chest wb review
The traditional central ray centering technique for the chest is to place the top of the image receptor (IR) _____ inches (_____ cm) above the shoulders.
1&1/2 to 2 inches (5 cm)
Match each of the following descriptions of clinical indicators to its correct term. 1. One of the most common inherited diseases 2. Condition most frequently associated with congestive heart failure 3. Dyspnea 4. Accumulation of air in pleural cavity 5. Accumulation of pus in pleural cavity 6. A form of occupational lung disease 7. A contagious disease caused by an airborne bacterium 8. Irreversible dilation of bronchioles 9. Most common form is emphysema 10. Acute or chronic irritation of bronchi 11. Collapse of all or portion of lung 12. Inflammation of pleura A. Atelectasis B. Bronchiectasis C. Bronchitis D. Chronic obstructive pulmonary disease E. Shortness of breath F. Cystic fibrosis G. Empyema H. Pleurisy I. Pneumothorax J. Pulmonary edema K. Tuberculosis L. Silicosis
1. F 2. J 3. E 4. I 5. G 6. L 7. K 8. B 9. D 10. C 11. A 12. H
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
Identify the following labeled structures as seen on PA and lateral chest radiographs in Figs. 2.2 and 2.3. A. ______________ B. ______________ C. ______________ D. ______________ E. ______________ F. ______________ G. ______________ H. ______________ I. ______________ J. ______________ K. ______________ L. ______________
A. Apex of left lung B. Trachea C. Carina D. Heart E. Left costophrenic angle F. Right hemidiaphragm (or base) G. Hilum H. Apex of lungs I. Hilum J. Heart K. Right and left hemidiaphragm L. Right and left costophrenic angles (superimposed)
A. Should the 35- × 43-cm (14- × 17-inch) image receptor 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
For patients with the following clinical histories, which lateral projection would you perform—right or left? A. Patient with severe pains in left side of chest __________________________ B. Patient with no chest pain but recent history of pneumonia in right lung __________________________ C. Patient with no chest pain or history of heart trouble __________________________
A. Left B. Right C. Left
List the three divisions of the structure located proximally to the larynx that serve as a common passageway for both food and air. A. ______________ B. ______________ C. ______________
A. Nasopharynx B. Oropharynx C. Laryngopharynx
A. The delicate, double-walled sac or membrane that contains the lungs is called the __________________________. B. The outer layer of this membrane adhering to the inner surface of the chest wall and diaphragm is the __________________________. C. The inner layer adhering to the surface of the lungs is the __________________________, or __________________________. D. The potential space between these two layers (identified in B and C) is called the __________________________. E. Air or gas that enters the space identified in D results in a condition called __________________________.
A. Pleura B. Parietal pleura C. Pulmonary or visceral pleura D. Pleural cavity E. Pneumothorax
A. Which anterior oblique projection would best demonstrate the left lung—right anterior oblique(RAO) or left anterior oblique (LAO)? ______________________________________________________ B. Which posterior oblique projection would best demonstrate the left lung—RPO or LPO? ______________________________________________________
A. RAO B. LPO
If a person accidentally inhales a food particle, which bronchus is it most likely to enter, and why? A. The __________________________ bronchus B. Why? __________________________
A. Right B. It is larger in diameter and more vertical.
The bony thorax consists of (A) the single __________________________ anteriorly, (B) two __________________________, (C) two __________________________, (D) twelve pairs of __________________________, and (E) twelve __________________________ posteriorly.
A. Sternum B. Clavicles C. Scapulae D. Ribs E. Thoracic vertebrae
Identify the correct anatomic terms for the following structures. A. Adam's apple ______________ B. Voice box ______________ C. Breastbone ______________ D. Shoulder ______________ E. Collarbone ______________
A. Thyroid cartilage B. Larynx C. Sternum D. Scapula E. Clavicle
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? ______________________________________________________________________
AP and lateral upper airway projections
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
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 to 20 degrees cephalad
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 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.
What is the term for the small air sacs located at the distal ends of the bronchioles, in which oxygen and carbon dioxide are exchanged in the blood? __________________________
Alveoli
The trachea is located __________________________ (anteriorly or posteriorly) to the esophagus.
Anteriorly
The three parts of the aorta are the __________________________, __________________________, and __________________________.
Ascending, arch, and descending aorta
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 standard exposure factors. B. Decrease the kV moderately (−−). C. Increase the kV slightly (+). D. Increase the kV moderately (++).
B. Decrease the kV moderately (− −).
Which of the following is not a form of occupational lung disease? A. Anthracosis B. Emphysema C. Silicosis D. Asbestosis
B. Emphysema
Situation: A patient with a history of pleurisy comes to the radiology department. Which 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
Which of the following chest projections/positions is recommended to detect calcifications or cavitations within the upper lung region beneath the clavicles? A. Left lateral decubitus B. PA C. RPO and LPO D. AP lordotic
D. AP lordotic
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.
What is the name of the structure that acts as a lid over the larynx to prevent foreign objects such as food particles from entering the respiratory system? __________________________
Epiglottis
True/False: Echocardiography and electrocardiography are basically the same procedure.
False
True/False. CR centering for the PA chest projection on an obese patient is 1 to 2 inches (2.5 to 5 cm) lower than for a sthenic patient.
False (Centering for obese patient is at the same location—T-7)
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)
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? ____________________ (Note: Less separation than this is caused by the divergent x-rays.)
Greater than 1 cm (1/2 to 3/4 inch)
The __________________________ bone is seen in the anterior portion of the neck and is found just below the tongue or floor of the mouth.
Hyoid
Which type of body habitus is associated with a broad and deep thorax? __________________________
Hypersthenic
Situation: A patient has a possible small pneumothorax.Routine chest projections (PA and lateral) fail to show the pneumothorax conclusively. Which additional projections could betaken to rule out this condition? ______________________________________________________________________
Inspiration and expiration PA projections and/or a lateral decubitus AP chest with affected side up
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? ____________________
Left lateral decubitus
For certain studies of the heart, the __________________________ (right or left) anterior oblique requires a rotation of __________________________°.
Left, 60 degrees
Where is the central ray 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 patient with large pendulous breasts? ____________________________________________________________
Lift the breasts up and outward and then remove her hands as she leans against the chest board (image receptor) to keep them in the position.
The heart is enclosed in a double-walled membrane called the __________________________.
Pericardial sac or pericardium
Why is a PA chest preferred to an AP projection? ____________________
Places the heart closer to the image receptor 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
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? ____________________
Right lateral decubitus (affected side up)
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.
What circumstances or clinical indications suggest that an AP lordotic projection should be ordered? ______________________________________________________________________
Rule out calcifications or masses beneath the clavicles
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
Careful collimation during a chest radiograph will improve image quality by decreasing __________________________ radiation to the IR.
Scatter
To ensure better lung inspiration during chest radiography, exposure should be made during the __________________________ inspiration.
Second
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
What is another term for the condition termed visceral inversion? __________________________.
Situs inversus
The CR is placed at the level of the ____________________ vertebra for a PA chest projection.
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 underinflated. Explain to the patient 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 central ray 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 central ray centering technique for a PA chest projection requires the technologist to palpate the __________________________ and measure down from that bony landmark _____ inches (_____ cm) for a male and _____ inches (_____ cm) for a female patient.
Vertebra prominens, 8 inches (20 cm) for male, 7 inches (18 cm) for female
Situation: 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? A. Do not alter them. Use the standard exposure factors. B. Decrease the kV moderately (−−). C. Increase the kV slightly (+). D. Increase the kV moderately (++).
C. Increase the kV slightly (+).
Which of the following devices should be used for the erect PA and lateral chest projections for an infant? A. Upright chest device B. Supine table Bucky C. Pigg-O-Stat D. Plexiglas restraint board
C. Pigg-O-Stat
Which of the following anatomic structures is examined to determine rotation on a PA chest radiograph? A. Appearance of ribs B. Shape of heart C. Symmetric appearance and location of sternoclavicular joints D. Symmetric appearance and location of costophrenic angles
C. Symmetric appearance and location of sternoclavicular joints
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 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.
38. What is a common radiographic sign seen on a chest radiograph for a patient with respiratory distress syndrome (RDS)? A. Enlargement of heart B. Fluid in apices C. Sail sign D. Air bronchogram
D. Air bronchogram sign
Which of the following types of body habitus may cause the costophrenic angles to be cut off if careful vertical collimation is not used? A. Hypersthenic B. Hyposthenic C. Sthenic D. Hyposthenic and asthenic
D. Hyposthenic and asthenic
A radiograph of a lateral projection of the chest shows the posterior ribs and costophrenic angles are separated more than 1/2 inch, 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 identified by visualization of the gastric air bubble or the inferior heart shadow, both of which are associated with the left hemidiaphragm.
Optimal technical factor selection ensures proper penetration of the: A. Heart B. Great vessels C. Lung regions D. Hilar region E. All of the above
E. All of the above
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.
Which positioning tip will help prevent the patient's chin andneck from being superimposed over the upper airway and apices ofthe lungs for a PA chest radiograph? ______________________________________________________________________ ______________________________________________________________________
Extend the neck upward
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 older 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 an LPO projection of the adult chest.
False (A grid is recommended.)
Explain why the right lung is smaller than the left lung and the right hemidiaphragm is positioned higher than the left hemidiaphragm. __________________________
Presence of liver on right
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
Explain the primary purpose and benefit of performing chest radiography using a 72-inch (183-cm) source image receptor distance (SID). ____________________________________________________________
Reduces distortion and magnification of the heart and other chest structures
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.
Why should a left lateral be performed unless departmental protocol indicates otherwise? ________________________________________
A left lateral better demonstrates the heart region
Which of the following sets of exposure factors is recommended for a chest examination of a young pediatric patient? A. 70 to 85 kV, short exposure time B. 90 to 100 kV, medium exposure time C. 100 to 120 kV, short exposure time D. 120 to 150 kV, long exposure time
A. 70 to 85 kV, short exposure time
Fill in the correct terms for the following portions of the lungs. A. Lower, concave portion: __________________________ B. Central area in which bronchi and blood vessels enter the lungs: __________________________ C. Upper, rounded portion above the level of the clavicles: __________________________ D. Extreme, outermost lower corner of the lungs: __________________________
A. Base B. Hilum (hilus) C. Apex (apices) D. Costophrenic angle
A. What is the name of the prominence, or ridge, seen when looking down into the bronchus where it divides into the right and left bronchi? __________________________ B. This prominence, or ridge, is approximately at the level of the __________________________ vertebra.
A. Carina B. T5
To prevent the clavicles from obscuring the apices on an AP projection of the chest, the central ray should be angled (A) ____________________ (caudad or cephalad) so that it is perpendicular to the (B) ____________________.
A. Caudad (±5 degrees) B. Sternum
Identify the labeled parts on this computed tomography (CT) image (Fig. 2.4) of a transverse section of the thorax at the level of T5, the fifth thoracic vertebra, which is also the level of the carina. (Hint: B, G, and H are major blood vessels.) A. ______________ B. ______________ C. ______________ D. ______________ E. ______________ F. ______________ G. ______________ H. ______________ I. ______________
A. Left mainstem bronchus B. Descending aorta C. T5 (fifth thoracic vertebra) D. Esophagus E. Region of carina F. Right main stem bronchus G. Superior vena cava H. Ascending aorta I. Sternum
Which of the following objects should be removed (or moved) before chest radiography? (Choose all that apply.) A. Necklace B. Bra C. Religious medallion around neck D. Dentures E. Pants F. Hair fasteners G. Oxygen lines
A. Necklace B. Bra C. Religious medallion around neck F. Hair fasteners G. Oxygen lines
The four divisions of the respiratory system are: A. ______________ B. ______________ C. ______________ D. ______________
A. Pharynx B. Trachea C. Bronchi D. Lungs
List four possible pathologic conditions that suggest the need for both inspiration and expiration PA chest radiographs. A. ______________ B. ______________ C. ______________ D. ______________
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
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 (183-cm) SID, an upright Bucky, a full-inspiration exposure, 75-kV and 600-mA, and a 1/60-second exposure time. A. Which of these factors is the most likely cause of 136 the problem? Briefly explain. __________________________ B. How can the technologist improve the image when making the repeat exposure? __________________________
A. The 78 kV is too low. The recommended kV range is 110 to 125. B. Increase the kV and reduce the mAs for the repeat exposure.
Identify the following structures in Fig. 2.1
A. Thymus gland B. Arch of aorta C. Heart D. Inferior vena cava E. Superior vena cava F. Thyroid gland G. Trachea H. Esophagus
List the four important structures located in the mediastinum. A. ______________ B. ______________ C. ______________ D. ______________
A. Thymus gland B. Heart and great vessels C. Trachea D. Esophagus
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). 128 A. ______________ B. ______________ C. ______________
A. To allow 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
The two important bony landmarks of the thorax that are used for locating the central ray on a posteroanterior (PA) and anteroposterior (AP) chest projection are the (A) __________________________ and the (B) __________________________, respectively.
A. Vertebra prominens [spinous process on seventh cervical (C7) vertebrae] B. Jugular notch (upper portion of sternum)
For the following types of pathologic conditions, indicate whether manual exposure factors would be increased (+), decreased (−), or generally remain the same (0) compared with standard chest exposure factors. _____ Left lung atelectasis _____ Lung neoplasm _____ Severe pulmonary edema _____ Respiratory distress syndrome (RDS) or adult respiratory distress syndrome (ARDS), known as hyaline membrane disease (HMD) in infants _____ Reactivation (secondary) tuberculosis _____ Advanced emphysema _____ Large pneumothorax _____ Pulmonary emboli _____ Primary tuberculosis _____ Advanced asbestosis
Atelectasis + Lung neoplasm 0 Pulmonary edema + (severe) RDS or ARDS (HMD in infants) + Reactivation (secondary) tuberculosis (slight increase) + Advanced emphysema − Large pneumothorax 0 Pulmonary emboli 0 Childhood tuberculosis 0 Asbestosis 0
Which of the following bony landmarks is palpated for centering of the AP chest projection? A. Vertebra prominens B. Jugular notch C. Thyroid cartilage D. Sternal angle
B. Jugular notch
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 positions will best demonstrate or elongate the left lung.