RAD 114 CHEST (Problem Solving for Technical and Positioning Errors)
A young child enters the ER 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 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
A patient with a possible neoplasm in the right lung apex comes to the radiology department for a chest exam. The PA and lateral projections do not clearly demonstrate the neoplasm because or 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 15-20 degrees cephalad to project the clavicles above the apices and to demonstrate clearly the possible tumors
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 seen below the diaphragm. In what way can this be corrected during the repeat radiograph?
Center the CR higher (to the level of T7, which will be found 7-8 inches below the vertebra prominens). Make sure the IR is centered to the CR 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. 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. Which positioning step or action must be taken to perform a successful chest exam?
Ensure placement of the correct right/left anatomical side marker on the IR, 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 of the radiographic series should be performed? Soft tissue lateral of the upper airway Right and left lateral decubitus Erect PA and lateral CT scan of the chest
Erect PA and lateral
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
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?
LPO RAO
A patient enters the ER 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 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 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, and 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?
The kV is too low; it should be 100-125 kV range
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 prevented on the repeat exposures?
The lungs are under-inflated. Explain to the patient the need for a deep inspiration, and take the exposure on the second deep inspiration.
A radiograph of a lateral projection of the chest shows the posterior ribs and costophrenic angles are separated more than 0.5", or 1 cm, 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 indentified by visualization of the gastric air bubble or the inferior heart shadow, both of which are associated with the left hemidiaphragm.
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, and upright Bucky, a full-inspiration exposure, 75 kV and 600 mA, and a 1/60 second exposure time. How can the technologist improve the image when repeating the exposure?
Increase the kV Decrease the mAs
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 (+)