Bontrager ch.2
The bony thorax consists of the single ___________ anteriorly, two ___________, two ____________, twelve pairs of ____________, and 12 _________________ posteriorly.
1) sternum 2) clavicles 3) scapulae 4) ribs 5) thoracic vertebrae
what are the correct anatomic terms for the following: 1) adam's apple 2) voice box 3) breastbone 4) shoulder 5) collarbone
1) thyroid cartilage 2) larynx 3) sternum 4) scapula 5) clavicle
The two important bony landmarks of the thorax that are used for locating the CR on a PA and AP chest projection are the ______________________ and the _____________________, respectively
1) vertebra prominens (spinous process on the 7th cervical vertebra 2) jugular notch (upper portion of the sternum)
The 4 divisions of the respiratory system are:
1. Pharynx 2. Trachea 3. Bronchi 4. Lungs
The traditional central ray centering technique for the chest is to place the top of the image receptor (IR) _____ inches (_____ cm) above the shoulders.
1.5-2, 5
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 aspiration?
10 ribs (Ten)
Chest radiography for the adult patient usually uses a kilovoltage range of ___ to ___ kVp.
110, 125
Which set of exposure factors is recommended for a chest examination of a young pediatric patient?
70 to 85 kVp, short exposure time
Why should a left lateral be performed unless departmental protocol indicates otherwise?
A left lateral better demonstrates the heart region
Identify the following structures
A) Apex of left lung B) Trachea C) Carina D) Heart E) Left costophrenic angle F) Right costophrenic angle (Base) G) Hilum H) Apex of lungs I) Hium J) Heart K) Right & left hemidiaphragm L) Right & left costophrenic angles (Superimposed)
List the three divisions of the structure located proximally to the larynx that serve as a common passageway for both food and air.
A) Nasopharynx B) Oropharynx C) Laryngopharynx
List four possible pathologic conditions that suggest the need for both inspiration and expiration PA chest radiographs.
A) Small pneumothorax B) Fixation or lack of normal diaphragm C) Presence of foreign body D) Distinguishing b/t opacity in a rib or lung
If a person accidentally inhales a food particle, which bronchus is it most likely to enter and why?
A) The right bronchus B) It is larger in diameter and more vertical
List the four important structures located in the mediastinum.
A) Thymus gland B) Heart and Great vessels C) Trachea D) Esophagus
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).
A) To allow diaphragm to move lower B) To show possible air & fluid levels in the chest C) To prevent engorgement & hyperemia of the pulmonary vessels
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 projection(s) could the technologist perform to locate the foreign body?
AP in the lateral airway.
Situation: 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. If the patient cannot stand, AP semiaxial projection.
Situation: 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
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 sign
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
Terms for portions of the lungs Upper, rounded portion above the level of the clavicles
Apex (apices)
Collapse of all or portion of lung
Atelectasis
Terms for portions of the lungs Lower, concave portion
Base
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" or 2.5 cm, indicating excessive rotation. Describe the possible method for determining the direction of rotation.
By identifying the left hemidiaphragm by the gastric air bubble in the stomach or by the inferior border of the heart shadow.
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
To prevent the clavicles from obscuring the apices on an AP projection of the chest, the central ray should be angled _________ so that it is perpendicular to the ___________
Caudad, sternum
Most common form is emphysema
Chronic Obstructive Pulmonary Disease (COPD)
Terms for portions of the lungs Extreme, outermost lower corner of the lungs
Costophrenic angle
One of the most common inherited diseases
Cystic fibrosis
Situation: 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 (--).
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?
Do a normal Chest. Ensure proper placement of the correct right or left anatomic side marker on the the IR because the heart and other thoracic structures may be transposed from left to right.
Acumulation 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
What is the name of the structure acts as a lid over the larynx to prevent foreign objects such as food particles from entering the respiratory system?
Epiglottis
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: A grid is not recommended for a LPO projection of the adult chest.
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: Multislice CT (MSCT) can produce high-resolution images of the heart on one breath hold
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: 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 patients 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: In general for an average patient, more collimation should be visible on the lower margin of the chest image than on the top for 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- to 3/4-inches) Note: Less separation than this is caused by divergent x-rays
Optimal technical factor selection ensures proper penetration of the:
Heart Great vessels Lung regions Hilar region
Terms for portions of the lungs 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 type of body habitus may cause the costophrenic angles to be cut off if careful vertical collimation is not used?
Hyposthenic & asthenic
Identify the following structures A) Thymus B) Arch of aorta C) Heart D) Inferior vena cava E) Superior vena cava F) Thyroid G) Trachea H) Esophagus
Identify the following structures A) Thymus B) Arch of aorta C) Heart D) Inferior vena cava E) Superior vena cava F) Thyroid G) Trachea H) Esophagus
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, and upright Bucky, a full-inspiration exposure, a 75-kVp and 800-mA, and a short exposure time. How can the technologist improve the image when making the repeat exposure?
Increase the kVp and reduce the mAs for the repeat exposure.
Situation: 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
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 lung. Which specific oblique positions will best elongate the left lung? (More than one oblique position will accomplish this goal.)
LPO, RAO
Should the 14- x 17-inch (35- x 43-cm) image receptor be aligned in portrait or landscape orientation for a PA chest projection of a hypersthenic patient?
Landscape
Which lateral projection would you perform (left or right) for a patient with no chest pain or history of heart trouble?
Left
Which lateral projection would you perform (left or right) for a patient with severe pains in the left side of chest?
Left
Which posterior oblique projection would best elongate the left thorax: Right Posterior Oblique (RPO) Left Posterior Oblique (LPO)
Left Posterior Oblique (LPO)
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
For certain studies of the heart, the _____ (right of left) anterior oblique requires a rotation of _____ degrees
Left, 60
Where is the central ray placed fir a lateral projection of the upper airway?
Level of C6-C7, midway between thyroid cartilage & 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 & outward and then remove her hands as she leans against the chest board (IR) to keep in the position
Which objects should be removed (or moved) before chest radiography?
Necklace Bra Religious medallion around neck Hair fasteners Oxygen lines
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?
PA with expiration
The outer later of this membrane adhering to the inner surface of the chest wall and diaphragm is the _____ _____.
Parietal pleura
The heart is enclosed in a double-walled membrane called the
Pericardium
Which device 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 that contains the lungs is called the _____.
Pleura
The potential space between the parietal pleura and 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 the pleura
Pleurisy
Accumulation of air in the pleural cavity
Pneumothorax
Air or gas that enters the pleural cavity results in a condition called _____.
Pneumothorax
What is the name of the condition characterized by free air entering the pleural cavity?
Pneumothorax
Should the 14- x 17-inch (35- x 43-cm) image receptor be aligned in portrait or landscape orientation for a PA chest projection of a asthenic patient?
Portrait
Explain why the right lung is smaller than the left lung and the right hemidiaphragm is positioned higher than the left hemidiaphragm
Presence of the 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 tissues from being superimposed over upper chest fields
Condition most frequently associated with congestive heart failure
Pulmonary edema
The inner later adhering to the surface of the lungs is the _____, or _____ _____.
Pulmonary, visceral pleura
Explain the primary purpose and benefit of performing chest radiography using a 72-inch (180-cm) source image receptor distance (SID).
Reduces distortion & magnification of the heart & other chest structures.
Which lateral projection would you perform (left or right) for a patient with no chest pain but recent history of pneumonia in right lung?
Right
Which anterior oblique projection would best elongate the left thorax: Right Anterior Oblique (RAO) Left Anterior Oblique (LAO)
Right Anterior Oblique (RAO)
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 be best to demonstrate this condition, and why?
Right lateral decub because of the fluid level
Which specific position would be used if a 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)
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 is the left SC joint. What is the positioning error?
Rotation- The patient is rotated into a slight RAO position
What circumstances or clinical indications suggest that 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 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
Dyspnea
Shortness of breath
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 & upper vertebrae & ribs through heart and other mediastinal structures.
A form of occupational lung disease
Silicosis
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 decubitus C) Erect PA and lateral D) CT scan of the chest
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 decubitus C) Erect PA and lateral D) CT scan of the chest
What is another term for the condition termed visceral inversion?
Situs inversus
Which anatomic structures are examined 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.
T4-5
The CR is placed at the level of _____ vertebra for a PA chest projection.
T7
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, and upright Bucky, a full-inspiration exposure, a 75-kVp and 800-mA, and a short exposure time. Which of these factors is the most likely cause of the problem?
The 75-kVp is too low. The recommended range is 110- to 125-kVp.
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 deep inspiration, and take the exposure on the 2nd deep inspiration
True/False: Because they have shallower (superior-inferior dimension) lung fields, the central ray is often centered higher for geriatric patients.
True
True/False: Long hair may produce an artifact when imaging with digital radiographic systems.
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 airborne bacterium
Tuberculosis
True/False: Chest radiography is the most commonly repeated radiographic procedure because of poor positioning or exposure factor selection errors.
Ture
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, 20 7, 18
Which of the following chest projections/positions is recommended to detect calcifications or cavitation within the upper lung region beneath the clavicles? A) Left lateral decubitus B) PA C) RPO and LPO D) AP lordotic
Which of the following chest projections/positions is recommended to detect calcifications or cavitation within the upper lung region beneath the clavicles? A) Left lateral decubitus B) PA C) RPO and LPO D) AP lordotic
Which of the following is not a form of occupational lung disease? A) Anthracosis B) Emphysema C) Silicosis D) Asbestosis
Which of the following is not a form of occupational lung disease? A) Anthracosis B) Emphysema C) Silicosis D) Asbestosis
The trachea is located _____ to the esophagus
anteriorly
The three parts of the aorta are the
ascending aorta, aortic arch, descending aorta
