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Chapter 20 The Chest (Thorax) and Abdomen > Chest, Sternum, Ribs and Abdomen > Flashcards

Chest, Sternum, Ribs and Abdomen Flashcards

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1
Q

Why are Upright done in a chest?

A
  1. Allows diaphragm to reach the lowest position
  2. Allows for demonstration of FREE air/fluid levels in pleural cavity
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2
Q

If Proper inspiration for chest what is visualize?

A

Demonstrate 10 posterior Ribs above diaphragm

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3
Q

S.I.D for chest? And why?

A

72”, minimizes magnification of the heart shadow/image

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4
Q

(Chest) High kVP 110-125, why?

A

Creates low radiographic contrast

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5
Q

(Chest) High mA, short time, why?

A

Minimizes heart motion and adequate density

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6
Q

Good penetration in a chest?

A

Faint visualization of thoracic spine through shadow of heart

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7
Q

Grid is used for?

A

Typically used to absorb scatter radiation

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8
Q

Proper IR placement and anatomical markers

A
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9
Q

Patient Prep for chest

A
  1. Everything off from waist up
  2. Gown open to the back
  3. Remove all artifacts
  4. Collimate the beam-reduce patient dose and improve quality of radiograph
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10
Q

Routine Chest Views

A
  1. Posteroanterior - Upright Anterior
  2. Left lateral projection- Upright left lateral
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11
Q

Landmarks for chest?

A
  1. T7- Inferior angle of scapula (PA)
  2. 7”-8” below C7 (Lateral)
  3. 4” inferior to the jugular notch (AP)
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12
Q

Size of Bucky, S.I.D for PA Chest

A

14x17- Vertical Bucky - 72” S.I.D

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13
Q

Position for PA chest?

A

Upright anterior position

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14
Q

Midpoint of IR centered to T7

A

Top cassette about 1.5-2” above shoulders if place lengthwise

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15
Q

Chest is

A

MSP centered to IR

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16
Q

Roll shoulders forward and depress

A

Draw scapula’s out laterally away from the lungs

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17
Q

Lift head slightly up why?

A

Move chin out of the way from chest

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18
Q

Central Ray for a PA chest?

A

Perpendicular to T7 at MSP

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19
Q

Respiration for PA chest?

A

Double inspiration, exposure at 2nd inspiration

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20
Q

Structures seen in a PA chest?

A

Heart, Lung, and mediastinum. No rotation of the sternoclavicular joints

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21
Q

Position of Lateral chest?

A

Upright left lateral position

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22
Q

Size of Bucky, S.I.D for lateral chest?

A

14x17- Vertical Bucky- 72” SID

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23
Q

Center thorax?

A

To middle of IR

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24
Q

Left lateral Chest

A

Is MSP parallel, MCP perpendicular

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25
Extend chin up slightly
Move chin out of the way
26
Central Ray for left lateral chest?
Perpendicular to T7 at MCP
27
Respiration for left lateral chest
Double inspiration, exposure at 2nd inspiration
28
Structures seen in left lateral chest?
Superimposition of the posterior ribs, indicating no rotation
29
Hilum (Root)
Is a depressed surface at the center of the medial surface of the lung. It is the point at which various structures enter and exit the long
30
Size & S.I.D Lateral Decubitus Position
14x17 - Grid - 72” SID
31
Recumbent position, lying on side of interest
RLD or LLD position
32
(lateral decubitus position) no rotation raise patient approx. 2-3 inches with decub sponge
Patient on side, arms above head, flex knees and superimpose (help with rotation)
33
Lateral decubitus IR?
Approx. 2” beyond shoulders, cassette or IR lengthwise only
34
Central ray for Lateral decubitus?
horizontal and perpendicular to T7 at MSP
35
Lateral decubitus respiration
Exposure after 2nd inspiration, extend chin up slightly
36
What is visualized in a lateral decubitus?
Any FREE fluid present in the pleural space will be demonstrated on the dependent chest wall
37
Size & S.I.D Lordotic position?
14x17 - Grid- 72” SID
38
Lordotic standing position?
Upright posterior, approx. 8”-12” away from the vertical Bucky (lean back)
39
Positioning a lordotic
Center patient in middle of IR to midsternum
40
Central Ray for lordotic
Perpendicular to MSP at midsternum, or Tube angled 15-30 degrees cephalon with the patient upright
41
Respiration for lordotic
Exposure after 2nd inspiration
42
What is visualize in a lordotic X-ray?
Apices of both lungs, free of superimposition by the clavicles
43
Situs Inversus
All internal organs are on the opposite side, note heart and air in stomach on patient’s Right side
44
Size & SID AP RIB UPPER
14x17 - Bucky- 40” SID Upright or Recumbent position
45
(AP Rib Upper) Coronal plane is parallel to IR
Upper margin of IR is 1.5-2” above level of spinous process of C-7
46
Central Ray for AP Rib Upper?
C.R. Perpendicular IR. Center of midclavicular line at approx. level of axillary fold
47
What is visualizable in a AP upper rib?
Ribs 1-10 visualized. Posterior ribs best visualized
48
Size & SID AP Oblique Upper Rib
14x17 - Bucky - 40”SID RPO or LPO Position
49
(AP Oblique Upper Rib) Conronal plane is 45 degrees to IR
Upper margin of IR is 1.5-2” above level of spinous process of C7
50
Central ray AP oblique upper rib?
C.R. Perpendicular IR. Center of midline of anterior surface at approx. Level of axillary fold
51
AP oblique upper rib respiration?
Exposure after inspiration- no motion (upper)
52
What is visualized in the AP oblique upper rib?
Ribs 1-10 visualized. Axillary portions are best seen. RPO- Right axillary ribs LPO- Left axillary ribs
53
Size & SID PA upper Rib
14x17 - Bucky - 40”SID Prone or Upright Anterior Position
54
(PA upper Rib) Coronal plane is parallel to IR
Upper margin of IR is 1.5-2” above level of spinous process of C7
55
Central ray for PA upper Rib?
C.R perpendicular IR. Center of midclavicular line at approx. level of axillary fold
56
Respiration for PA upper Ribs?
Exposure after inspiration- no motion (upper)
57
What is visualized in PA upper Rib?
Ribs 1-10 visualized. Anterior ribs best visualized
58
Size & SID PA Oblique upper Rib
14x17 - Bucky - 40” SID RAO or LAO position
59
(PA oblique upper rib) Coronal plane is 45 degrees to IR
Upper margin of IR is 1.5-2” above level of spinous process of C7
60
Central Ray for PA oblique upper Rib?
C.R. Perpendicular IR. Center of midline of posterior surface midway between spine and midaxillary line of affected side of approx. level of axillary fold
61
Respiration of PA oblique upper rib?
Exposure after inspiration- no motion (upper)
62
What is visualized in PA oblique upper rib?
Ribs 1-10 visualized. Axillary portions are best seen. LAO- Right axillary rib RAO-Left axillary rib
63
Size & SID AP Lower Posterior Ribs
14x17- Bucky - 40”SID
64
(AP lower ribs) coronal plane is parallel to IR
Lower margin of IR is at level of iliac crest
65
Central Ray AP lower ribs?
C.R. Perpendicular IR. Center of midclavicular line at approx. level of tip of xiphoid process
66
Respiration for AP lower Ribs?
Expiration-no motion
67
AP lower ribs best visualized?
Ribs 8-12, posterior ribs are best visualized
68
Size & SID AP Oblique lower ribs?
14x17 - Bucky - 40” SID RPO or LPO
69
(AP Oblique lower ribs) Coronal plane is 45 degrees to IR
Lower margin ofIR is at level of iliac crest
70
Central ray AP Oblique lower ribs
C.R. Perpendicular IR. Center of midline of anterior surface at approx. level of xiphoid process
71
Respiration AP Oblique lower ribs
Expiration- no motion
72
What is best visualized in AP Oblique lower ribs?
Ribs 8-12 visualized. Axillary portions are best been RPO- right axillary Ribs LPO- left axillary Ribs
73
AP abdomen a.k.a
KUB (kidney, Ureters, Bladder)
74
what do ways can a KUB be performed?
Upright and Supine
75
Upright/decubitus abdomen
Demonstrate air-fluid levels in intestines and to visualize free intraperitoneal air, if present.
76
Why do we have to wait several minutes to perform an upright KUB
Demonstrate true results
76
Why do we have to wait several minutes to perform an upright KUB
Demonstrate true results
77
Why do we have to wait several minutes to perform an lateral abdomen?
Demonstrate abdominal aorta and foreign bodies in GI tract
78
KUB shield
May shield male patient with gonad shield if requested Shield both genders with upright exam of abdomen if requested
79
Prep for Abdomen
Remove everything except underpants, shoes and socks Gown open to the back, you may need two if Hypersthenic body habitus
80
Technical prep for Abdomen
1. KVP- Sthenic 70-80kVp, long scale of contrast 2. mAs- short enough exposure time to decrease motion(s) 3. Sufficient density (mA) or brightness
81
Involuntary motion (peristalasis) (abd)
Patient can not control, Appear as a localized haze in bowels
82
Voluntary motion (Abd)
Patient CAN control PREVENT BY: 1. Prep of breathing instructions 2. Patient comfort 3. Pause after expiration before exposure
83
Quietly of x-ray, or what we need to see an a x-ray abdomen
1. Psoas muscle 2. Lower border of liver 3. Kidney shadows Right and left 4. Transverse process of lumbar spine
84
Abdomen x-ray ways?
1. Three way- abdomen acute series KUB(supine), upright abdomen, and PA CXR 2. Two way- Abdomen 2 view KUB (supine) and upright
85
Size & SID for AP abdomen
14x17, LW 40” SID Position: Supine
86
(AP abd) MSP perpendicular to table and centered to IR
IR centered at height of iliac crest
87
Central Ray AP ABD
C.R: iliac crest down MSP
88
Respiration for AP ABD
Expiration
89
Pubic Symphysis
Must be at the bottom of the IR.
90
If pubic symphysis missing?
Perform “bladder shot” collimate 10x12 CW. CR: perpendicular 2” above symphysis, down MSP Rotation determined by spinous process are center equally
91
Size & SID AP Upright ABD
14x17, LW 40” SID Position Upright posterior
92
IR for upright abd
MSP perpendicular to wall Bucky
93
Central ray upright abd?
C.R. Perpendicular 2” above iliac crest, down MSP
94
Respiration for upright abd
Expiration
95
Image: distention of bowel, free air on right side and air fluid line
***remember to perform first. This allows a true reflection of air-fluids levels if any present***
96
Diaphragm must be present?
On top of image for a upright
97
Left lateral decubitus abd
Performed when patient cannot stand for upright
98
Left later decubitus abd
Always perform left side down= LLD
99
Why it needs to be left lateral decubitus abd, and not right
Any amount of free air could be better seen outlined against the lower margin of the liver than it could against any organ on the left side (stomach)
100
Size & SID left lateral decubitus abd
14x17, 40” SID, Grid or VB
101
IR LW to patient (LLD abd)
CW in IR
102
Position: LLD
Patient elevated on sponge
103
Central Ray left lateral decubitus abd
C.R perpendicular and horizontal 2” above iliac crest, down MSP
104
LLD abd IR
MSP perpendicular to IR and horizontal
105
Respiration for LLD abd
Expiration
106
Decubitus and/ or Upright abd
***horizontal x-ray beam is necessary to demonstrate air fluid levels**
107
Sternum Size & SID position
10x12, LW 40” SID for RAO 10x12, LW 72” SID for Lateral
108
Typical position for sternum
Upright RAO and Lateral
109
What kind of kVp for sternum?
Low kVp
110
Respiration for Sternum
Inspiration
111
Oblique for sternum, degree?
15-20 degrees
112
Bony thorax most common reason for x-ray?
Trauma
113
Nontraumatic (bony thorax)
Usually malignant bone disease Multiple myeloma/ metastatic bone lesions
114
Atelectasis
Lung collapse
115
Pneumothorax
Air in pleural cavity Always shows atelectasis
116
Pneumonia
Inflammation of the lungs by bacteria or viral infection
117
Emphysema
Chronic lung condition (COPD-Barrel-chested)..obstruction and destruction of the small airways and alveoli of the lungs (causes over inflation)
118
Tuberculosis (TB)
Infections lungs disease. Primary screening test for TB done with skin test.
119
Pneumoconiosis
Group of chronic occupational lung disease caused by inhalation of irritating dust (asbestos)
120
Congestive heart failure
Advanced cardiac insufficiency with pulmonary edema
121
Pleural effusion
Collection of fluid in the pleural space
122
Returned hollow viscus
Opening between the gastrointestinal tract and the peritoneal cavity
123
Peritonitis
Inflammation in the peritoneal cavity
124
Ascites
Accumulation of fluid in the peritoneal cavity
125
Other chest images
1. Decubitus position 2. Oblique position 3. Lordotic position 4. Right lateral 5. Supine position 6. Images with nipple markers
126
(Ribs) best visualized
Ribs closest to the IR
127
Respiration Upper ribs
Inspiration (diaphragm low)
128
Respiration lower ribs
Expiration (diaphragm high)
129
Oblique posterior positions
Same side oblique…clinical side of interest closest to the IR RPO-right LPO-Left
130
Oblique anterior positions (ribs)
Clinical side of interest FARTHER away from IR RAO-Left LAO-right

Chapter 20 The Chest (Thorax) and Abdomen (1 decks)

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