral

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 patients?

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

A child goes to radiology for an abdomen study. It is possible that he swallowed a coin. The ER physicians believes it may be in the upper GI tract. Which of the following routines would best identify the location of the coin?

KUB and lateral abdomen. With any foreign body study, two projections 90 degrees opposite is recommended to pinpoint the location of the foreign body.

A radiograph of an AP abdomen reveals the left iliac wing is more narrowed than the right. What specific positioning error caused this?

Patient was rotated into a slight right posterior oblique (RPO) position. ( The downside ilium will appear wider).

A patient is lying down facing upward with the posterior surface of the body against the IR. The right side of the body is turned 45 degrees towards the IR. The x-ray tube is directed vertically and enters the anterior surface of the body. What position has been performed?

RPO Right Posterior Oblique

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?

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 sternoclavicular (SC) joints are not the same distance from the spine. The right sternoclavicular joint is closer to the midline than is the left SC joint. What is the positioning error?

Rotation. The patient is rotated into the slight right anterior oblique (RAO) position.

A radiographic image of an AP projection of the abdomen demonstrates motion. The following exposure factors were selected : 78 kV, 200 mA, 2/10 second, grid, and 40 in ( 102 cm) SID. The technologist is sure that the patient did not breathe or move during the exposure. What may have caused this blurriness? What can be done to correct this problem on the repeat exposure?

The blurriness may be caused by involuntary motion. To control this motion, the technologist needs to increase the miliamperage and decrease the exposure time ( e.g. 400 mA at 1/10 second).

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

60 degree LAO

The ER physician suspects a patient has a kidney stone. The patient is sent to the radiology department to confirm the diagnosis. What specific positioning routine would be used to rule out the presence of a kidney stone?

A KUB would be performed with the correct exposure factors to visualize the possible stone.

A patient in intensive care may have developed intra - abdominal bleeding. The patient is in critical condition and cannot go to the radiology department. The physician has ordered a portable study of the abdomen. Which specific position or projection can be used to determine the extent of the bleeding?

A bedside portable left lateral decubitus projection could be performed to demonstrate any fluid levels in the abdomen.

A radiograph of an AP lordotic projection reveals the clavicles are projected within the apices. The clinical instructor informs the student technologist that the study is unacceptable, but during the repeat exposure the patient complains complains of being too unsteady to lean backward for another projection. What other options are available if the student wants to complete the study?

AP semiaxial Projection

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 the left lung apex?

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

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?

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

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

A radiograph of a PA projection of the chest reveals the top of the apices are 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 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 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

A patient is placed in a recumbent position facing downward. The left side of the body is turned 30 degrees toward the IR. Which specific position has been performed?

LAO Left Anterior Oblique

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

LPO and RAO obliques

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 decubitis

A patients enters the ER with an injury to the chest. the ER physician suspects a pneumothorax may be 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 KUB radiograph reveals that the symphysis pubis was cut off along the bottom of the image. Is this an acceptable radiograph? If it is not, how can this problem be prevented during the repeat exposure?

No, A KUB must include the symphysis pubis on the radiograph to ensure that the bladder is seen. The positioning error involves centering of the central ray to the iliac crest. The technologist should also palpate the symphysis pubis ( if permitted by institutional policy) or greater trochanter to ensure that it is above the bottom of the cassette.

A hypersthenic patient comes to the radiology department for a KUB. The radiograph reveals that the symphysis pubis is included on the image, but the upper abdomen, including the kidney, is cut off. What is the next step the technologist should take?

Repeat the exposure using two 14 x 17 in cassette placed crosswise. The hypersthenic patient often requires this type of IR placement for abdomen studies

A KUB radiograph reveals that the gonadal shielding is superior to the upper margin of the symphysis pubis. The female patient has a history of kidney stone. What is the next step the technologist should take?

Repeat the exposure without using gonadal shielding. Because the patient may have renal calculi in the distal ureters and urinary bladder, gonadal shielding cannot be used.

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 and lateral projection of the chest reveals the mediastinum of the chest is underpenetrated. The technologist used the following factors for the radiograph : a 72 in ( 183 cm) SID, an upright Bucky, a full- inspiration exposure, 75 kV and 600 mA, and 1/60 second exposure time. a) Which one of these factors is the most likely cause of the problem?

The 75 kV is too low. The ideal kV range is 110 to 125 kV.

A patient with a history of ascites comes to the radiology department. Which one of the following positions best demonstrates this condition?

The erect AP abdomen position best demonstrates air fluid levels. Ascites produces free fluid in the intraperitoneal cavity

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 prevent 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.

A radiograph of an AP projection of an average-size adult abdomen was produced using the following exposure factors: 90 kV, 400 mA, 1/10 second, grid, and 40 inch ( 102 cm) SID using film/screen (analog) imaging system. The overall density of the radiograph was acceptable, but the soft tissue structures, such as the psoas muscles and kidneys, were not visible. Which adjustment to the technical considerations will enhance the visibility of these structure on the repeat exposure?

The selected kV ( 90kV) was too high. The technologist needs to lower the kV to between 70 to 80 kV. The milliamperage and exposure time can be altered to maintain the density.

A patient with a possible dynamic ileus enters the emergency room. The patient is able to stand. The physician has ordered an acute abdominal series. What specific positioning routine should be used?

The three-way acute abdominal series, including the anteroposterior (AP) supine and erect abdomen and posteroanterior (PA) erect chest projections

A patient with a possible perforated duodenal ulcer enters the emergency room. The ER physician is concerned about the presence of free air in the abdomen. The patient is in severe pain and cannot stand. What positioning routine should be used to diagnose this condition?

The two-way acute abdomen series: AP supine abdomen and left lateral decubitus

A patient is placed into a recumbent position facing downward. the x-ray tube is directed horizontally and enters the left side and exits the right side of the body. An image receptor is placed against the side of the patient. Which position has been performed?

Ventral decubitus

An ambulatory patient with a clinical history of advanced emphysema enters the emergency room. The patient is having difficulty breathing and is receiving oxygen. The physician has ordered PA and lateral chest study. Should the technologist alter the typical exposure factors for this patient?

Yes, increase the exposure factor

A patient comes from the ER with a large distended abdomen caused by an ileus. The physician suspects that the distention is caused by a large amount of bowel gas that is trapped in the small intestine. The standard analog technique for a KUB on an adult is 76 kV, and 30mAs. Should the technologist change any of these exposure factors for this patient?

Yes. Decrease the mAs. Because trapped air is easier to penetrated than soft tissue with x-rays, reducing the mAs will prevent overexposing the radiograph.