Chapter 2: Review D

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 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(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 a patient's right clavicle. The PA and lateral projection are inconclusive. What additional projection(s) could be taken to rule out this condition?

AP lordotic.

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; CR is angled 15 to 20 degrees cephalad to project the clavicles above the apices and to demonstrate clearly the possible tumor.

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?

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

A radiograph of a PA projection of the chest shows the top of the apices is cut off and a wide collimation border can be see below the diaphragm. In what way can this be corrected during the repeat radiograph?

Center the central ray higher to level 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 patient with a clinical history of advanced emphysema comes to the radiology department for a chest x-ray. Automatic exposure control will not be used. How should the technologist alter the manual exposure settings for this patient?

Decrease the kV moderately. (--)

A radiograph of a lateral projection of the chest shows the posterior ribs and costophrenic angles are separated more than one half of an inch, or 1 centimeter, 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.

A patient comes to the radiology department for a presurgical chest examination. The clinical history indicates a possible situs inversus of 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 severe pleural effusion comes to the radiology department for a chest x-ray. Automatic exposure control will not be used. How should the technologist alter the manual exposure settings for this patient?

Increase the kV slightly (+).

A patient has a possible small pneumothorax. Routine chest projection 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. The patient is unable to stand or sit erect. Which specific projection would best demonstrate this condition, and why?

Right lateral decubistus; 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 and a left lateral projection of the chest show the mediastinum of the chest is underpenetrated. The technologist used the following factors for the radiograph: a 72-inch SID, an upright Bucky, a full-inspiration exposure, 75-kV and 600 mA, and a 1/60-second exposure time. Which of these factors is the most likely cause of the problem? Briefly explain. How can the technologist improve the image when making repeat exposures?

The 78 kV is too low. The recommended kV range is 110 to 125. Increase the kV and reduce the mAs for the repeat exposure.

A radiograph of a PA projection of the chest shows only sever posterior ribs above the diaphragm. What caused this problem, and how could it be prevented on the repeat exposure?

The lungs are underinflated. Explain to the patient the need for a deep inspiration, and take the exposure on the second.