Chapter 2

Question 1

What does the bony thorax consist of?

Answer 1

The bony thorax consists of the 2 clavicles, 2 scapulae, the 12 pairs of ribs, and the 12 thoracic vertebrae posteriorly.

Question 2

Radiographic anatomy of the chest is divided into three sections:

Answer 2

Radiographic anatomy of the chest is divided into three sections: bony thorax, respiratory system proper, and mediastinum.

Question 3

These topographic landmarks should be parts of the body that are easily and consistently located on patients, such as parts of the bony thorax. For chest positioning, two of these landmarks are

Answer 3

the vertebra promi-nens and the jugular notch

Question 4

The midthorax, at the level

Answer 4

T7

Question 5

inferior tip of the sternum, the xiphoid process is at the level of (vertebrae)

Answer 5

T9-T10

Question 6

Four general divisions of the respiratory system, are the

Answer 6

pharynx, trachea, bronchi, and lungs.

Question 7

serves as a passageway for food and fluids as well as air, making it common to the digestive and respiratory systems.

Answer 7

pharynx

Question 8

The pharynx is approximately consists of three divisions,

Answer 8

nasopharynx (na”-zo-far-inks), oropharynx o-ro-far-inks), and laryngopharynx (lah-ring”-go-far-inks).

Question 9

this marks the boundary between the nasopharynx and the oropharynx.

Answer 9

uvula (ư-vu-

Question 10

The upper margin of the larynx is at the approximate level of

Answer 10

C3

Question 11

where the larynx joins with the trachea, is at the level of

Answer 11

C6

Question 12

laryngeal prominence of the thyroid cartilage is located at the level of

Answer 12

C4-C5

Question 13

The trachea, located just anterior to the esophagus, extends from its junction with the larynx at the level of C6 downward to the level of

Answer 13

T4-T5

Question 14

AP and lateral radiographs of the upper airway allow visualization of the air-filled

Answer 14

trachea and larynx.

Question 15

The trachea bifurcates at the

Answer 15

carina

Question 16

The trachea bifurcates at the carina to form the

Answer 16

right and left primary bronchi

Question 17

that the right bronchus divides into _ secondary bronchi, but the left divides into only _, with each entering individual lobes of the lungs.

Answer 17

right bronchus divides into three
left divides into only two

Question 18

secondary bronchi continue to subdivide into smaller branches, called

Answer 18

bronchioles

Question 19

For the right lung the _ fissure separates the inferior and middle lobes, whereas the _ fissure separates the superior and middle lobes.

Answer 19

oblique fissure separates the inferior and middle lobes
horizontal fissure separates the superior and middle lobes

Question 20

The left lung has only two lobes-the superior (upper) and inferior (lower) -separated by a _ fissure.

Answer 20

single deep oblique

Question 21

What has the is ability to store certain hormones and release them slowly to aid in the regulation of body metabolism. These hormones also help to regulate body growth and development, especially in children.

Answer 21

thyroid gland

Question 22

The lungs are composed of a light, spongy, highly elastic substance called

Answer 22

parenchyma

Question 23

This substance allows for the breathing mechanism responsible for expansion and contraction of the lungs, which brings oxygen into and removes carbon dioxide from the blood

Answer 23

lungs are composed of a light, spongy, highly elastic substance called parenchyma (pah-reng-ki-mah).

Question 24

Each lung is contained in a delicate double-walled sac, or mem-brane, called the

Answer 24

pleura

Question 25

The outer layer of this pleural sac lines the inner surface of the chest wall and diaphragm and is called the

Answer 25

parietal pleura.

Question 26

The inner layer that covers the surface of the lungs, also dipping into the fissures between the lobes, is called the

Answer 26

pulmonary or visceral pleura

Question 27

The potential space between the double-walled pleura, called the ___, contains a lubricating fluid that allows movement of one or the other during breathing.

Answer 27

pleural cavity

Question 28

Air or gas present in this pleural cavity results in a condition called a __, in which air or gas pressure in the pleural cavity may cause the lung to collapse.

Answer 28

pneumothorax

Question 29

Accumulation of blood in the pleural cavity creates a condition called a _, whereas fluid within the cavity is referred to as _.

Answer 29

Accumulation of blood in the pleural cavity creates a condition called a hemothorax, whereas fluid within the cavity is referred to as pleural effusion.

Question 30

The _ of each lung is the rounded upper area above the level of the clavicles.

Answer 30

apex

Question 31

The apices of the lungs extend up into the lower neck area to the level of _ This important part of the lungs must be included on chest radiographs.

Answer 31

T1 (first thoracic vertebra).

Question 32

The _ is shown as the point of bifurcation, the lowest margin of the separation of the trachea into the right and left bronchi.

Answer 32

carina

Question 33

The _ of each lung is the lower concave area of each lung that rests on the diaphragm

Answer 33

base

Question 34

The _ is a muscular partition that separates the thoracic and abdominal cavities.

Answer 34

diaphragm

Question 35

The _ refers to the extreme outermost lower corner of each lung, where the diaphragm meets the ribs.

Answer 35

costophrenic angle

Question 36

The _, also known as the root region, is the central area of each lung, where the bronchi, blood vessels, lymph vessels, and nerves enter and leave the lungs.

Answer 36

hilum (hilus)

Question 37

The right lung is usually about 1 inch (2.5 cm) shorter than the left lung. The reason for this difference is the __, which is located in the right upper abdomen and which pushes up on the right hemidiaphragm.

Answer 37

large space-occupying liver

Question 38

The medial portion of the thoracic cavity between the lungs is called the ___.

Answer 38

mediastinum

Question 39

Four radiographically important structures located in the mediastinum are the

Answer 39

1) thymus gland, (2) heart and great vessels, (3) trachea, and (4) esophagus.

Question 40

said to be a temporary organ because it is prominent in infancy and reaches its maximum size of about 40 g at puberty, then gradually decreases in size until it almost disappears in adulthood.

Answer 40

thymus gland

Question 41

has a large role in the development of the immune system that helps the body resist disease. It is essential to the growth and development of thymic lymphocytes or T cells, which serve in rejecting things foreign to the body.

Answer 41

Thymus gland

Question 42

The heart is located posterior to the body of the sternum and anterior to

Answer 42

T5 to T8

Question 43

The great vessels in the mediastinum are the

Answer 43

inferior vena cava and superior vena cava, aorta, and large pulmonary arteries and veins.

Question 44

The __ is a large vein that returns blood to the heart from the upper half of the body

Answer 44

superior vena cava

Question 45

The __ is a large vein that returns blood from the lower half of the body.

Answer 45

inferior vena cava

Question 46

The aorta is divided into three parts:

Answer 46

ascending aorta (coming up out of the heart); arch of the aorta; and descending aorta

Question 47

The __, within the mediastinum, separates into the right and left primary and secondary bronchi,

Answer 47

trachea

Question 48

increase the volume of the chest during inspiration the thoracic cavity increases in diameter in __ dimensions.

Answer 48

three; vertical diameter, transverse diameter, anteroposterior diameter,

Question 49

The first of these is the vertical diameter, which is increased primarily by __ movement of the dia-phragm, increasing the thoracic volume.

Answer 49

contraction and downward movement

Question 50

The transverse diameter is the second dimension that is increased during inspiration. The ribs ___, and this increases the transverse diameter of the thorax.

Answer 50

swing outward and upward

Question 51

The third dimension is the anteroposterior diameter, which is also increased during inspiration by the __ ribs, especially the second through sixth ribs.

Answer 51

raising of the ribs

Question 52

During expiration, __ , causes the three diameters of the thorax to return to normal

Answer 52

the elastic recoil of the lungs, along with the weight of the thoracic walls

Question 53

To determine the degree of inspiration in chest radiography, one should be able to

Answer 53

identify and count the rib pairs on a chest radio-graph.

Question 54

general rule for average adult patients is to "show" a minimum of __ of ribs on a full inspiration PA chest radio-graph.

Answer 54

10 pairs

Question 55

Patient preparation for chest radiography includes the removal

Answer 55

of all opaque objects from the chest and neck regions, including clothes with buttons, snaps, hooks, or any objects that would be visualized on the radiograph as a shadow

Question 56

In general, chest radiography uses low contrast, described as long-scale contrast, with more shades of gray. This requires a high kVp of

Answer 56

110 to 125.

Question 57

As a general rule, in chest radiography, the use of high kvp (> 100) requires the use of __

Answer 57

grids

Question 58

Generally, chest radiography requires the use of __ mA and __ exposure time to minimize the chance of motion and resultant loss of sharpness.

Answer 58

high mA and short exposure time

Question 59

Generally, with newborns and small infants, for whom head support is required, chest radiographs are taken

Answer 59

AP supine

Question 60

For Peds chest X-ray __ kVp and __ mAs are required for pediatric patients with the shortest exposure time possible

Answer 60

lower kVp (70 to 85) and less mAs

Question 61

Higher-speed imaging systems or receptors generally used for peds patients for 2 reasons:

Answer 61

1- to reduce chance of motion 2-reduce exposure dose

Question 62

Frequently, older patients have less inhalation capability with resultant smaller lung fields, and a __ CR location is required

Answer 62

higher CR location is required (CR to T6-T7).

Question 63

A bariatric patient may present positioning and centering chal-lenges. Because of a larger body girth, the technologist may place the top of the IR

Answer 63

1 to 2 inches (2.5 to 5 cm) above the shoulder.

Question 64

T_ remains your centering point for most chest projections.

Answer 64

T7

Question 65

T7 is generally located at the level of the

Answer 65

inferior angle of the scapula.

Question 66

For the AP chest projection, the __ is a palpable landmark on the bariatric patient for a chest X-ray.

Answer 66

jugular notch

Question 67

T7 is approximately __ inferior to the jugular notch.

Answer 67

3 to 4 inches (8 to 10 cm)

Question 68

For a chest X-ray the patient should be asked to do what for respiration

Answer 68

hold the second full inspiration rather than the first.

Question 69

Occasional exceptions have been noted to taking chest radiographs on full inspiration only. For certain conditions, __ radiographs are taken on both full inspiration (Fig. 2.31) and full expiration (Fig. 2.32).

Answer 69

comparison

Question 70

All chest radiographs should be taken in an erect position if the patient's condition allows. Three reasons for this are as follows:

Answer 70

The diaphragm is able to move down farther. 2. Air and fluid levels in the chest may be visualized. Engorgement and hyperemia of pulmonary vessels may be prevented. The

Question 71

engorgement literally means

Answer 71

engorgement literally means "distended or swollen with fluid."

Question 72

Hyperemia (hy"-per-e-me-ah) is an excess

Answer 72

of blood that results in part from relaxation of the distal small blood vessels or arterioles. 3,4

Question 73

If a patient has fluid in their lungs how will this look for an erect and recumbent X-ray

Answer 73

In the recumbent position, a pleural effusion spreads out over the posterior surface of the lung, producing a hazy appearance of the entire lung. In the upright position, free fluid is located near the base of the lung.

Question 74

How does erect and supine chest positions effect engorgement and hyperemia of pulmonary vessels

Answer 74

An erect position tends to minimize engorgement and hyper-emia of pulmonary vessels, whereas a supine position increases these, which can change the radiographic appearance of these vessels

Question 75

Chest radiographs taken AP rather than PA at 72 inches (180 cm) result in __, which complicates the diagnosis of possible cardiac enlargement.

Answer 75

increased magnification of the heart shadow

Question 76

A longer source-to-image receptor distance (SID), such as 72 inches (180 cm), magnifies less because

Answer 76

the x-ray beam has less divergence.

Question 77

placing the heart closer to the IR on the PA results in

Answer 77

less magnification

Question 78

Chronic obstructive pulmonary disease (COPD) is

Answer 78

a form of persistent obstruction of the airways that usually causes difficulty in emptying the lungs emphysema or chronic bronchitis (smoking is the predominant cause of COPD) and Asthma

Question 79

Cystic fibrosis (sis-tik fi-bro-sis), the most common of inherited diseases, is a condition in which

Answer 79

secretions of heavy mucus cause progressive "clogging" of bronchi and bronchioles.

Question 80

Dyspnea (disp'-ne-ah) is a condition of

Answer 80

shortness of breath, which creates a sensation of difficulty in breathing; PA and lateral Chest usually taken

Question 81

Emphysema (em'-fi-se-mah) is an

Answer 81

irreversible and chronic lung disease in which air spaces in the alveoli become greatly enlarged as a result of alveolar wall destruction and loss of alveolar elasticity. From dust and smoking is evident on chest radiographs by increased lung dimensions, barrel chest with depressed and flattened diaphragm obscuring costophrenic angles, and an elongated heart shadow.

Question 82

Lung neoplasm

Answer 82

refers to a new growth or tumor.

Question 83

hamartoma (ham"-ahr-to-ma) is the most common

Answer 83

benign pulmonary mass, and it generally is found in peripheral regions of the lungs. These are seen on chest radiographs

Question 84

Lung cancer may be demonstrated on chest radiography as

Answer 84

slight shadows in the early stages and as more sharply defined, larger radiopaque masses in more advanced cases.

Question 85

Pneumothorax (noo-mo-thor-aks) is an accumulation

Answer 85

of air in the pleura space causes partial or complete collapse of the lung and results in shortness of breath

Question 86

Chest radiographs for pneumothorax should be taken

Answer 86

erect. If the patient cannot assume an erect position, a horizontal beam lateral decubitus position with the affected side up should be taken (not down as with pleural effusion).

Question 87

Pulmonary edema is a condition of

Answer 87

excess fluid within the lung that most frequently is caused by a backup in pulmonary circulation commonly associated with congestive heart failure. A common cause is coronary artery disease, The condition is seen on chest radiographs as a diffuse increase in radiodensity in the hilar regions fading toward the periphery of the lung

Question 88

Respiratory distress syndrome (RDS) (commonly called hyaline membrane disease [HMD] in infants and adult respiratory distress syndrome [ARDS] in adults) is an emergent condition in which the

Answer 88

alveoli and capillaries of the lung are injured or infected, resulting in leakage of fluid and blood into the spaces between alveoli or into the alveoli themselves with formation of hyaline membranes. This leakage can be detected radiographically as increased density (brightness) throughout the lungs

Question 89

Tuberculosis (too-ber"-ku-lo-sis) (TB) is a (potentially fatal) contagious disease that is caused by

Answer 89

airborne bacteria.

Question 90

Primary tuberculosis refers to TB that occurs in persons

Answer 90

who have never had the disease before. Hilar enlargement, along with enlarged mediastinal lymph nodes, is an important indicator of primary TB.

Question 91

Reactivation (secondary) tuberculosis

Answer 91

usually develops in adults and is generally first evident on radiography bilaterally in the upper lobes as irregular calcifications that are mottled in appearance. lordotic projections are frequently requested for visualization of calcifications and cavitations of the apices and upper lobes.