Ch2, Review Exercise D

14) 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 clearly demonstrate the neoplasm and eliminate the superimposition of the clavicle and the left lung apex?

AP semiaxial projection ; CR is angle 15 to 20 degrees cephalad to project the clavicles above the apices and clearly demonstrate the possible tumor.

10) 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?

Anterior posterior and lateral upper airway projections

11) 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?

Anterior posterior lordotic

5) 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? A) Do not alter them. Use the standards exposure factors. B) Decrease the kV moderately ( - -). C) Increase the kV slightly (+) D) Increase the kV moderately ( + +)

B) Decrease the kV moderately ( - -)

15) 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 and RAO oblique position will best demonstrate or elongate the left lung.

13) Situation: A patient with a history of pleurisy comes to the radiology department. Which one of the following radiographic series should be performed? A) Soft tissue lateral of the upper airway B) Right and left lateral decubitus C) Erect PA and lateral D) CT scan of the chest

C) Erect PA and lateral

4) A radiograph of a PA projection of the chest reveals the top of the apices are 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 central ray higher ( to the level of 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.

8) A radiograph of a lateral projection of the chest reveals the posterior ribs and costophrenic angles are separated more than 1/ 2 inch, or 1 cm, indicating excessive rotation. Describe a possible method of 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

7) 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?

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.

3 b) How can the technologist improve the image when making the repeat exposure?

Increase the kV and reduce the mAs for the repeat exposure.

6) 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 patients?

Increase the kV slightly (+)

12) Situation: A patient has a possible small pneumothorax. Routine chest projections (PA and lateral) fail to reveal 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

9) 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 best demonstrate this condition, and why?

Right lateral decubitus ; in a patient with hemothorax ( fluid), the side of interest should be down.

1) A radiograph of a PA view of the chest reveals the sternoclavicular (SC) joints are not the same distance from the spine. The right sternoclavicular joint is closer to the midline than is the left SC joint. What is the positioning error?

Rotation. The patient is rotated into the slight right anterior oblique (RAO) position.

3) A radiograph of a PA and lateral projection of the chest reveals the mediastinum of the chest is underpenetrated. The technologist used the following factors for the radiograph : a 72 in ( 183 cm) SID, an upright Bucky, a full- inspiration exposure, 75 kV and 600 mA, and 1/60 second exposure time. a) Which one of these factors is the most likely cause of the problem? Briefly explain.

The 75 kV is too low. The ideal kV range is 110 to 125 kV.

2) 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 prevent on the repeat exposures?

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