Bon. CHEST- part 2 positions
Optimal technical factor selection ensures proper penetration of the:
A. Heart B. Great vessels C. Lung regions D. Hilar region
where is the thyroid cartilage located
C5
Clinical indication described? One of the most common inherited diseases
Cystic fibrosis
3 reasons why you may be required to do an inspiration/expiration chest series?
small pneumothorax presence of a foreign body fixation or lack of normal movement of the diaphragm
the lower concave portion of the lung is termed
the base
why would you do a PA projection of the chest rather than an AP
the heart is closer to the IR it decreases magnification of the heart
how can you tell rotation on a PA chest xray
the space between the sternum and clavicles
a general rule states that radiographic grids are required with chest radiography for
to reduce scatter radiation
why would you roll you shoulders forward on a PA chest xray
to remove the scapula out of the lung fields
Structures in the mediastinum
trachea, esophagus, thymus gland, heart and great vessels
a contagious disease caused by airborne bacteria
tuberculosis
the 2 most common landmarks for chest positioning
vertebra prominens, laryngeal prominens
What is sinus inversus?
when the organs are flipped
Which of the following set of exposure factors is recommended for a chest examination of a young PEDIATRIC patient?
70 to 85 kV, short exposure time
what is the required SID for chest radiography
72 in.
what is the recommended kV for upper airway projections
75-85 kV
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
Which of the following chest projections/positions is recommended to detect calcifications or cavitations within the upper lung region beneath the clavicles?
AP lordotic
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 15-20 degrees cephalad
What is a common radiographic sign seen on a chest radiograph for a patient with respiratory distress syndrome (RDS)?
Air bronchogram
Situation: 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
Which posterior oblique projection would best demonstrate the left lung- RPO OR LPO
LPO
For certain studies of the heart, the _____ (right or left) anterior oblique requires a rotation of _____ degrees.
Left; 60 degrees
slight shadows in early stages, larger radiopaque masses in advanced stages
Malignant lung cancer
Which anterior oblique projection would best demonstrate the left lung - RAO or LAO?
RAO
Explain the primary purpose and benefit of performing chest radiography using a 72" SID.
Reduces distortion and magnification of the heart and other chest structures
A radiograph of a PA view of the chest shows that the 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?
The patient is rotated into a slight RAO position.
the 3 types of occupational lung disease
arthrocosis, silicosis, asbestos
one of the most common inherited lung diseases. it causes the production of abnormally thick mucus, leading to the blockage of the bronchi
cystic fibrosis
body landmark for an AP PA chest
jugular notch vertebral prominens
what is the correct anatomic name for the adams apple
laryngeal prominens
what is the name of the structure that serves as a common passageway for both food and air
pharynx
inflammation of pleura (possible air/fluid levels)
pleurisy
Condition most frequently associated with congestive heart failure. increased diffuse radiodensity in hilar regions and air-fluid levels
pneumonia
Patchy infiltrate with increased radiodensity
pneumonia
accumulation of air in the pleural cavity. the lung is displaced from chest wall and no lung makings visible on radiograph
pneumothorax
the thymus gland is at its maximum size at
puberty
For patients with the following clinical histories, which lateral position would you perform - right or left? Patient with no chest pain but the recent history of pneumonia in the right lung
right
The CR is placed at the level of the _____ vertebra for a PA chest projection.
scapula, T7
Clinical indication described? Shortness of breath
Dyspnea
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: In general for an average patient, more collimation should be visible on the lower margin of the chest image than on the top for a 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 (1/2-3/4")
Which type of body habitus is associated with a broad and deep thorax?
Hypersthenic
Which of the following types of body habitus may cause the costophrenic angles to be cut off if careful vertical collimation is not used?
Hyposthenic and asthenic
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
how many posterior ribs should be seen above diaphragm
10
Which of the following objects should be removed (or moved) before chest radiography?
A. Necklace B. Bra C. Religious medallion around neck F. Hair fasteners G. Oxygen lines
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 inspiration?
10 ribs
Chest radiography for the adult patient usually uses a kilovoltage range of ______ to ______ kV.
110 to 125 kV
what is the recommended kV for chest projections
110-125 kV
what type of CR angle is required for the AP semi axial (alternative lordotic) position for the lung apices
15 to 20 degrees cephalic
The traditional CR centering technique for the chest is to place the top or the IR ______ inches above the shoulders
2 in. to (1.5 cm)
where is the CR placed for a PA projection of the chest on a female a male
6 in. below the vertebra prominens 8 in. below the vertebra prominens
Why should a left lateral be performed unless departmental protocol indicates otherwise?
A left lateral better demonstrates the heart region
A radiograph of a PA and a left lateral projection of the chest show the mediastinum of the chest is under-penetrated. The technologist used the following factors: 72" SID, upright Bucky, full-inspiration exposure, 75 kV, 600 mA, and a 1/60-second exposure time. A. Which of these factors is the most likely cause of the problem? Briefly explain. B. How can the technologist improve the image when making the repeat exposure?
A. 78 kV is too low; recommended kV range is 110-125 B. Increase the kV and reduce the mAs for the repeat exposure
To prevent the clavicles from obscuring the apices on an AP projection of the chest, the central ray should be angled (A) _________ so that it is perpendicular to the (B) ___________.
A. Caudad (+/- 5 degrees) B. Sternum
A. Should the 14 x 17" IR be aligned in portrait or landscape orientation for a PA chest projection of a hypersthenic patient? B. For an asthenic patient?
A. Landscape B. Portrait
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 movement C. Presence of a foreign body D. Distinguishing between opacity in rib or lung
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 the diaphragm to move down farther B. To show possible air and fluid levels in the chest C. To prevent engorgement and hyperemia of the pulmonary vessels
Situation: 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
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 OF 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 tumor.
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 projections will best elongate the left lung? (More than one oblique projection will accomplish this goal.)
Both the LPO (AP oblique)and RAO positions will best demonstrate or elongate the left lung.
Situation: 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 patient?
C. Increase the kV slightly (+).
The upper margin of the lungs is at the level of the:
C7-T1
where is the vertebral prominens located
C7-T1
severe cases appear as emphysema
COPD
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 (T7); make sure the IR is centered to the CR and the top collimation light border is at the vertebra prominens.
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 kV moderately (--).
Which of the following is not a form of occupational lung disease?
Emphysema
An erect chest PA radiograph aids the patient to achieve full inspiration and helps to prevent _____ and _____ of the pulmonary vessels.
Engorgement; hyperemia
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.
True/False: Echocardiography and electrocardiography (EKG) 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: 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: A grid is not recommended for a LPO projection of the adult chest.
False (a grid is recommended)
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 an obese patient 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: Because the heart is always located in the left thorax, the use of anatomic side markers on a PA chest projection may not be necessary.
False (heart may be located in right thorax)
Situation: A patient with a possible small pneumothorax. (AIR UP) 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
Which of the following bony landmarks is palpated for centering of the AP chest projection?
Jugular notch
For patients with the following clinical histories, which lateral position would you perform - right or left? Patient with severe pains in the left side of the chest
Left
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? (fluid down)
Left lateral decubitus
Where is the CR placed for a lateral projection of the upper airway?
Level of C6-C7, midway between thyroid cartilage and jugular notch
What are the recommended patient instructions when performing an erect PA chest on a female with large pendulous breasts?
Lift the breasts up and outward and them remove her hands as she leans against the chest board (IR) to keep them in position
Which of the following devices 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 IR to reduce magnification of the heart
What is the name of the condition characterized by fluid entering the pleural cavity?
Pleural effusion
What is the name of the condition characterized by free air entering the pleural cavity?
Pneumothorax
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
Clinical indication described? Condition most frequently associated with congestive heart failure
Pulmonary edema
Which specific position would be used if the patient were UNABLE TO STAND but the physician suspected that the patient had FREE AIR in the left pleural cavity? (air up)
Right lateral decubitus (affected side up)
Situation: 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.
What circumstances or clinical indications suggest that an AP lordotic projection should be ordered?
Rule out calcifications or masses beneath the clavicles
Careful collimation during a chest radiograph will improve image quality by decreasing _________ radiation to the IR.
Scatter
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 and upper vertebrae and ribs through heart and other mediastinal structures.
A form of occupational lung disease
Silicosis
What is another term for the condition termed visceral inversion?
Situs inversus
Which of the following anatomic structures is examined to determine rotation on a PA chest radiograph?
Symmetric appearance and location of sternoclavicular joints
where is the jugular notch located
T2-T3
Where is the carina located
T4-T5
where is the heart located
T5-T8
where is the lower scapular angle located
T7
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 the need for a deep inspiration, and take the exposure on the second deep inspiration.
True/False: Because they have shallower (superior-inferior dimension) lung fields, the CR is often centered higher for geriatric patients.
True
True/False: Chest radiography is the most commonly repeated radiographic procedure because of poor positioning or exposure factor selection errors.
True
True/False: Long hair may produce an artifact when imaging with digital radiographic systems.
True
True/False: Multi-detector CT can produce high-resolution images of the heart on one breath-hold.
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 recommended CR centering technique for a PA chest projection requires the technologist to palpate the __________ and measure down from that bony landmark ______ inches for a male and ______ inches for a female patient.
Vertebra prominens; 8"; 7"
collapse of all or part of lung
atelectasis
irreversible dilation of the bronchi
bronchiectasis
acute or chronic irritation of the bronchi
bronchitis
the ridge where the trachea that bifurcates into the right and left bronchus
carina
which is the most inferior epiglottis hyoid bone carina vocal chords
carina
what is the CR for an AP semi supine projection of the chest
caudad - or + 5 degrees
name 2 ways to demonstrate possible air or fluid levels in the chest
decubitus, upright (trying to find something in either lung)
increased lung dimensions (barrel -chested)
emphysema
accumulation of pus in the pleural cavity
empyema
what is the name for the structure that acts as a lid over the larynx
epiglottis
which is more posterior, trachea or esophagus
esophagus
coughing up blood
hemoptysis
For patients with the following clinical histories, which lateral position would you perform - right or left? Patient with no chest pain or history of heart trouble
left
Situation: 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?
make a note on the chart, Ensure placement of the correct R or L anatomic side marker on the IR, because the heart and other thoracic structures may be transposed from right to left.
What AEC is used for a PA chest Lateral chest
outer cell center cell
what are the 3 layers of the pleura
parietal, visceral, plural cavity
To ensure better lung inspiration during chest radiography, exposure should be made during the _________ inspiration.
second full
how can you tell rotation can be seen on a lateral chest xray
sepiration of the spine and ribs
