RTE 1503C Rad Positioning & Anatomy (Bontragers) ch 2
In chest radiography uses contrast, described as contrast with more shades of gray.
- low - long-scale
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 because they need the affected side up
What is the purpose of the respiratory system?
to exchange gaseous substance between air and blood
Where should the CR be on a PA (posterioanterior) chest projection?
vertebra prominens ( 7th cervical vertebrae )
What is the landmark for a PA chest?
vertebra prominens (C7)
The central ray (CR) for an AP supine adult chest projection is centered
3-4 inches (8-10 cm) below the jugular notch
What is the average of hyposthenic people?
35%
What is the average of hypersthenic people?
5%
Which anterior oblique would best demonstrate the left lung?
Right anterior oblique
What circumstances or clinical indications suggest that an AP lordotic projection should be ordered?
to rule out calcification or masses beneath the clavicles
A patient has a possible small phneumothorax. Routine chest projections ( PA and lateral ) fail to show the phneumothorax conclusively. What additional projection(s) could be taken to rule out this condition?
Inspiration and expiration PA projections
pneumothorax
air or gas present in pleural cavity
Which body habitus is associated with a broad and deep thorax?
hypersthenic
Which body habitus may cause the costophrenic angles to be cut off if careful vertical collimation is not used?
hyposthenic and asthenic
What is the average of asthenic people?
10%
Which posterior oblique projection would best demonstrate the left lung?
Left posterior oblique
The trachea is located ____________to the esophagus.
anteriorly
Where is the landmark for a Lateral Upper Airway?
C6-7
A patient enters the ED with a possible hemothorax in the right lung. With help the patient can sit erect on a cart. What position should be used?
Erect PA & erect right lateral on cart
A patient enters the ED with a possible pneomothorax in the left lung. Because of trauma the patient cannot stand or sit erect. What position should be used?
Right Lateral Decube
Where is the landmark for an AP Upper Airway?
T1-2
__________ has the highest number of repeats in many radiology departments.
chest x-rays
Why do you extend the neck for a chest x-ray?
ensures that the chin and neck and not superimpose the upper most lung region
All chest radiographs should be taken in an position if the patient's condition allows.
erect
A patient with a history of pleurisy comes to the radiology department. What radiographic series should be performed?
erect PA and lateral
Where should the CR be on an AP (anteriorposterior) chest projection?
jugular notch
What is the average of sthenic people?
50%
How many lobes does the lungs have and what are they?
( root region ) central area of each lung where the bronchi, blood vessels, lymph vessels, and nerves enter and leave lungs
A radiograph of a PA and 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 a 600-mA, and a 1/60-second exposure time. Which of these factors is the most likely cause of the problem? How can the technologist improve the image when making a repeat exposure?
- 75kV is too low, for a chest the kV needs to be set at 110-125 - You need to increase your kV and decrease your mA
Why is an erect chest x-ray the best?
-allows diphragm to move farther down -demonstrates air-fluid levels -prevents engorgement of pulmonary vessels -will breath deeper & get more ribs
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?
-move the CR higher - center the IR to the CR and the top collimation light border is at the vertebra prominens
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 and the ?
-vertebra prominens - jugular notch
When looking at a chest image what do you need to see?
10 ribs apeces costaphrenic angles heart
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 a 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 the 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, because you're trying to see the apices so you need to bring the tube down and angle up
A patient with a clinical history of advanced emphysema comes to the radiology department for a CXR. AEC will not be used. How should the technologist alter the manual exposure settings for this patient?
Decrease your kV moderately
A patient with severe pleural effusion comes to the radiology department for the CXR. AEC will not be used. How should the technologist alter the manual exposure settings for this patient?
Increase your kV slightly
A patient in ICU after abdominal surgery. Surgeon is concered about possible perforated bowel, patient cannot sit or stand. Which position will best demonstrate any possible intra-abdominal free air
Left lateral decube
A patient is in the ICU with multiple injuries. The attending physician is concerned about a pleural effusion in the left lung. The patient had surgery recently & cannot stand. Which position/projection would be best to rule out the pleural effusion
Left lateral decube
PA and lateral projections demonstrate a suspicious region in the left lung. The radiologist orders and oblique projection that will demonstrate or "elongate" the left lung. Which specific oblique projections will best elongate the left ling?
Left posterior oblique (LPO), right anterior oblique (RAO)
An ambulatory pt comes to radiology with a clinical history or possible pneumonia. The patient complains of pain in the center of her chest. What positioning routine should be preformed on the this patient
PA & lateral projections
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, the side that has the fluid should be down to level off to see where the fluid is
The carina, or ridge, is approximately at the _______ level of the vertebrae.
T5
Where is the landmark for a Left Lateral Chest?
T7
Where is the landmark for AP Supine or Semierect?
T7 perpendicular sternum
For an AP portable chest on a an older or hypersthenic male patient, which of the following should occur
The CR should be centered 3 in (8 cm) below the jugular notch
Chest radiographs must be taken on to show the lungs as they appear fully expanded.
full inspiration
A patient enters the ER to be treated for severe trauma. The Dr orders an AP supine chest to evaluate the lungs. What can the tech do to reduce the magnification of the heart?
increase the SID as much as possible
A _______ lateral is best for chest x-ray because?
left more accurately demonstrates the heart region without much magnification
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?
lungs are underinflated. exposure needs to be taken on the 2nd breath
What is the general rule for average adult patients to " show " a on a good PA chest radiograph?
minimum of 10
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 in a slight RAO position