Chest and Abdomen

Question 1

Special Considerations for Chest and Abdomen

Answer 1

1) Much overlapping anatomy in chest and abdomen on the radiographic image
2) Both cavities contain air and fluid
3) Minimum of one view upright
4) Air goes up until it meets a barrier; fluids fall to seek their own level
5) Using a horizontal x-ray beam and a vertical IR demonstrates air-fluid levels

Question 2

What is chest radiography performed?

Answer 2

to visualize the visceral anatomy of the chest (heart and lungs)

Question 3

chest radiography requires (high/low) (kvp/mAs) to adequately demonstrate subtle lung markings

Answer 3

high kVp

Question 4

Chest radiography is performed at 72” why?

Answer 4

To reduce magnification of the heart

Question 5

Set-Up Flow

Answer 5

1) Measure for all set-ups in the series
2) Set control panel
3) Set SID
4) Set collimation and apply side marker
5) Apply lead shielding to patient
6) position patient at bucky
7) Align cassette to the patient
8) Align CR to center of cassette
9) No filtration

Question 6

Routine Chest Series (view)

Answer 6

PA Chest

Left Lateral Chest

Question 7

PA Chest: SID?

Answer 7

72”

Question 8

PA Chest: Film Size?

Answer 8

14 x 17

Question 9

PA Chest: Film Placement?

Answer 9

Vertical / 1 1/2 above VP

If you have a wide chest you can turn it transverse with the top at the shoulders

Question 10

PA Chest: ID Blocker?

Answer 10

Up

Question 11

PA Chest: CR

Answer 11

CR to spine and mid film

Question 12

PA Chest: Collimate

Answer 12

to film size

Question 13

PA Chest: Patient Positioning

Answer 13

Roll shoulders forward, deep inspiration and hold

Question 14

PA Chest: Filter?

Answer 14

No

Question 15

Optimal PA Chest Criteria

Answer 15

1) All heart and lung anatomy is included
2) Unwanted anatomy out of lungs
3) No rotation / SC joints symmetrical
4) Adequate penetration of structures
5) Upper 4 thoracic vertebrae identified well
6) Adequate inspiration of lungs
7) Count 10 posterior ot 7 anterior ribs
8) Lung markings are “crisp” / not “fuzzy”

Question 16

PA Chest Image Criteria

Answer 16

1) Upper 4 Thoracic Identified Well
2) 10 Posterior or 7 Anterior Ribs Visible
3) Tracheal Air Shadow Midline to Spine
4) Include Top of Apices to Bottom of Costophrenic Angles
5) Unwanted anatomy out of lungs
6) SC joints symmetrical
7) Lung markings “crisp”

Question 17

Left Lateral Chest: SID

Answer 17

72”

Question 18

Left Lateral Chest: Film Size

Answer 18

14 x 17

Question 19

Left Lateral Chest: Placement

Answer 19

Vertical / 1 1/2 above VP

Question 20

Left Lateral Chest: ID Blocker

Answer 20

Up

Question 21

Left Lateral Chest: Patient Placement

Answer 21

patient true lateral with left side against bucky and arms extended over head, Left perked on bucky upper left, deep inspiration and hold, no filter

Question 22

Left Lateral Chest: CR

Answer 22

CR to center of film and mid-axillary line

Question 23

Left Lateral Chest: Filter

Answer 23

No

Question 24

Left Lateral Chest Image Criteria

Answer 24

1) Apices through costophrenic angles visualized and clear
2) Posterior ribs superimposed
3) IVFs open
4) Sternum in profile

Question 25

The most common radiographic exams performed on pediatric patients and toddlers include

Answer 25

1) Chest 2) Abdomen 3) Bone Survey 4) Extremities

Question 26

Correct Immobilization Procedures

Answer 26

1) Place blanket covered film on table 2) Lay child on film 3) Have one person (preferably a parent or caretaker) hold the arms over the baby head 4) Have another person (preferably a parent or caretaker) hold baby waist and leg

Question 27

For Infants - Swaddling

Answer 27

The wrapping of the arms and legs is comforting to most babies making it much easier to keep them still. You may still need assistance to anchor the babys legs - Mom or Dad should be your helper

Question 28

Infant Inspiration

Answer 28

With some infants and small children, the best way to get a good inspiration might be to 'flick' the soles of their feet to induce crying. Although this may seem cruel, it assists the radiographer in catching the child taking in a deep breath between wails

Question 29

Accessory Views

Answer 29

1) Apical Lordotic Chest | 2) Left Lateral Decubitus Chest

Question 30

Apical Lordotic Chest

Answer 30

**this removes clavicles from the lung fields for evaluation of the lung apices 1) Chest is tipped and CR is directed parallel to film OR 2) Chest is parallel to film and CR is tilted 15 degrees cephalic 72" SID Projects Clavicles

Question 31

Left Lateral Decubitus Chest

Answer 31

** either right or left put side with suspected fluid down / this view is done to evaluate air fluid levels in the chest and must have a beam that is parallel to the floor otherwise the image will be distorted CR parallel to floor A-P Projection

Question 32

Chest (does/does not) equal bony thorax

Answer 32

does not

Question 33

Deep inspiration is absolutely necessary to demonstrate lung's ability to aerate

Answer 33

no more to add

Question 34

Should be done upright to demonstrate fluid levels or a decubitus can be done

Answer 34

no more to add

Question 35

May be done with AP projection if necessary

Answer 35

no more to add

Question 36

Shield the front of the pelvis; most scatter ricochets back from the bucky (because of high kVp and easily penetrated lung tissue)

Answer 36

no more to add

Question 37

Abdominal Series

Answer 37

Recumbent AP Abdomen Upright AP Abdomen **Done to evaluate the air fluid levels in the abdomen as well as the organs inside. Also referred to as a KUB (kidney, ureter, bladder) a Scout Film

Question 38

Recumbent AP Abdomen

Answer 38

``` • "Flat Plate", "KUB" • Used to rule out: masses, aneurysm, calcifications, foreign bodies, fetal shadows, bowel gas pattern • If aneurysm is suspected, do lateral abdomen (soft-tissue lateral lumbar) • Patient Supine (table bucky) • 14 x 17 film, vertical • 40" SID • Bottom of Film at greater trochanters • Must see bottom of bladder • Exhale and Hold ***Must include Bladder ```

Question 39

Upright AP Abdomen

Answer 39

Used to identify: Free air in abdominal cavity Air-fluid levels ``` • 14x17, vertical • 40" SID • Top of cassette at axilla level • CR approx 2" above crest • center mid-film • must include top of diaphragm • expose on expiration ***Must include diaphragm ```

Question 40

Megan Blas

Answer 40

It's usually normal to see air under the left hemi-diaphragm

Question 41

A left lateral decubitus abdomen view may be taken in place of the upright

Answer 41

no other info

Question 42

Exposing on expiration raises the diaphragm and makes the abdomen thinner requiring less exposure

Answer 42

no other info

Question 43

Gonadal shield may be used on males if it doesn't interfere with abdominal anatomy

Answer 43

no other info

Question 44

To make sure you used enough kVp you should only be able to count the first 4 thoracic vertebrae

Answer 44

no other info