Chest Radiography Problem Solving
A radiograph of a PA and a PA left lateral projection of the chest demonstrates the mediastinum of the chest is under-penetrated. The technologist use 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 time exposure time. A. Which of these factors is most likely to be the cause of the problem? B. How can the technologist improve the image when making a repeat exposure?
A. kVp is too low B. Increase kVp; 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, Hey 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
A routine chest series indicates a possible mass beneath the patient's right clavicle. The PA and lateral projections are inconclusive. What additional projections could be taken to rule out this condition?
AP lordotic
A patient with a possible neoplasm is 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 a super imposition 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 an to eliminate the super imposition of the clavicle and the left lung Apex?
AP semiaxial projection; CR 15-20 degrees cephalad to project clavicles
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 projection well best elongate the left thorax?
Both LPO and RAO oblique positions will best demonstrate or elongate lung
A radiograph of a PA Projection of the chest demonstrates the top of the opposite is cut off in a white collImation border can be seen below the diaphragm. How can this be corrected during the repeat radiograph?
Center central ray higher
A patient with a clinical history of advanced emphysema comes to the radiology department for a chest x-ray. 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 inch or 2.5 cm, indicating excessive rotation. Describe a possible method for determining the direction of rotation.
Determine which hemidiaphragm is more posterior
A patient comes to the radiology department for a pre-surgical 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 correct placement anatomic markers
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
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 (+)
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 a lateral decubitus AP chest with 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 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.
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 under-inflated; Patient needs deep inspiration; take exposure on second deep inspiration.