Merrill's Workbook Ch 10

list two reasons why exposures can be made after both inspiration and expiration:

- demonstrate pneumothorax - check for a foreign body

(PA Oblique Projections) with reference to the patient where should the upper border of the IR be placed?

1 1/2 to 2 inches above the vertebral prominens

(AP Oblique Projections) how far above the top of the shoulders should the upper border of the IR be placed?

1 1/2 to 2 inches above the vertebral prominens or about 5 inches above the jugular notch

how many posterior ribs should be demonstrated above the diaphragm with proper full inspiration?

10

Lateral Projection: size of collimated field:

14x17

PA Projection: size of collimated field:

14x17

(AP Oblique Projections) to what level of the patient should the central ray be directed?

3 inches below the jugular notch

when performing the PA oblique projection, LAO position, to demonstrate lungs, how many degrees should the patient be rotated?

45 degrees

when performing the PA oblique projection, RAO position, how many degrees should the patient be rotated?

45 degrees

when performing the PA oblique projection, LAO position, to demonstrate the heart and great vessels, how many degrees should the patient be rotated?

55 to 60 degrees

(AP Oblique Projections) what is the minimum recommended SID?

72 inches

(AP Projection) what is the recommended SID?

72 inches or 60 inches depending on equipment limitations

which AP oblique image (RPO position or LPO position) demonstrates the maximum area of the left lung?

LPO position

Lateral Projection: anatomic landmarks and relation to IR:

MCP perpendicular (T) MSP parallel (=)

PA Projection: anatomic landmarks and relation to IR:

MSP perpendicular (T) MCP parallel (=)

Lateral Projection: CR orientation and entrance point:

Perpendicular (T) enters MCP at level T7 inferior scapular angle

T/F a lateral projection image of the chest should be viewed so that the side of the patient where the central ray entered is nearer the viewer.

T

T/F the heart and mediastinal structures should be clearly demonstrated within the lung field of the elevated side in oblique images of 45 degrees of body rotation

T

T/F the patient's heart will appear larger in the right lateral projection image than in the left lateral projection image.

T

T/F when viewing PA oblique chest images (LAO position) the left lung should be partially superimposed by the spine

T

T/F when viewing the PA oblique chest images, the patient's left side should be toward the viewer's right side

T

(PA Oblique Projections) to what level of the patient should the central ray be directed?

T7

Lateral Projection: which thoracic structures are of primary interest with the left lateral projection? a) heart and left lung b) heart and right lung c) trachea and diaphragm d) trachea and esophagus

a

what area of the trachea divides into two lesser tubes? a) carina b) larynx c) pharynx

a

what mediastinal structure consists of C-shaped cartilaginous rings? a) trachea b) diaphragm c) esophagus

a

what thoracic structures are the organs of respiration? a) lungs b) bronchi c) bronchiole

a

which AP oblique projection produces an image very similar to that produced by the PA oblique projection, ROA position? a) AP oblique projection, LPO position b) AP oblique projection, RPO position

a

which bony structure forms the anterior border of the mediastinum? a) sternum b) scapulae c) thoracic vertebral column

a

which cavity contains the heart and lungs? a) thoracic b) abdominal c) medistinum

a

which part of the thoracic cavity contains all thoracic organs except the lungs and pleurae? a) mediastinum b) pleural cavity c) abdominal cavity

a

which structures are at the terminal end of the respiratory system? a) alveoli b) bronchi c) bronchioles

a

from the following list, circle the nine evaluation criteria that indicate the patient was properly positioned for a lteral projection: a) the heart and diaphragm should be seen in sharp outline b) the sternum should be seen in lateral view without rotation c) penetration of lung fields and heart should be clearly seen d) the ribs should be superimposed posterior to the vertebral column e) neither the arm nor its soft tissues overlap the superior lung field f) the hilum should be seen in the approximate center of the image g) the sternal ends of clavicles should be superimposed with the vertebral column h) the sternal ends of clavicles should be seen equidistant from the vertebral column i) the thoracic intervertebral spaces should be open (except in patients with scoliosis) j) the costophrenic angles and lower apices of lungs should be clearly demonstrated k) a small amount of the heart should be seen on the right side of the vertebral column l) the long axis of lung fields should be demonstrated in the vertical position without forward-backward leaning

a b c d e f i j l

from the following list circle the eight evaluation criteria that indicate a patient was properly positioned for a PA projection: a) the trachea should be visible in the midline b) the heart and diaphragm should show sharp outlines c) the clavicles should be located superior to the apices d) ten posterior ribs should be seen above the diaphragm e) the scapulae should be projected outside the lung fields f) the exposure should clearly demonstrate the lung fields g) the ribs should be superimposed posterior to the vertebral column h) the hilum should be seen in the approximate center of the image i) the entire lung fields from the apices to the costophrenic angles should be seen j) no rotation; the sternal ends of the clavicles should be equidistant from the vertebral column k) the clavicles should be lying horizontal with their sternal ends overlapping the first or second ribs l) a faint shadow of the ribs and superior thoracic vertebrae should be seen through the heart shadow

a b d e f i j l

Lateral Projection: what purpose might an IV stand serve when the patient is positioned?

a patient who is unsteady may use the IV stand for support

(PA Oblique Projections) with reference to the patient respiration, when should the exposure be made?

after the second full inspiration

respiratory sacs

alveoli

mediastinal blood vessel

aorta

superior portion of a lung

apex

PA Projection: what is the recommended source to image receptor distance (SID)? explain why

at least 72 inches to reduce magnification of thoracic structures

a collapse of all or part of a lung

atelectasis

PA Projection: what is the purpose of depressing the shoulders? a) to move the scapulae laterally b) to keep the clavicles below the apices c) to place the midsagittal plane in a vertical position

b

PA Projection: what special positioning instructions may be given to a woman with large pendulous breasts to avoid superimposing the lower part of the lung fields? a) instruct the patient to cross both arms above the head b) instruct the patient to pull her breasts upward and laterally c) instruct the patient to press her breasts directly in front of her against the vertical IR holder

b

what is the name of the medial aspect of each lung in which the primary bronchus enters? a) apex b) hilum c) pleural space

b

what is the name of the superior portion of each lung? a) base b) apex c) hilum

b

which primary broncus is shorter and wider than the other? a) left b) right c) inferior d) superior

b

which structures branch from the distal end of the trachea? a) tertiary bronchi b) primary bronchi c) secondary bronchi

b

inferior part of the lung

base

these branch from the trachea

bronchi

PA Projection: why should the shoulders be rotated forward? a) to keep the clavicles below the apices b) to place the diaphragm at its lowest point c) to move the scapulae laterally away from the lung fields

c

PA Projection: with reference to the patient where should the upper border of the IR/collimated field be placed? a) at the level of the clavicles b) at the level of the acromion processes c) about 1 1/2 to 2 inches above the top of the shoulders

c

how many degrees should the patient be rotated? a) 25 degrees b) 35 degrees c) 45 degrees d) 55 degrees

c

Lateral Projection: which thoracic structure is of primary interest with the right lateral projection? a) heart b) trachea c) left lung d) right lung

d

PA Projection: if a patient were to remove one shoulder from contact with the grid device before the exposure the image effect would be: a) the clavivles would appear above the apices b) the sternum would superimpose the vertebral column c) the sternoclavicular joints would appear symmetrical d) the sternal ends of the clavicles would no longer be equidistant from the vertebral column

d

which structure separates the thoracic cavity from the abdominal cavity? a) liver b) heart c) trachea d) diaphragm

d

inferior border of thoracic cavity

diaphragm

destructive and obstructive airway changes leading to an increased volume of air in the lungs

emphysema

Lateral Projection: describe how the patient's arms should be positioned

extend the arms directly upward flex the elbows and with the forearms resting on the elbows hold the arms in this position

separates a lung into lobes

fissure

mediastinal organ

heart

where vessels enter a lung

hilum

underaeration of the lungs caused by a lack of surfactant

hyaline membrane (respiratory syndrome)

name the three portions of the pleura: inner layer: _____ outer layer: _____ space between layers: _____

inner: visceral pleura outer: parietal pleura space between layers: pleural cavity

this lung has two lobes

left

which side of the chest (right or left) is of primary interest with the PA Oblique projection, RAO position?

left

pneumonia involving the alveoli of an antire lobe without involving the bronchi

lobar (bacterial pneumonia)

major section of a lung

lobe

pneumonia involving the bronchi and scattered distress through out the lung

lobular (bronchopneumonia)

side of lung where vessels enter

medial

area between the lungs

mediastinum

Lateral Projection: what body plane should be perpendicular (T) and centered to the midline of the IR?

midcoronal

PA Projection: which body plane should be perpendicular (T) and centered to the midline of the IR?

midsagittal

(AP Projection) what body plane should be centered to the midline of the IR?

midsagittal plane

PA Projection: CR orientation and entrance point:

perpendicular (T) enters MSP at level T7 (inferior scapular angle)

double walled serous membrane sac

pleura

collection of fluid in the pleural cavity

pleural effusion

accumulation of air in the pleural cavity resulting in collapse of the lung

pneumothorax

replacement of air with fluid in the lung interstitium and alveoli

pulmonary edema

PA Projection: how should the patients hand be positioned? explain why

rest the backs of the hands low on the hips below the costophrenic angles; this maneuver rotates the scapulae laterally so that they do not superimpose the lungs

which Pa oblique projection provides the best view of the left atrium and the entire left branch of the bronchial tree?

right PA oblique projection RAO position

which lung (right or left) is shorter and broader than the other? explain why

right lung its close proximity to the liver and heart

how many lobes are found in the right lung? the left lung?

right lung has 3 lobes left lung has 2 lobes

condition of unknown origin often associated with pulmonary fribrosis

sarcoidosis

found in each lobe

segment

anterior bony wall of the mediastinum

sternum

(AP Oblique Projections) what breathing instructions should be given to the patient?

stop breathing after the second full inspiration

Lateral Projection: what breathing instructions should be given to the patient?

suspend respiration after full inspiration of the second breath

what breathing instructions would be given to the patient? explain why

take in a breath and blow it out then take in another full breath and hold it in. (suspend respiration after second full inspiration) the greatest are of lung structures is demonstrated in full expansion and without strain after the patient suspends breathing on a second inspiration

what determines how many degrees the patient should be rotated for the PA oblique projection, LAO position?

the desired structures to be demonstrated (more rotation when the heart is of primary interest)

(AP Oblique Projections) which side (the one closer to or the father from the IR) is generally the side of interest?

the one closer to the IR

(PA Oblique Projections) which side (the one closer to or farther from the IR) is generally the side of interest?

the one farther from the IR

(AP Projection) with reference to the patient where should the IR be placed?

the upper border of the IR should be 1 1/2 to 2 inches above the relaxed shoulders

pertaining to the chest cavity

thoracic

number of lobes in the right lung

three

PA Projection: why is it preferable to have patient upright?

to allow the diaphragm to reach its lowest level and to prevent engorgement of the pulmonary vessels

to demonstrate the heart, why should the exposure be made after normal inspiration rather than deep inspiration?

to prevent distortion (elongation) of the heart caused by a full inferior movement of the diaphragm

major airway tube

trachea

chronic infection of the lung caused by the tubercle bacillus

tuberculosis

PA Projection: key patient/part positioning points:

upright facing vertical grid

Lateral Projection: key patient/part positioning points:

upright left lateral position

(AP Projection) if the patients condition permits, how should the arms and shoulders be positioned? explain why

with elbows flexed, pronate the hands and place them on the hips to draw the spacuplae laterally