Workbook Chapter 2 Chest Problem solving for technical positioning errors

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 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

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? (There are more than one)

Both the left posterior oblique and right posterior oblique positions will best demonstrate or elongate the left lung

A radiographic 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?

Central ray needs to be level at T7, central ray needs to be centered to the image receptor.

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 after the manual exposure settings for this patient?

Decrease the kV moderately

Situation: A patient with a history of pleurisy comes to the radiology department. Which radiographic series should be performed?

Erect PA and lateral

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 the patient?

Increase the kV slightly

Situation: A patient has a possible small pneumothorax. 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

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 - needs second exposure with deep inspiration

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 that is the left SC joint. What is the positioning error?

Rotation - Slight right posterior oblique

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 SID, an upright bucky, a full-inspiration exposure, 75 kV and 600 mA, 1/60 second exposure time. Which of these factors is the most likely to cause the problem? How can the technologist improve the image when making the exposure?

78kV is too low. 110 to 125 is recommended. Increase kV and reduce mAs.

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 semi-axial projection: Central ray is angled 15-20 degrees cephalad to project the clavicles above the apices and to demonstrate clearly a possible tumor.

A radiograph of a lateral projection of the chest shows the posterior ribs and costophrenic angles are separated more than .5 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 anterior

Situation: A patient comes to the radiology department for a presurgical chest examination. The clinical history indicates a possible situs inversus of the the thorax (transportion of structures within the thorax). Which positioning step or action must be taken to perform a successful chest examination?

Place the correct right/left anatomic marker on image receptor because the heart and other thoracic structures may be transposed right to left.

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?

Right lateral decubitus