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PoRIT > Chest > Flashcards

Chest Flashcards

(40 cards)

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1
Q

List the patient pathways for emergency department patients

A
  • Trauma
    -Acute respiratory issues such as pneumothorax or breathing difficulties
    -Acute cardiac issues
  • Haemoptysis
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2
Q

List the patient pathways for inpatient patients

A
  • Pre - operative
  • HAP/infection
  • NG tube placement
  • Pacemaker placement
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3
Q

List the patient pathways for GP referred patients

A
  • Chronic respiratory issues
  • cough for more than 3 weeks? - cancer pathway
  • COPD and lung conditions
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4
Q

List the patient pathways for outpatients patients

A
  • Respiratory clinic
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5
Q

List the routine projections

A
  • PA (preferred option)
  • AP (for portable)- erect and supine
  • Lateral
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6
Q

What projection is suited for a patient that is able to stand and sit unaided?

A

PA

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7
Q

What projection is suited for a patient with a trauma request?

A

AP supine

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8
Q

What projection is suited for a patient with a portable request?

A

AP erect

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9
Q

What projection is suited for a pacemaker placement?

A

PA and/or Lateral

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10
Q

What projection is suited for an unknown density seen on PA/AP chest?

A

Lateral

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11
Q

What is the exposure factor for a PA?

A

120kVp and 0.5 mAs

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12
Q

What is the exposure factor for a Lateral?

A

90kVp and 4mAs

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13
Q

Position points for PA

A
  • P stands in front of IR with feet slightly apart
  • neck extended and chin resting on surface
  • median sagittal plane at 90 degrees to IR
  • shoulders rotated forwards and downwards
  • dorsal aspect of hands behind and below the hips with the elbows bought forward
  • encouraged to maintain position
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14
Q

Centre point for PA?

A

Horizontal central ray at level of T6 - just below the shoulder blades

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15
Q

Distance for PA?

A

180 cm FFD

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16
Q

What needs to be included in the collimation of PA?

A

Soft tissues borders laterally
C6 superiorly and L1 inferiorly
(C6 - just above C7, most prominent)
(L1 - find where the last rib is and this should be in line with L1)

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17
Q

How should respiration be for PA?

Study These Flashcards
A

Exposure made on full arrested inspiration

18
Q

Image Critique for PA?

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A

P -
- No rotation, medial end of clavicles equidistant from spine
- scapula clear of lung fields
- 10th posterior ribs seen above diaphragm as this means adequate inspiration
A -
- lung fields are well inflated, apices (top of lung fields), costophrenic angles (sharp) and heart
C -
- level of T6
- Include soft tissue borders laterally if possible
- C6 superiorly, L1 inferiorly
E -
- lung markings of chest
- ribs and thoracic vertebrae visualised faintly through heart
M -
- correct marker
- visible within primary beam
- not overlying important anatomy
A -
- no movement unsharpness
- clothing and jewellery

19
Q

List possible indications for AP and Supine

Study These Flashcards
A
  • Trauma ex resuscitation room or foreign body
    Post op
    Mobility Issues
    Age of patient, elderly or under the age of 3
20
Q

How is AP different with PA?

Study These Flashcards
A

In AP:
- the heart size is magnified and mediastinum is widened
- lung fields are shortened
- clavicles projected higher
- ribs appear horizontal
- scapula projected over lung fields

21
Q

Positioning points for AP

Study These Flashcards
A
  • p seated
  • IR placed in contact with P back the top edge clear of the shoulders
  • median sagittal plane at 90 degrees to IR
  • encouraged to relax and maintain position
  • arms may be abducted by hands externally rotated to face palm outwards (moved scapula clear) or allow hands to hold rail side or away from chest wall
22
Q

Centre point for AP

Study These Flashcards
A

horizontal central ray at the level of T6 - midway between the sternal notch and xiphisternum (xiphoid process)

23
Q

Distance for AP

Study These Flashcards
A

180 cm (if unachievable, min. 120cm) FFD

24
Q

What needs to be included in the collimation of PA?

Study These Flashcards
A

Include soft tissue borders laterally and C6 superiorly and L1 inferiorly

25
How should respiration be for PA?
Exposure made on full arrested inspiration
26
Image critique for AP?
P- - no rotation, medial ends of clavicles equidistant from spine - 10th posterior ribs seen above diaphragm to show adequate inspiration - scapula clear of lung fields A - -Lung fields (well inflated), apices (top of lung fields) , costophrenic angles (sharp), heart -Soft tissues laterally C - - level of T6 - Include soft tissue borders laterally if possible - C6 superiorly, L1 inferiorly E - - lung markings of chest - ribs and thoracic vertebrae visualised faintly through heart M - - correct marker - visible within primary beam - not overlying important anatomy A - - no movement unsharpness - clothing and jewellery
27
How is supine different from AP?
Supine - - it is difficult to assess fluid level or pools posteriorly - lesser degree of inspiration demonstrated - cannot assess for perforation
28
Position points for supine
- P laying on back - IR placed in contact with P back the top edge clear of shoulders. - (trauma) IR is placed in casette tray under trolley - Median sagittal plane at 90 degrees to IR - encouraged to relax and maintain position - arms abducted away from chest wall if possible
29
Centre point for supine
Central ray to the level of T6 - midway between sternal notch and xiphisternum
30
Distance for supine
180 cm FFD (if unachievable , min. 120)
31
Collimation for supine
Include soft tissues borders laterally, C6 superiorly, L1 inferiorly
32
How should respiration be for PA?
Exposure made on full arrested inspiration
33
Image critique for supine
P - - No rotation (medial end of clavicles equidistant from spine) - 8th posterior ribs seen above diaphragm (inspiration will not be as full) A - - Lung fields (well inflated), apices, costophrenic angles, heart - Soft tissues laterally C - - At level of T6 - Soft tissue borders laterally if possible, C6 superiorly, L1 inferiorly E - - Lung markings of chest - Ribs and thoracic vertebrae visualised faintly through heart M - - Correct marker - Visible in primary beam - Not overlying important anatomy A - - No movement unsharpness - Clothing and jewellery
34
Indications for Lateral
(not routinely performed) - for mass - foreign body - post cardiac surgery - pacemaker insertion (left or right lateral
35
Position point for lateral
- Patient standing/seated with side under investigation in contact with and median sagittal plane parellel to the IR - arms raised to permit hands to to be placed on the of the head or raised above the head anteriorly (use bars if needed) - IR adjusted to include apices and lower lobes to level of 1st lumbar vertebra - chin raised away from chest - encourage to maintain position
36
Centre point for lateral?
- central ray at 90 degree to the middle of IR in the mid axilllary line (centre point at t7)
37
Distance for lateral
180 cm FFD
38
What to include in your collimation?
Include soft tissue borders anteriorly and posteriorly
39
How should respiration be for lateral?
Exposure should be made on full arrested inspiration
40
Image Critique for Lateral
P- - bone and soft tissues of arms clear - sternum in profile - L and R anterior ribs superimposed - L and R posterior ribs superimposed - open intervertebral foramina A - -Lung fields (well inflated), apices (top of lung fields) , costophrenic angles (sharp), heart -Soft tissues anteriorly and posteriorly C - - level of T7 - Include soft tissue borders anteriorly and posteriorly E - - vascular markings of chest - sharp outlines of the hemi diaphragms - bony detail M - - correct marker - visible within primary beam - not overlying important anatomy A - - no movement unsharpness - clothing and jewellery

PoRIT (2 decks)

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